Quick help, please.

  1. Question for class.

    52 yr. old pt. has cough, fever, sob, and malaise. CXR shows lower lobe pneumonia. MD starts pt. on Levaquin 500 mg. QD, also corticosteroid theraphy and Albuterol tx. 5 days after therapy is started, pt. complains of sharp chest pain on inspiration. What does the nurse suspect and why?
  2. Visit clee1 profile page

    About clee1, LPN, EMT-P

    Joined: Dec '05; Posts: 851; Likes: 162
    LPN, EMT-P; from US
    Specialty: 9 year(s) of experience in Hospice, Med/Surg, ICU, ER

    9 Comments

  3. by   Hoozdo
    Quote from clee1
    Question for class.

    52 yr. old pt. has cough, fever, sob, and malaise. CXR shows lower lobe pneumonia. MD starts pt. on Levaquin 500 mg. QD, also corticosteroid theraphy and Albuterol tx. 5 days after therapy is started, pt. complains of sharp chest pain on inspiration. What does the nurse suspect and why?
    Maybe a PE. Pt is laying in bed doing nothing and not on any thrombolytic. DVT forms in legs, travels to lungs, bang......a PE.
  4. by   NurseBranch
    Quote from Hoozdo
    Maybe a PE. Pt is laying in bed doing nothing and not on any thrombolytic. DVT forms in legs, travels to lungs, bang......a PE.

    This was my first thought, too.:spin:
  5. by   P_RN
    PE, Pleurisy, costochondritis from the coughing. But PE would be at the top of my list.
  6. by   clee1
    Thank you all so much!

    I was thinking pneumothorax, because of the sudden sharp pain. I was under the impression that PE was sudden, almost-always fatal sob. But, I guess that the rationale does make sense....

    I appreciate ya'll taking the time to reply.
  7. by   TazziRN
    I've seen lots of PE's recup and go home.
  8. by   kimmie518
    I've been trying to think this one out for a while.

    This is what I'm thinking, but I'm probably wrong. Now the patient could have a PE, but the question states chest pain only on inspiration. I thought the pain doesn't come from the actually clot itself, but from the lack of oxygen to the surrounding tissues, therefore, pain would be present on both inhalation and exhalation (although pain can be worse on inhalation).

    According to the symptoms in the question, it can be either a PE or pleural effusion. Because the question pertains to pneumonia, and pleural effusions are a complication of pneumonia, I'm going with a pleural effusion. PE's are not a complication of pneumonia, but bed rest.

    I don't know how a pneumothorax relates directly from pneumonia- it seems a little far-fetched. Although, a pneumothorax can be a complication of a thoracentesis which is used to treat a pleural effusion.
    Last edit by kimmie518 on Feb 18, '07
  9. by   pepsihla
    i would say pleural effusion, sharp pain on inspiration and SOB. I'd like to know the breath sounds and o2 sats
  10. by   cardiacRN2006
    Pleurisy was my first thought...
  11. by   avery
    Pleural effusion or inflammation of the pleural sac that was more like a friction rub is what I am thinking.

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