Pneumonia Question

Posted
by jamd11 jamd11 Member Nurse

Specializes in Family Practice & Obstetrics. Has 4 years experience.

This is NOT a homework question...I follow a few facebook groups ran by nurses helping students prepare for their registration exams and one posted this question and have not posted the answer and it has me scratching my head... I'm torn between A,B or D....I personally have not came across this yet. I am a new grad and I was wondering what experiences nurses would do in this situation:

Mrs. Stewart has developed pneumonia, and her temperature is 38.6ÂșC (101F). Mrs. Stewart is shivering and "feels distressed and uncomfortable." Which one of the following actions should the nurse take?

a. Increase oral fluid consumption to 3 L per day.

b. Provide extra blankets.

c. Wrap the axilla and groin.

d. Notify the physician.

I thought A to liquefy lung secretions, decrease body temp and make up for insensible water loss rt fever. BUT I have a feeling 3L is a bit much, I could be wrong? I also know that dropping a temp too quickly can cause a rebound, spiking the fever higher.

B- more therapeutic than anything. But I was always taught to never put more blankets on a febrile pt.

D- My least favourite choice, but could it be right? I gather from this question that she's been diagnosed and the doctor obviously knows. Pneumonia, has a febrile stage... and I feel something should be done prior to calling an MD...

Thoughts?

Pepper The Cat

Pepper The Cat, BSN, RN

Specializes in Gerontology. Has 36 years experience. 1,768 Posts

Well I'd go with d because most of our docs do blood cultures when the temp is over 38.5

B no extra blankets for fever

C I don't know what is meant by "wrapping the axils and groin.

A I think 3 litres is a lot of water!

blondy2061h

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience. 1 Article; 4,094 Posts

I'm so sick of the "no extra blankets for fevers" myth. If someone is chilling, you need to warm them up enough so they stop chilling. Shivering will raise the body temperature more than a blanket.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience. 8,013 Posts

I would hope we could rule out A, since we don't know the patient's Hx in terms of cardiac or renal function, we don't know if the pneumonia is thought to be due to or exacerbated by aspiration, possible hyponatremia, etc.

As for B, the patient isn't cold and doesn't claim to be cold, and to a point we don't actually want to discourage a fever. Rigors in these patients are usually due to the hypothalamus getting signals that there has been a sudden increase in cytokines and other infection biomarkers, and as a result causes rigors to create a sudden increase in body temp to combat what it interprets to be a sudden "bloom" in infectious bacteria, which is why I might go with "D". This is not always true, I would never call a Doc on an ICU patient with Rigors unless we weren't already suspecting sepsis.

I have no idea what "C" is referring to.

jamd11

jamd11

Specializes in Family Practice & Obstetrics. Has 4 years experience. 69 Posts

Ahhhhaa....Blood cultures! I knew I was missing something with my thinking process thanks !

Pepper The Cat

Pepper The Cat, BSN, RN

Specializes in Gerontology. Has 36 years experience. 1,768 Posts

I'm so sick of the "no extra blankets for fevers" myth. If someone is chilling, you need to warm them up enough so they stop chilling. Shivering will raise the body temperature more than a blanket.

But they are not shivering because they are cold. They are shivering because their body is trying to lower the temp. Add extra blankets and the temp just keeps going up

blondy2061h

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience. 1 Article; 4,094 Posts

But they are not shivering because they are cold. They are shivering because their body is trying to lower the temp. Add extra blankets and the temp just keeps going up

Their body thinks it is cold because of the change in set point of the hypothalamus. Adding additional warmth can make the body feel warmer and calm shivers. A fever will break when it breaks. Blankets won't prevent that. Shivering is aerobic activity that warms the body. In this state, that is what the body is trying to do. If shivering cooled the body we would do it when it was warm out, not cold. Now, if someone had a critically high fever I would feel differently, but not a 38.6.

SouthernPoint

SouthernPoint

201 Posts

A = Too much fluid

B = Not at this given moment.

C = Pt is Hyperthermic, not Hypothermic

D = Yuup, hopefully the MD will order BC x's2.

Now after you get your BC order and they are obtained. Go get your Pt a cup of room temp water and a nice blanket.

nurseprnRN

nurseprnRN, BSN, RN

2 Articles; 5,114 Posts

But they are not shivering because they are cold. They are shivering because their body is trying to lower the temp. Add extra blankets and the temp just keeps going up

No, shivering increases temperature by making for a lot of metabolic energy being expended with the work of the muscles. The patient is shivering to make heat (this is why you shiver when you're cold, too, BTW). Wrapping her up in blankets so she gets hotter will eventually tell her body it's done its intended job to make her hot enough to kill bacteria, and might make her feel better (do you feel better with shaking chills when you wrap up?) but since we have more resources at our disposal than Florence did, we will probably go further than that. :)

Backing up here, if this is for NCLEX land, you must look at only what they tell you. Only.

Someone who is febrile might become dehydrated, but they haven't told you any other information to say that she is -- no decreased BP, no dry mouth, no tachycardia. So... no dice on the bigtime fluid bolus, oral or otherwise. :no:

The extra blankets' insulation will make her hotter, probably not a good idea, and not therapeutic, as above. :no:

The axilla and groin thing is to capture the people that remember something about warm packs in axillae and groins in hypothermia and they'll confuse it with the shivering. :eek: Nope.

Now, normally, NCLEX wants to know what you, the nurse, would do. They usually hatehatehate the answer that says, "Turf to social work/dietary/chaplain/etc." for that reason. However, the nurse's responsibility is to do an assessment and deduce that something is going on that will, in fact, require a medical plan of care, and does, in fact, include notifying a physician of a significant change in condition. They have given you no other choice in terms of addressing this new development from a purely nursing intervention standpoint, and they have given you every indication that there is something here that will require doctoring as well as nursing. So the answer is D, notify the doc of the patient's change in condition.

xoemmylouox, ASN, RN

Has 13 years experience. 3,150 Posts

D sounds like the NCLEX answer to me.

~PedsRN~

~PedsRN~, BSN, RN

Specializes in Acute Care Pediatrics. Has 4 years experience. 826 Posts

Totally D. 1) If the fever is new, we need blood cultures for sure. 2) patients who just become distressed when you are talking about airways freak me out. :p

chrisrn24

chrisrn24

905 Posts

D to me.

Patient is "distressed." That is a key word to me.