Pneumonia Question

[jamd11]

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 38.6ºC (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?

[danceyrun]

I am also thinking D. I am just a student but it seems that 3L/day is an awful lot to increase fluids to, especially without an MD clearance. Wrapping the groin/axilla sounds odd, but also like something that would need an MD order. Like GrnTea said, piling blankets on doesnt seem therapeutic. So by process of elimination (besides the fact that the provider prob wants to do cultures and start a broad spectrum antibiotic) it sounds like D is the best answer.

[nurseprnRN, BSN, RN]

I am also thinking D. I am just a student but it seems that 3L/day is an awful lot to increase fluids to, especially without an MD clearance. Wrapping the groin/axilla sounds odd, but also like something that would need an MD order. Like GrnTea said, piling blankets on doesnt seem therapeutic. So by process of elimination (besides the fact that the provider prob wants to do cultures and start a broad spectrum antibiotic) it sounds like D is the best answer.

Actually, "wrapping groin and axillae" is a nonsense phrase, but will, as I said, entrap some people who vaguely remember something about those areas and hypothermia/chilling.

As to your expectation that the physician may ask for cultures or whatever, if it is not explicitly stated in an NCLEX question you assume it at your peril, and you will often be wrong because NCLEX knows you want to do that. :) In this particular question, your nursing responsibility to notify about a change in condition is the only rationale that counts, and they want to know if you know that.

[applewhitern, BSN, RN]

Some nurses place ice packs in the axillary and groin areas to cool a patient with a high temp. This used to be quite common. Now of course we have cooling blankets. Actually, back when I was in nursing school, we were taught the ice pack thing.

[jamd11]

So the facebook group moderator posted the answer as A - with no rationale . I hope it was a typo

[Dranger]

Probably D but notifying the physician is usually NOT the answer on the NCLEX

[cardiacnurse12]

3L/day = 125 ml/hr - a very common IVF rate. NCLEX rule is to do whatever you can to help the patient in a dangerous situation before you call the doc, and increasing fluids would help to loosen secretions as previously stated. My choice would have been D, because it sounds like sepsis, but as it says that the patient has pneumonia (medical diagnosis), chances are that the information given is nothing new to the doc, and a nursing intervention is indicated, hence the answer being A.

[jamd11]

3L/day = 125 ml/hr - a very common IVF rate. NCLEX rule is to do whatever you can to help the patient in a dangerous situation before you call the doc and increasing fluids would help to loosen secretions as previously stated. My choice would have been D, because it sounds like sepsis, but as it says that the patient has pneumonia (medical diagnosis), chances are that the information given is nothing new to the doc, and a nursing intervention is indicated, hence the answer being A.[/quote']

But the question stated push 3L orally not IV. I just think the question was worded very poorly .

[jamd11]

This is also not for the nclex. I am a Canadian New grad just following an online Facebook group that posts questions daily and this one had me confused :|

[MunoRN, RN]

'A' is a truly horrible answer for a variety of reasons, maybe not everything on Facebook is accurate.

[psu_213, BSN, RN]

Now I don't know that A is best choice here, but I did find this from MayoClinic.com:

"The Institute of Medicine determined that an adequate intake (AI) for men is roughly 3 liters (about 13 cups) of total beverages a day. The AI for women is 2.2 liters (about 9 cups) of total beverages a day."

Here is the link to the entire article: http://www.mayoclinic.com/health/water/NU00283

Also, don't fall into the "what if?" trap. For example, you could say "well, what if they have CHF? What if they have ESRD?" etc. You can only use the facts in evidence about the pt.