Pneumonia Simulation help?

[Tara-janne]

Hi there,

yesterday we had a simulation assessment where a "patient" (who was a real person but acting) came in to "hospital" with pneumonia. They had a good day with no pain and no cough. So i said i'd do a set of obs on them, then they started coughing an getting a really sharp pain in their chest 8/10 so i did the pain assessment and looked on her drug chart and she only had paracetamol for pain relief PRN and an antibiotic. My question here is, would you as a student nurse ask your RN if we should give the patient paracetamol and also get a doctor to come review her and her meds to give her something a little bit stronger? I failed my simulation because i got really confused because my RN said if i had of called the doctor to come see the patient it would take a little while for them to get to the "ward" meanwhile the patient is in pain and coughing.

[Double-Helix, BSN, RN]

Paracetamol? Are you in the UK?

I think we're missing information here. Did you give the patient the pain medication that they had ordered before or as you were calling the doctor to request a different pain medication? Did you attempt any other interventions to help ease the coughing and pain in addition to the medication? Simply calling the doctor would not be enough as it doesn't show that you are using the nursing process to assess, intervene and evaluate.

[AnArtist]

You don't have enough to go on, you need to listen to breath sounds, ask the patient when the pain began, and get vital signs. Ask if the patient is using accessory muscles to breathe; if she is breathing evenly in each lung. It could be that the diagnosis of "pneumonia" was a distracting question and that this "patient" actually has something more serious.

[Double-Helix, BSN, RN]

I agree with AnArtist that a patient without pain or coughing for a day who suddenly develops severe cough and pain warrants further assessment. Just assuming it's related to a previously diagnosed pneumonia could cause you to miss something significant.

[Tara-janne]

Sorry, im in New Zealand, and I think we do things a little differently here and I also didnt give all the info. But it's ok i've got my answers now, thanks everyone.