Pt with Pneumonia - Interventions

[Christina0985]

Hi Guys,

I am currently working on a case study.

Derek Smith, a 75-year-old male, has been admitted to the medical ward with pneumonia. He has been feeling generally unwell and coughing for the past two weeks. When you come in to see him, he is sitting up in bed. Mr Smith has an audible inspiratory wheeze. Other clinical data include: Temperature: 38.5 0C, Respiration rate: 24 breaths/min, Oxygen saturation: 95% on Oxygen mask 5L/min, skin colour: pink.

My problems ive chosen to work with are Ineffective Airway Clearance and Risk of a fluid volume deficit related to dyspnoea and fever (most ppl tend to be going with ineffective airway clearance and impaired gas exchange which is making me doubt my problems ive chosen, however if i back them up well enough, I dont see the problem).

The interventions I was going to work with are cough enhancement for airway clearance (as I think this is the priority to improve airway patency. Have taken into account the ABC) but I also know that hydration, high humidity ventilation and chest physiotherapy are also important. So any ideas on whether im on the right track with cough enhancement or not??

And for Risk of Fluid volume deficit ive gone with monitoring fluid input and output. Am I likely to be on the right track here?

Any help would be appreciated as evidence based literature is scarce.

[RNTutor, BSN, RN]

As to your choice of nursing dx, you might want to consider going with impaired gas exchange instead of risk of fluid volume deficit. The reason would be that an actual problem is almost always going to be a higher priority than a "risk of" problem. Also, if you go by the ABC's (airway, breathing, circulation), you could make the argument that fluid volume deficit would be Circulation, but impaired gas exchange still trumps it as Breathing.

That being said, on to the Interventions.

Cough enhancement would be good, because it can help get some mucus out and decrease coughing spasms (no more tickle in the throat if you get the mucus out!). Another great thing is deep breathing, to keep the lungs open and reduce the risk of atelectasis and retention of secretions. An incentive spirometer is also nice for this, because sometimes it's kind of fun for the patient to see how far they can push the indicator with their breath (or maybe that's just the pediatric nurse in me coming out!)

The more I think about it, the less I like fluid deficit as a priority dx based on this case study...especially because it doesn't give you any info on his current i/o. Whereas we KNOW that he has impaired gas exchange because he's only 95% on O2, and he's breathing is a little rapid. I think I would go with that one.