The client is a 68-year-old male with a history of smoking for 40 years and mild chronic obstructive pulmonary disease (COPD). He presents with a new diagnosis of pneumonia, confirmed by chest x-ray and laboratory results. He reports increasing shortness of breath over the past 48 hours, along with a productive cough with greenish sputum.
He has a history of hypertension and diabetes type 2, which are both managed with medications. The client denies any recent travel or exposure to sick contacts. The primary health care provider initiated a chest x-ray and blood cultures to confirm the diagnosis of pneumonia. The client is also receiving IV antibiotics and supplemental oxygen.
Day 1,
1100:
Client admitted from the emergency department with a new diagnosis of pneumonia, confirmed by chest x-ray and laboratory results. Client reports dyspnea and exhibits shortness of breath at rest. Client is hypoxic, confirmed by oxygen saturation of 89%. Placed on oxygen at 2 L/min via nasal cannula. Congested cough with green sputum noted.
Sputum specimen obtained and sent to the laboratory for further analysis. Crackles heard on auscultation, breath sounds diminished bilaterally. IV initiated in the left forearm with a 22-gauge angiocath for intermittent antibiotic therapy and further treatment. Client remains hypoxic. Less dyspnea noted at rest, but extreme shortness of breath noted on exertion.
Day 2,
1500:
Client is stable with ongoing IV antibiotic treatment. Oxygen saturation remains at 92% on 2 L/min nasal cannula. No signs of infection at the IV site. Client's cough remains productive with green sputum. Continue monitoring respiratory status and adjust oxygen as necessary.
On physical examination, the client appears mildly distressed, with labored breathing and use of accessory muscles. The client is alert and oriented but appears fatigued. Breath sounds are diminished bilaterally with crackles noted on auscultation. There is no cyanosis, but the client is visibly short of breath, especially on exertion. The chest is clear to percussion, but there is a productive cough with green sputum. No signs of swelling or infection at the IV site. Heart sounds are regular, and there are no murmurs or additional heart sounds noted.
• Chronic Obstructive Pulmonary Disease (COPD)
• Hypertension
• Type 2 Diabetes Mellitus
• History of smoking (40 pack-years)
• Temperature: 101.2°F (38.4°C)
• Pulse: 102 beats per minute
• Respiratory Rate: 22 breaths per minute
• Blood Pressure: 130/85 mmHg
• Oxygen Saturation: 89% on room air, 92% on 2 L/min nasal cannula
• Chest x-ray: Bilateral infiltrates suggestive of pneumonia.
• Sputum culture: Positive for Streptococcus pneumoniae.
• Oxygen saturation: 89% on room air, 92% on 2 L/min oxygen via nasal cannula.
• IV antibiotics (ceftriaxone 1g daily)
• Oxygen therapy at 2 L/min via nasal cannula
• Chest x-ray and blood cultures for pneumonia confirmation
• Sputum culture for microbiological analysis
• Maintain IV access for further antibiotic therapy
Which of the following information should the nurse include in discharge teaching for the client? (Select all that apply)
