Lewis: Medical-Surgical Nursing, 9th Edition

Chapter 28: Nursing Management: Lower

Respiratory Problems
Answer Guidelines for Case Study

1. 1. How would you classify J.H.s pneumonia? Why is this important?

Because J.H. contracted the pneumonia before entering the health
care system, his pneumonia would be classified as community-
acquired pneumonia. Classification of pneumonia helps the health
care provider identify the most probable causative organism and
select appropriate antimicrobial therapy

1. 2. What is your analysis of J.H.s arterial blood gas results?

Partially compensated respiratory acidosis. The pH is decreased
(acidotic), the PaCO2 is elevated (acidotic), and the HCO3 is increased
(alkalotic in an attempt to compensate for elevated PaCO2).

1. 3. Priority Decision: Based on the assessment data presented,

what are the priority nursing diagnoses? Are there any collaborative
problems?
Nursing diagnoses: Ineffective airway clearance, impaired gas
exchange, anxiety, acute pain, imbalanced nutrition: less than body
requirements, ineffective health maintenance, ineffective breathing
pattern.
Collaborative problems: Hemorrhage, paraneoplastic syndrome

1. 4. Priority Decision: What are the priority nursing interventions

for J.H?
1. 1. Oxygen administration
2. 2. Monitoring for worsening dyspnea, oxygenation, retention of
CO2
3. 3. Antibiotic administration
4. 4. Rest and positioning to facilitate oxygenation and ventilation
5. 5. Nutrition

5. 5. Delegation Decision: Identify activities that can be delegated to

unlicensed assistive personnel.
1. 1. Obtaining and applying oxygen (RN needs to monitor)
2. 2. Obtaining vital signs (RN needs to evaluate)
3. 3. Repositioning patient for comfort
4. 4. Assisting patient with eating
5. 5. Assisting patient with ADLs
1. 6. You are planning a meeting with J.H. and his family to discuss their
needs. The physician tells you that he is terminally ill. Who will you
include in this meeting?
J.H.
J.H.s wife and, if desired by J.H. and his wife, his adult
children
A chaplain
Social worker

1. 7. Evidence-Based Practice: J.H.s children tell you that they are

worried they will get lung cancer because their father has it and
they grew up around his second-hand smoke. They want to know
what kind of screening is available for them. How will you respond?
A recent study by the National Lung Screening Trial showed a 20%
decrease in deaths from lung cancer in patients who underwent
screening with low-dose spiral CT scanning compared with those
who had chest x-rays. Screening is only recommended for patients
55 to 74 years old who are current or former smokers with at least a
30 pack-year smoking history. Screening in other individuals has not
been shown to be beneficial and exposes the patients to
unnecessary radiation.
Source: Jett JR, Midthun DE: Screening for lung cancer: For patients
at increased risk for lung cancer, it works, Ann Intern Med 155:541,
2011.

8. 8. What is the goal if radiation therapy is used for J.H.?

Relief of the obstruction to relieve the dyspnea and
pneumonia
Improve the quality of J.H.s life by relieving symptoms

9. 9. What other issues should be addressed in your teaching of J.H.

and his wife as you prepare to move him for discharge and care at
home?
Should J.H. return to work? What are the reasons that he
would or would not? Think about benefits, self-esteem, and
physical ability.
Are there financial concerns if J.H. is not working? How does
he apply for disability? Are there income sources for him and his
wife?
Will he need home oxygen, a hospital bed, a wheelchair? Is
the home accessible for J.H. with his physical limitations?
What community resources are available to J.H. and his family
as they make the adjustment to end-of-life care? Is hospice an
option? Does hospice have both an inpatient and home option?
 What is the support system available to J.H. and his wife?
Church, family, friends?
What support is available to J.H.s adult children and
grandchildren?