Forty-eight hours after admission to the hospital, Mr. Edwards had abnormal lung sounds (crackles) in the left base and both upper lobes. His vital signs were as follows: temperature, 102.4° F (39.1° C); blood pressure, 140/92 mm Hg; pulse, 110 beats/min; respirations, 32 breaths/min; and SpO2, 82%. He could not lie flat, and it was difficult for him to speak because of dyspnea. He was placed on a nonrebreather mask at an oxygen concentration of 60%. He was also unable to cough up any sputum.
Mr. Edwards’s health care provider determined his pneumonia had worsened. A chest x-ray film and arterial blood gas levels were obtained. His chest x-ray film indicated that both upper lobes and the left lower lobe had infiltrates. The arterial blood gas levels indicated respiratory acidosis (see Chapter 41). His PaO2 was 55 mm Hg, PaCO2 was 65 mm Hg, pH was 7.30, and SpO2 was 80%. He spent 5 days in an intensive care unit (ICU) and 2 weeks in a transitional care unit. He is being discharged on home oxygen therapy. His discharge plan includes an outpatient rehabilitation program to begin 1 month after discharge.
· When Mr. Edwards was hypoxic (PaO2 55 mm Hg, SpO2 80%), which additional assessment findings would you expect to find?
· Based on the case scenario and information in Question 1, determine the two priority nursing diagnoses for Mr. Edwards and list the appropriate interventions or nursing activities that you must implement.
· What do you need to do to prepare Mr. and Mrs. Edwards for home oxygen therapy?
