Respiratory System | Pneumonia & Tuberculosis NCLEX Quiz 38

If the client still has pneumonia. the breath sounds in the right base will be bronchial. not the normal vesicular breath sounds. If the client still has dyspnea. fever. and increased respiratory rate. he should be examined by the physician before discharge because he may have another source of infection or still have pneumonia.

The client is having difficulty breathing and is probably becoming hypoxic. As an emergency measure. the nurse can provide oxygen without waiting for a physicians order. Antibiotics may be warranted. but this isn’t a nursing decision. The client should be maintained on bedrest if he is dyspneic to minimize his oxygen demands. but providing additional will deal more immediately with his problem. The client will need nutritional support. but while dyspneic. he may be unable to spare the energy needed to eat and at the same time maintain adequate oxygenation.

Pneumococcal or streptococcal pneumonia. caused by streptococcus pneumoniae. is the most common cause of community-acquired pneumonia. H. influenzae is the most common cause of infection in children. Klebsiella species is the most common gram-negative organism found in the hospital setting. Staphylococcus aureus is the most common cause of hospital-acquired pneumonia.

A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs. At this point. the bacilli are walled off and skin tests read positive. However. all but infants and immunosuppressed people will remain asymptomatic. The general population has a 10% risk of developing active TB over their lifetime. in many cases because of a break in the body’s immune defenses. The active stage shows the classic symptoms of TB: fever. hemoptysis. and night sweats.

The common feature of all type of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Atelectasis and bronchiectasis indicate a collapse of a portion of the airway that doesn’t occur in pneumonia. An effusion is an accumulation of excess pleural fluid in the pleural space. which may be a secondary response to pneumonia.

Clients with chronic illnesses generally have poor immune systems. Often. residing in group living situations increases the chance of disease transmission.

This test would be classed as negative. A 5 mm raised area would be a positive result if a client was HIV+ or had recent close contact with someone diagnosed with TB. Indeterminate isn’t a term used to describe results of a PPD test. If the PPD is reddened and raised 10mm or more. it’s considered positive according to the CDC.

Fever. chills. hemoptysis. dyspnea. cough. and pleuritic chest pain are common symptoms of pneumonia. but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.

Chest auscultation reveals bronchial breath sounds over areas of consolidation. Bronchovesicular are normal over midlobe lung regions. tubular sounds are commonly heard over large airways. and vesicular breath sounds are commonly heard in the bases of the lung fields.

Sputum C & S is the best way to identify the organism causing the pneumonia. Chest x-ray will show the area of lung consolidation. ABG analysis will determine the extent of hypoxia present due to the pneumonia. and blood cultures will help determine if the infection is systemic.