CRITICAL THINKING EXERCISES NO.

A 62-year-old female client with a history of COPD is admitted to the hospital with an acute
exacerbation and left-sided pneumonia. The nurse observes increased anterior-posterior
diameter of the chest, reddish-blue skin tone and prolonged expiratory phase when
breathing. Admission vital signs: Temperature 101.5 F, BP 154/92, HR 110 and RR 26
breaths/min.

1. What nursing diagnosis is the priority for this patient?

 Impaired Gas Exchange R/T altered oxygen supply as evidenced by cyanosis of skin.

2. During the initial physical assessment of the patient, she exhibits a frequent cough with
copious purulent secretions expectorated. This assessment finding is compatible with
which etiology of pneumonia?
 The etiology compatible with the symptoms of the patient is bacteria, specifically
pneumococcal pneumonia. Pneumococcal pneumonia is caused by the
Streptococcus pneumoniae germ that normally lives in the upper respiratory tract.
Bacterial pneumonia can occur on its own or develop after you've had a viral cold or
the flu. Bacterial pneumonia often affects just one part, or lobe, of a lung. Same with
the case of the patient which has a left-sided pneumonia.

3. What should the nutritional plan for this patient include?

 Choose complex carbohydrates, such as whole-grain bread and pasta, fresh fruits
and vegetables.
 Limit simple carbohydrates, including table sugar, candy, cake and regular soft
drinks.

 Eat 20 to 30 grams of fiber each day, from items such as bread, pasta, nuts, seeds,
fruits and vegetables. Eat a good source of protein at least twice a day to help
maintain strong respiratory muscles. Good choices include milk, eggs, cheese, meat,
fish, poultry, nuts and dried beans or peas.

 Choose mono- and poly-unsaturated fats, which do not contain cholesterol. These
are fats that are often liquid at room temperature and come from plant sources,
such as canola, safflower and corn oils.
 Limit foods that contain trans fats and saturated fat. For example, butter, lard,
fat and skin from meat, hydrogenated vegetable oils, shortening, fried foods,
cookies, crackers and pastries.
Diet Hints

 Rest just before eating.

 Eat more food early in the morning if you're usually too tired to eat later in the day.

 Avoid foods that cause gas or bloating. They tend to make breathing more difficult.

 Eat 4 to 6 small meals a day. This enables your diaphragm to move freely and lets
your lungs fill with air and empty out more easily

 If drinking liquids with meals makes you feel too full to eat, limit liquids with meals;
drink an hour after meals.

 Consider adding a nutritional supplement at nighttime to avoid feeling full during

the day

4. To optimize oxygenation for this client with left-sided pneumonia, what body position
should be encouraged?
 In pulmonary physiotherapy, using the lateral recumbent or side-lying position
can be a great way of ventilating the lungs. If the client lies in the right lateral
recumbent position, the secretion found in the left lung will be more easily
extruded as the lung is ventilated.
5. The patient says that she is beginning to feel slightly “short of breath”. What is the
appropriate choice in initiating supplemental oxygen in this patient?
 Provide oxygen therapy, as ordered. You can position the patient in a high fowlers to
facilitate ease of breathing.

Prepared by: Prof. Eric Mahinay Jr.