You are caring for a 34-year-old patient who experienced blunt chest trauma in a motor vehicle

crash. A chest tube was inserted to treat a simple pneumothorax and hemothorax. The chest
drainage system has drained 400ml of light red fluid during the 1st 6 hours after insertion. The
patient has become increasingly short of breath during the past hour. What physical assessment
skills and strategies would you use to determine potential changes in the patient’s respiratory
condition? What are potential causes of this increasing shortness of breath? What would you do
to prepare for an emergency situation in this patient? (10pts)

Assessing the airway patency and listen to the lungs. Observe breathing pattern, including
use of accessory muscles. Monitor cardiac rhythm. Measure vital signs and pulse oximetry will
help to determine the potential changes in the patient’s respiratory conditions. Shortness of
breath can result from a range of problems, including an allergic reaction, an anxiety attack, or
anemia. But most often, the underlying cause is heart or lung condition. During this kind of
emergency situation, the best management for these patients includes early mobilization,
aggressive pain control, proper fluid management, and respiratory physiotherapy. Endotracheal
intubation should be reserved for the patients with airway compromise, refractory problems with
gas exchange, hyperventilation and decrease mental status.

Consider the scenario and answer the following questions. Case Study: Community Acquired
Pneumonia
Teresa, a 20 year old college student, lives in a small dormitory with 30 other students. Four
weeks after start of classes, she was diagnosed as having bacterial pneumonia and was admitted
to the hospital. (10 pts.)
 What intervention can the nurse provide to decrease the viscosity of secretions?
- Controlled coughing, this type of coughing comes from deep in your lungs. Postural
drainage, the patient will lie down in different positions to help drain mucus from her
lungs. Also mucolytic agents reduce sputum viscosity and improve secretion
clearance.
 The nurse is assessing Teresa during the admission process. What manifestations of
bacterial pneumonia does the nurse expect to find?
- When cough, it may produce greenish, yellow or even bloody mucus.
- Fever, sweating and shaking chills.
- Shortness of breath.
- Rapid, shallow breathing.
- Stabbing chest pain that worsens when coughing and breathing.
 The nurse assesses Teresa for arterial hypoxemia. What does the nurse understand is the
reason why this complication develops?
- Arterial hypoxemia early in acute pneumococcal pneumonia is principally caused by
persistence of pulmonary artery blood flow to consolidated lung resulting in an
intrapulmonary shunt, but also, to a varying degree, it is caused by intrapulmonary
oxygen consumption by the lung during the acute phase and by ventilation-perfusion
mismatch later.
 The nurse is assessing vital signs and lung sounds every 4 hours. What complications
should the nurse monitor for?
- Respiratory failure, sepsis, multiorgan failure, coagulopathy, and exacerbation of
preexisting comorbidities.