Page 1583 - Saunders Comprehensive Review For NCLEX-RN

6. Record the color, amount, and consistency of sputum.
7. Suction the client’s lungs, if necessary, to clear the
airway and prevent infection.
8. Monitor weight.
9. Encourage small, frequent meals to maintain nutrition
and prevent dyspnea.
10. Provide a high-calorie, high-protein diet with
supplements.
11. Encourage fluid intake up to 3000 mL/day to keep
secretions thin, unless contraindicated.
12. Place the client in a Fowler’s position and leaning
forward to aid in breathing (Fig. 50-6).
13. Allow activity as tolerated.
14. Administer bronchodilators as prescribed, and instruct
the client in the use of oral and inhalant medications.
15. Administer corticosteroids as prescribed for
exacerbations.
16. Administer mucolytics as prescribed to thin secretions.
17. Administer antibiotics for infection if prescribed.

D. Client education (Box 50-7)

IX. Pneumonia
A. Description
1. Infection of the pulmonary tissue, including the
interstitial spaces, the alveoli, and the bronchioles
2. The edema associated with inflammation stiffens the
lung, decreases lung compliance and vital capacity,
and causes hypoxemia.
3. Pneumonia can be community-acquired or hospital-
acquired.
4. The chest x-ray film shows lobar or segmental
consolidation, pulmonary infiltrates, or pleural
effusions.
5. A sputum culture identifies the organism.

6. The white blood cell count and the erythrocyte
sedimentation rate are elevated.

B. Assessment

1. Chills
2. Elevated temperature
3. Pleuritic pain
4. Tachypnea
5. Rhonchi and wheezes
6. Use of accessory muscles for breathing
7. Mental status changes
8. Sputum production

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