A client has been treated with antibiotic therapy for right lower-lobe pneumonia for 10 days and will be discharged today. Which of the following physical findings would lead the nurse to believe it is appropriate to discharge this client?
A. Continued dyspnea
B. Fever of 102*F
C. Respiratory rate of 32 breaths/minute.
D. Vesicular breath sounds in the right base.
Correct Answer: D. Vesicular breath sounds in right base
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.
Option A: Assess the rate, rhythm, and depth of respiration, chest movement, and use of accessory muscles. Tachypnea, shallow respirations, and asymmetric chest movement are frequently present because of the discomfort of moving chest wall and/or fluid in the lung due to a compensatory response to airway obstruction. Altered breathing pattern may occur together with the use of accessory muscles to increase chest excursion to facilitate effective breathing.
Option B: Investigate sudden change in condition, such as increasing chest pain, extra heart sounds, altered sensorium, recurring fever, changes in sputum characteristics. Delayed recovery or increase in severity of symptoms suggests resistance to antibiotics or secondary infection.
Option C: Assess and record respiratory rate and depth at least every 4 hours. The average rate of respiration for adults is 10 to 20 breaths per minute. It is important to take action when there is an alteration in the pattern of breathing to detect early signs of respiratory compromise.
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