Pneumonia Question

This is NOT a homework question...I follow a few facebook groups ran by nurses helping students prepare for their registration exams and one posted this question and have not posted the answer and it has me scratching my head... I'm torn between A,B or D....I personally have not came across this yet. I am a new grad and I was wondering what experiences nurses would do in this situation:


[FONT=lucida grande]Mrs. Stewart has developed pneumonia, and her temperature is 38.6�C (101F). Mrs. Stewart is shivering and "feels distressed and uncomfortable." Which one of the following actions should the nurse take?
[FONT=lucida grande]a. Increase oral fluid consumption to 3 L per day.
[FONT=lucida grande]b. Provide extra blankets.
[FONT=lucida grande]c. Wrap the axilla and groin.
[FONT=lucida grande]d. Notif[FONT=lucida grande]y the physician.

I thought A to liquefy lung secretions, decrease body temp and make up for insensible water loss rt fever. BUT I have a feeling 3L is a bit much, I could be wrong? I also know that dropping a temp too quickly can cause a rebound, spiking the fever higher.

B- more therapeutic than anything. But I was always taught to never put more blankets on a febrile pt.

D- My least favourite choice, but could it be right? I gather from this question that she's been diagnosed and the doctor obviously knows. Pneumonia, has a febrile stage... and I feel something should be done prior to calling an MD...


Thoughts?


Well I'd go with d because most of our docs do blood cultures when the temp is over 38.5B no extra blankets for feverC I don't know what is meant by "wrapping the axils and groin. A I think 3 litres is a lot of water!

I'm so sick of the "no extra blankets for fevers" myth. If someone is chilling, you need to warm them up enough so they stop chilling. Shivering will raise the body temperature more than a blanket.

I would hope we could rule out A, since we don't know the patient's Hx in terms of cardiac or renal function, we don't know if the pneumonia is thought to be due to or exacerbated by aspiration, possible hyponatremia, etc. As for B, the patient isn't cold and doesn't claim to be cold, and to a point we don't actually want to discourage a fever. Rigors in these patients are usually due to the hypothalamus getting signals that there has been a sudden increase in cytokines and other infection biomarkers, and as a result causes rigors to create a sudden increase in body temp to combat what it interprets to be a sudden "bloom" in infectious bacteria, which is why I might go with "D". This is not always true, I would never call a Doc on an ICU patient with Rigors unless we weren't already suspecting sepsis.I have no idea what "C" is referring to.

Ahhhhaa....Blood cultures! I knew I was missing something with my thinking process thanks !

Quote from blondy2061hI'm so sick of the "no extra blankets for fevers" myth. If someone is chilling, you need to warm them up enough so they stop chilling. Shivering will raise the body temperature more than a blanket.

Quote from Pepper The CatBut they are not shivering because they are cold. They are shivering because their body is trying to lower the temp. Add extra blankets and the temp just keeps going up

A = Too much fluidB = Not at this given moment. C = Pt is Hyperthermic, not HypothermicD = Yuup, hopefully the MD will order BC x's2.Now after you get your BC order and they are obtained. Go get your Pt a cup of room temp water and a nice blanket.

Quote from Pepper The CatBut they are not shivering because they are cold. They are shivering because their body is trying to lower the temp. Add extra blankets and the temp just keeps going up

D sounds like the NCLEX answer to me.

Totally D. 1) If the fever is new, we need blood cultures for sure. 2) patients who just become distressed when you are talking about airways freak me out.

D to me. Patient is "distressed." That is a key word to me.

I am also thinking D. I am just a student but it seems that 3L/day is an awful lot to increase fluids to, especially without an MD clearance. Wrapping the groin/axilla sounds odd, but also like something that would need an MD order. Like GrnTea said, piling blankets on doesnt seem therapeutic. So by process of elimination (besides the fact that the provider prob wants to do cultures and start a broad spectrum antibiotic) it sounds like D is the best answer.