A 68 years old male patient was admitted to the medical ward with acute community-acquired pneumonia. His medical history shows that he was diagnosed with paraseptal emphysema 3 years ago. The patient was a smoker for 53 years and consumes 1 pack of cigarettes per day. He stopped smoking three years ago. The patient has a history of hypertension, and diabetes controlled with oral diabetic agents. The patient is confused about place and time. The family stated that this is a new change for the patient. The vital signs during the admission are: BP = 90/50 mm Hg, HR = 101 bpm, RR = 28 breaths/min, and temperature = 38.5 degrees Celcius. The pulse oximeter reading on room air is 85%. The complete blood count is as follows: White Blood Cells = 12,500, platelets = 350,000; hematocrit = 30%; and hemoglobin = 10 g/dL. The arterial blood gas analysis results are: pH, 7.30; PaO2, 55; PaCO2, 50; and HCO3, 25. Chest x-ray results show right lower lobe consolidation, presence of apical bullae, a flattened diaphragm, and a small pleural effusion in the right lower lobe. Lung auscultation indicates severely diminished breath sounds in the right lower lobe and absence of breath sounds at the base. The breath sounds in the rest of the lungs are slightly decreased. The patient complains of fatigue and shortness of breath and cannot finish a short sentence before the respiratory rate increases above the baseline and his nail beds and lips turn a bluish tinge and the pulse oximetry decreases to 82%. The patient is diaphoretic and is using accessory muscles. The patient coughs weakly, but he does not raise any sputum.
a. What nursing assessment findings support the diagnosis of pneumonia?
b. What diagnostic findings support the diagnosis of pneumonia?
c. What nursing diagnoses should the nurse formulate for the patient?
d. What goals should the nurse develop for the patient?
e. What overall interventions should the nurse provide?
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