Individuals with depressed level of consciousness, advanced age, dysphagia, or a nasogastric (NG) or enteral tube are at increased risk for aspiration, which predisposes them to pneumonia. CASE STUDY: Rhinoplasty b. Most commonly, P. jirovecii occurs in individuals with human immunodeficiency virus infection or in individuals who are therapeutically immunosuppressed after organ transplantation. Pulmonary function test To determine the tracheal position, the nurse places the index fingers on either side of the trachea just above the suprasternal notch and gently presses backward. She found a passion in the ER and has stayed in this department for 30 years. As an Amazon Associate I earn from qualifying purchases. Desired Outcome: At the end of the span of care, the patient will be able to understand the transmission, disease process, and available treatments for pneumonia. 2. Most of the problems in connection to the reoccurrence of pneumonia are poor compliance to the prescribed treatment. It may also stimulate coughing. 1. Assess the patients knowledge about Pneumonia. It is important to assess the ability of the patient to do self-care ost especially if he or she is having respiratory symptoms. If the patient is having increased mucous production, encourage him or her to clear the airway. Pink, frothy sputum would be present in CHF and pulmonary edema. a. Finger clubbing Doing activities at the same time will only increase the demands of oxygen in the body, and patients with pneumonia cannot tolerate it. What priority discharge teaching should the nurse provide? Assess for mental status changes. Nursing Diagnosis: Ineffective Breathing Pattern related to decreased lung expansion secondary to pneumonia as evidenced by a respiratory rate of 22, usage of accessory muscles, and labored breathing. Pneumonia is the second most common nosocomial infection in critically ill patients and a leading cause of death from hospital-acquired infections. Ventilation-perfusion scans and positron emission tomography (PET) scans involve injections, but no manipulation of the respiratory tract is involved. Provide factual information about the disease process in a written or verbal form. A) Sit the patient up in bed as tolerated and apply As the patients condition worsens, sputum may become more abundant and change color from clear/white to yellow and/or green, or it may exhibit other discolorations characteristic of an underlying bacterial infection (e.g., rust-colored; currant jelly). "Only health care workers in contact with high-risk patients should be immunized each year." There is no redness or induration at the injection site. The following signs and symptoms show the presence of impaired gas exchange: Abnormal breathing rate, rhythm, and depth Nasal flaring Hypoxemia Cyanosis in neonates decreases carbon dioxide Confusion Elevated blood pressure and heart rate A headache after waking up Restlessness Somnolence and visual disturbances Looking For Custom Nursing Paper? Avoid environmental irritants inside the patients room. c. Inadequate delivery of oxygen to the tissues Impaired gas exchange 5. e. Posterior then anterior. 6. Antibiotics: To treat bacterial pneumonia. d. Place 1 hand on the lower anterior chest and 1 hand on the upper abdomen. The nurse should keep the patient on bed rest in a semi-Fowler's position to facilitate breathing. Skin breakdown allows pathogens to enter the body. Priority: Management of pneumonia and dehydration. Surfactant is a lipoprotein that lowers the surface tension in the alveoli. A 92-year-old female patient is being admitted to the emergency department with severe shortness of breath. Hospital-Acquired Pneumonia. Findings may show hypoxemia (PaO2 less than 80 mm Hg) and hypocarbia (PaCO2 less than 32-35 mm Hg) with resultant respiratory alkalosis (pH greater than 7.45) in the absence of underlying pulmonary disease. Immunosuppression and neutropenia are predisposing factors for the development of nosocomial pneumonia caused by common and uncommon pathogens. The nurse determines effective discharge teaching for a patient with pneumonia when the patient makes which statement? A) "I will need to have a follow-up chest x-ray in six to. Pneumonia Nursing Care Plan 4 Impaired Gas Exchange Nursing Diagnosis: Impaired Gas Exchange related to the overproduction of mucus in the airway passage secondary to pneumonia as evidenced by cyanosis, restlessness, and irritability. c. Terminal structures of the respiratory tract Assess for mental status changes.Poor oxygenation leads to decreased perfusion to the brain resulting in a decreased level of consciousness, restlessness, agitation, and lethargy. What the oxygenation status is with a stress test St. Louis, MO: Elsevier. Gram-negative pneumonia is associated with a high mortality rate, even with appropriate antibiotic therapy. Give health teachings about the importance of taking prescribed medication on time and with the right dose. b. When does the nurse record the presence of an increased anteroposterior (AP) diameter of the chest? 1) b. 3.1 Ineffective airway clearance. A relative increase in antibody titers indicates viral infection. b. Surfactant Steroids: To reduce the inflammation in the lungs. A pulmonary angiogram outlines the pulmonary vasculature and is useful to diagnose obstructions or pathologic conditions of the pulmonary vessels, such as a pulmonary embolus. The patient is infectious from the beginning of the first stage through the third week after onset of symptoms or until five days after antibiotic therapy has been started. d. Keep the inner cannula in place at all times to prevent dislodging the tracheostomy tube. Patients with compromised immune systems such as those with COPD, HIV, or autoimmune diseases should be educated on the risk and how to protect themselves. Stop feeding when the patient is lying flat. Priority Decision: When F.N. a. Assess the patient for iodine allergy. Administer supplemental oxygen, as prescribed. c. Lateral sequence Smoking further increases the risk of developing pneumonia and should be avoided. d. a total laryngectomy to prevent development of second primary cancers. These symptoms are very crucial and the patient must be given immediate care and intervention to avoid hypoxia. a. Observing for hypoxia is done to keep the HCP informed. This intervention decreases pain during coughing, thereby promoting a more effective cough. Provide tracheostomy care. This assessment helps ensure that surgical patients remain infection-free, as nosocomial pneumonia has a high morbidity and mortality rate. Advise individuals who smoke to stop smoking, especially during the preoperative and postoperative periods. d. Direct the family members to the waiting room. What covers the larynx during swallowing? Deficient knowledge (patient, family) regarding condition, treatment, and self-care strategies (Including information about home management of COPD) 7. The tissue changes of TB and cancer of the lung may be diagnosed by chest x-ray or CT scan, MRI, or positron emission tomography (PET) scans. c. A negative skin test is followed by a negative chest x-ray. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. The oxygenation status with a stress test would not assist the nurse in caring for the patient now. c. Airway obstruction Attempt to replace the tube. c. a throat culture or rapid strep antigen test. She received her RN license in 1997. c. A nasogastric tube with orders for tube feedings d) 8. Ciliary action impaired by smoking and increased mucus production may be caused by the irritants in tobacco smoke, leading to impairment of the mucociliary clearance system. Coughing and difficulty of breathing may cause. Usually, people with pneumonia preferred their heads elevated with a pillow. 4. Urinary antigen test: To detect Legionella pneumophila and Streptococcus pneumoniae. patients with pneumonia need assistance when performing activities of daily living. CH. b. CO2 causes an increase in the amount of hydrogen ions available in the body. So to avoid that, they must be assisted in any activities to help conserve their energy. A third type is pneumonia in immunocompromised individuals. a. a. Administer oxygen with hydration as prescribed. b. NurseTogether.com does not provide medical advice, diagnosis, or treatment. d. Oxygen saturation by pulse oximetry. This is most common in intensive care units usually resulting from intubation and ventilation support. Is elevated in bacterial pneumonias (greater than 12,000/mm3). 3.7 Risk for Deficient Fluid Volume. An ET tube has a higher risk of tracheal pressure necrosis. Document the results in the patient's record. This work is the product of the This patient is older and short of breath. Nursing Diagnosis: Hyperthermia related to the disease process of bacterial pneumonia as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, and profuse sweating. The carina is the point of bifurcation of the trachea into the right and left bronchi. b. e. Sleep-rest Discussion Questions d. Pleural friction rub. 3. i. Sexuality-reproductive The patient may demonstrate abnormal breathing, difficulty breathing (dyspnea), restlessness, and inability to tolerate activity. Nigel wishes to use the PES format for Mr. Hannigan's nursing diagnoses. It is important to pre-oxygenate the patient before the nurse suctions to avoid respiratory distress. Productive cough (viral pneumonia may present as dry cough at first). Select all that apply. Change ventilation tubing according to agency guidelines. A 73-year-old patient has an SpO2 of 70%. Dyspnea and severe sinus pain as well as tender swollen glands, severe ear pain, or significantly worsening symptoms or changes in sputum characteristics in a patient who has a viral upper respiratory infection (URI) indicate lower respiratory involvement and a possible secondary bacterial infection. c. Patient in hypovolemic shock A patient's ABGs include a PaO2 of 88 mm Hg and a PaCO2 of 38 mm Hg, and mixed venous blood gases include a partial pressure of oxygen in venous blood (PvO2) of 40 mm Hg and partial pressure of carbon dioxide in venous blood (PvCO2) of 46 mm Hg. Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range. Implement precautions to prevent infection.Proper handwashing is the best way to prevent and control the spread of infection. 6. - It requires identification of specific, personalized risk factors, such as smoking, advanced age, and obesity. What is the significance of the drainage? b. symptoms. Health perception-health management: Tobacco use history, gradual change in health status, family history of lung disease, sputum production, no immunizations for influenza or pneumococcal pneumonia received, travel to developing countries 28: Obstructive Pulmonary Diseases. Cough reflex Assess the patients vital signs at least every 4 hours. Report significant findings. c. Persistent swelling of the neck and face What is the first action the nurse should take? Bilateral ecchymosis of eyes (raccoon eyes) Nursing care plans: Diagnoses, interventions, & outcomes. a. Deflate the cuff, then remove and suction the inner cannula. a. 2018.01.18 NMNEC Curriculum Committee. (Symptoms) Reports of feeling short of breath d. Chronic herpes simplex infections of the mouth and lips. People with community-acquired pneumonia usually do not need to be hospitalized unless an underlying condition such as chronic obstructive pulmonary disease (COPD), heart disease or diabetes mellitus, or a weakened immune system complicates the disease. It can be obtained by coughing, aspiration, transtracheal aspiration, bronchoscopy or open lung biopsy. - According to the Expanded CURB-65 scale, which is used as a supplement to clinical judgment to determine the severity of pneumonia, the patient's score is a 5; placement in the intensive care unit is recommended. Immobile patients or those who need assistance should be turned every 2 hours, assisted into an upright position, or transferred into a chair to promote lung expansion. 1. What is the first patient assessment the nurse should make? The available treatments of pneumonia can give a good prognosis to the patient for as long as he or she complies with it. causing a clinical illness o Mandatory testing for health care professionals o Usually performed twice o Priority Nursing Diagnoses: Ineffective breathing pattern Ineffective airway clearance Impaired Gas . The most common is a cough producing purulent sputum (often dark brown) that is foul smelling and foul tasting. d. Contain dead air that is not available for gas exchange. Decreased immunoglobulin A (IgA) decreases the resistance to infection. Nursing Diagnosis: Impaired Gas Exchange related to decreased lung compliance and altered level of consciousness as evidence by dyspnea on exertion, decreased oxygen content, decreased oxygen saturation, and increased PCO2. To help clear thick phlegm that the patient is unable to expectorate. The patient receives 1 point for each criterion: confusion (compared to baseline); BUN greater than 20 mg/dL; respiratory rate greater than or equal to 30 breaths/min; systolic BP of less than 90 mm Hg; and age greater than or equal to 65 yrs. To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Impaired Gas Exchange; May be related to. Assess lung sounds and vital signs. 1. What does the nurse teach the patient with intermittent allergic rhinitis is the most effective way to decrease allergic symptoms? Chronic hypoxemia Atelectasis Provide tracheostomy care every 24 hours. There is a prominent protrusion of the sternum. Air trapping Nurses also play a role in preventing pneumonia through education. How does the nurse assess the patient's chest expansion? 7. a. Verify breath sounds in all fields. Week 1 - Nursing Care of Patients with Respiratory Problems Influenza, Atelectasis, Pneumonia, TB, & Expert Help. Palpation identifies tracheal deviation, limited chest expansion, and increased tactile fremitus. Wear gloves on both hands when handling the cannula or when handling ventilation tubing. An open reduction and internal fixation of the tibia were performed the day of the trauma. Factors that increase the risk of nosocomial pneumonia in surgical patients include: older adults (older than 70 years), obesity, COPD, other chronic lung diseases (e.g., asthma), history of smoking, abnormal pulmonary function tests (especially decreased forced expiratory flow rate), intubation, and upper abdominal/thoracic surgery. Gravity and hydrostatic pressure in this position promote perfusion and ventilation matching. As such, here are the signs and symptoms that demonstrate the presence of impaired gas exchange. c. Use cromolyn nasal spray prophylactically year-round. c. Course crackles Nursing diagnosis for pleural effusion may vary depending on the patient's individual symptoms and condition. Recognize the risk factors for infection in patients with tracheostomy and take the following actions: Risk factors include the presence of underlying pulmonary disease or other serious illness, increased colonization of the oropharynx or trachea by aerobic gram-negative bacteria, increased bacterial access to the lower airway, and cross-contamination from manipulation of the tracheostomy tube. During a follow-up visit one week after starting the medication, the patient tells the nurse, "In the last week, my urine turned orange, and I am very worried about it." Pneumonia causing increased pus and mucus in the alveoli will interfere with gas exchange and oxygenation. Place the patient in a comfortable position. Macrolide antibiotics such as azithromycin and clarithromycin are commonly used as first-line drugs for pneumonia. Which instructions does the nurse provide to the patient to minimize exposure to close contacts and household members? 2) It is a highly contagious respiratory tract infection. If there is no improvement with the symptoms, the doctor may prescribe a different type of antibiotic. While the nurse is feeding a patient, the patient appears to choke on the food. Cough suppressants. Priority Decision: A pulse oximetry monitor indicates that the patient has a drop in arterial oxygen saturation by pulse oximetry (SpO2) from 95% to 85% over several hours. A patient presents to the emergency department with a temperature of 101.4F (38.6C) and a productive cough with rust-colored sputum. f. PEFR: (6) Maximum rate of airflow during forced expiration The nurse expects which treatment plan? Maximum amount of air lungs can contain d. Ventilate the patient with a manual resuscitation bag until the health care provider arrives. NMNEC Concept: Gas Exchange. b. Unstable hemodynamics Match the descriptions or possible causes with the appropriate abnormal assessment findings. Use of accessory respiratory muscles (scalene, sternocleidomastoid, external intercostal muscles), decreased chest expansion due to pleural pain, dullness when tapping on affected (consolidated) areas. The nitroglycerin tablet would not be helpful, and the oxygenation status is a bigger problem than the slight chest pain at this time. d. Assess arterial blood gases every 8 hours. Fever and vomiting are not manifestations of a lung abscess. The nurse identifies a nursing diagnosis of impaired gas exchange for a patient with pneumonia based on which physical assessment findings? Signs and symptoms of respiratory distress include agitation, anxiety, mental status changes, shortness of breath, tachypnea, and use of accessory respiratory muscles. Streptococcus pneumoniae is the causative agent for most of the cases of adult community-acquired pneumonia. What Are Some Nursing Diagnosis for COPD? d. VC: (4) Maximum amount of air that can be exhaled after maximum inspiration . Nursing care plan for impaired gas exchange. How to use esophageal speech to communicate b. g) 4. c. Comparison of patient's SpO2 values with the normal values A risk nursing diagnosis describes human responses to health conditions or life processes that may develop in a vulnerable individual, family, or community. 27: Lower Respiratory Problems / CH. Administer oxygen.Supplemental oxygen may be needed to support oxygenation and to maintain sp02 levels. 7. c. Remove the inner cannula if the patient shows signs of airway obstruction. Other antibiotics that may be used for pneumonia include doxycycline, levofloxacin, and combination of macrolide and beta-lactam (amoxicillin or amoxicillin/clavulanate known as Augmentin). Which medication therapy does the nurse anticipate will be prescribed? f. Instruct the patient not to talk during the procedure. Put the palms of the hands against the chest wall. Techniques that will be used to alleviate a dry mouth and prevent stomatitis What is the most appropriate action by the nurse? Discuss to the patient the different types of pneumonia and the difference between him/her. Normal venous blood gas values reflect the normal uptake of oxygen from arterial blood and the release of carbon dioxide from cells into the blood, resulting in a much lower PaO2 and an increased PaCO2. 3.4 Activity Intolerance. 1. A) Seizures Hopefully the family will have some time to discuss this before they are instructed to leave the room, unless it is an emergency. The position of the oximeter should also be assessed. Airway obstruction is most often diagnosed with pulmonary function testing. What is a primary nursing responsibility after obtaining a blood specimen for ABGs? During preoperative teaching for the patient scheduled for a total laryngectomy, what should the nurse include? Nursing Diagnosis. 2. What should the nurse do when preparing a patient for a pulmonary angiogram? a. All other answers indicate a negative response to skin testing. If the patient is enteral fed, recommend continuous rather than bolus feeding. d. Apply an ice pack to the back of the neck. c. Patient in hypovolemic shock Building up secretions in the airway will only cause a problem since it will obstruct the airflow from going in and out of the body. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. e) 1. Notify the health care provider. h. Role-relationship Oral hygiene moisturizes dehydrated tissues and mucous membranes in patients with fluid deficit. a. b. Organizing the tasks will provide a sufficient rest period for the patient. Initially, oxygen is administered at low concentrations, and oxygen saturation is closely monitored. Primary care, with acute or intensive care hospitalization due to complications. 5) e. Observe for signs of hypoxia during the procedure. The assessment findings include a temperature of 98.4F (36.9C), BP 130/88 mm Hg, respirations 36 breaths/min, and an oxygen saturation reading of 91% on room air. Which values indicate a need for the use of continuous oxygen therapy? A patient's initial purified protein derivative (PPD) skin test result is positive. c. "An annual vaccination is not necessary because previous immunity will protect you for several years." Always change the suction system between patients. For which problem is this test most commonly used as a diagnostic measure? Always maintain sterility or aseptic techniques when performing any invasive procedure. through the second week after the onset of symptoms. Warm and moisturize inhaled air d. Dyspnea and severe sinus pain Drug therapy is an alternative to avoidance of the allergens, but long-term use of decongestants can cause rebound nasal congestion. Put the index fingers on either side of the trachea. COPD ND3: Impaired gas exchange. In healthy individuals, pneumonia is not usually life-threatening and does not require hospitalization. c. A tracheostomy tube allows for more comfort and mobility. For best yield, blood cultures should be obtained before antibiotics are administered. d. Oxygen saturation by pulse oximetry In patients with unilateral pneumonia, positioning on the unaffected side (i.e., good side down) promotes ventilation to perfusion adaptation. a. Popkin, B. M., DAnci, K. E., & Rosenberg, I. H. (2010). A 36-year-old patient with type 1 diabetes mellitus asks the nurse whether an influenza vaccine is necessary every year. d. Pleural friction rub Atrial Fibrillation Nursing Diagnosis and Nursing Care Plan, Readiness for Enhanced Coping Nursing Diagnosis and Nursing Care Plans, Cystic Fibrosis Nursing Diagnosis Care Plan - NurseStudy.Net. 27 - Lower Respiratory Problems, Coronary Artery Disease & Acute Coronary Synd, Integumentary System (Lewis Med-Surg CH.22 &, Barbara T Nagle, Hannah Ariel, Henry Hitner, Michele B. Kaufman, Yael Peimani-Lalehzarzadeh, 1.1 (Anatomy) Functional Organization of the. Take an initial assessment of the patients respiratory rate and blood oxygen saturation using a pulse oximeter. Nurses should assess for and encourage pneumonia vaccines for eligible populations. Retrieved February 9, 2022, from, Pneumonia: Symptoms, Treatment, Causes & Prevention. Chest x-ray examination: To confirm presence of pneumonia (i.e., infiltrate appearing on the film). Nursing Diagnosis: Ineffective Airway Clearance related to the disease process of bacterial pneumonia as evidenced by shortness of breath, wheeze, SpO2 level of 85%, productive cough, difficulty to expectorate greenish phlegm. Pneumonia is an infection of the lungs caused by a bacteria or virus. Encourage plenty of rest without interruption in a calm environment, and space out activities such as bathing or therapy to limit oxygen consumption. Monitor cuff pressure every 8 hours. The health care provider orders a pulmonary angiogram for a patient admitted with dyspnea and hemoptysis. A) Admit the patient to the intensive care unit. d. Auscultation. After the intervention, the patients airway is free of incidental breath sounds. 1. 2. NANDA Nursing diagnosis for Pneumonia Pneumonia ND1: Ineffective airway clearance. Thorough hand hygiene before and after patient contact (even if gloves are worn). What are the characteristics of a fenestrated tracheostomy tube (select all that apply)? What action should the nurse take? It can have too much oxygen or carbon dioxide in the body which is not very beneficial to the organs or systems. Use narcotics and sedatives with caution.Narcotics for pain control or anti-anxiety medications should be monitored closely as they can further suppress the respiratory system. b. Cuff pressure monitoring is not required. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public. c. Determine the need for suctioning. e. Observe for signs of hypoxia during the procedure. To help alleviate cough and allow the patient to rest, cough suppressants may be given at low doses. Discharging the patient is unsafe. d. Comparison of patient's current vital signs with normal vital signs oxygen. Instruct patients who are unable to cough effectively in a cascade cough. - Sputum associated with pneumonia may be green, yellow, or even rust colored (bloody). Impaired Gas Exchange is a NANDA nursing diagnosis that is used for conditions where there is an alteration in the balance between the exchange of gases in the lungs. a. Touching an infected object and then touching your nose or mouth can also transfer the germs. The syringe used to obtain the specimen is rinsed with heparin before the specimen is taken and pressure is applied to the arterial puncture site for 5 minutes after obtaining the specimen. These interventions contribute to adequate fluid intake. Nursing Diagnosis for Pleural Effusion Impaired Gas Exchange r/t decreased function of lung tissue Ineffective Breathing Pattern r/t compromised lung expansion Acute Pain r/t inflammatory process Anxiety r/t inability to take deep breaths Risk for infection r/t pooling of fluid in the lung space Nursing Care Plans for Pleural Effusion The patient will have improved gas exchange. Basket stars are active at night. What accurately describes the alveolar sacs? a. treatment with antibiotics. Encourage fluid intake and nutrition.Hydration is vital to prevent dehydration and supports homeostasis. b. Finger clubbing They are as follows: Ineffective Airway Clearance Impaired Gas Exchange Ineffective Breathing Pattern Risk for Infection Acute Pain Decreased Activity Tolerance Hyperthermia Risk for Deficient Fluid Volume Risk for Imbalanced Nutrition: Less Than Body Requirements What should be the nurse's first action? d. "Antiviral drugs, such as zanamivir (Relenza), eliminate the need for vaccine except in the older adult.". Nursing Diagnosis: Ineffective Airway Clearance. Homes should be well ventilated, especially the areas where the infected person spends a lot of time. A repeat skin test is also positive. Priority Decision: A patient's tracheostomy tube becomes dislodged with vigorous coughing. e. FVC Lung consolidation with fluid or exudate St. Louis, MO: Elsevier. 5. b. Nursing diagnosis: Deficient knowledge about the disease process and treatment of pneumonia related to lack of information as evidenced by failure to comply with treatment. Periorbital and facial edema reduced by about half since second hospital day Pneumonia is an infection of the lungs that can be caused by bacteria, fungi, or viruses. Page . deep inspiratory crackles (rales) caused by respiratory secretions, and circumoral cyanosis (a late finding). The patient needs to be able to effectively remove these secretions to maintain a patent airway. The nurse can install an air filter machine that will help create a dust-free environment that will be ideal for a patient with pneumonia. b. Epiglottis b. Nutritional-metabolic: Decreased fluid intake, anorexia and rapid weight loss, obesity Buy on Amazon, Gulanick, M., & Myers, J. L. (2022). b. Order stat ABGs to confirm the SpO2 with a SaO2. Hospital acquired pneumonia may be due to an infected. a. Suction the tracheostomy. The treatment is macrolide (erythromycin, azithromycin [Zithromax]) antibiotics to minimize symptoms and prevent the spread of the disease. If the patients condition worsens or lab values do not improve, they may not be receiving the correct antibiotic for the bacteria causing infection. (2022, January 26). Fever reducers and pain relievers. Impaired gas exchange related to alveolar-capillary membrane changes as evidenced by shortness of breath, low SPO2, and bacteria found in sputum culture.