John Talley, a 51-year-old truck driver, has had an upper respiratory infection for the past 2 weeks. Although he has seen his health care provider, he does not seem to be improving. He is convinced that if he takes the antibiotic just 1 more day, he will surely improve. However, after 5 days of drug therapy, John continues to experience chills, fever, and a productive cough. His wife insisted that he return to the clinic for further evaluation and treatment. At the clinic the patient’s physical examination and diagnostic tests reveal the following findings: Temperature is 39.2°C (102.6°F), pulse rate is 112 beats/min, respiratory rate is 30 breaths/min, and blood pressure is134/88 mmHg. He is visibly short of breath and is experiencing intermittent coughing episodes. On auscultation of his lung fields, bilateral crackles and wheezes are discovered. His WBC count is 14,400 mm 3. A chest x-ray is taken to confirm a diagnosis of pneumonia and reveals right lower lobe infiltrates (white areas in the lung that indicate infection). The patient is diagnosed with bacterial pneumonia. He is hospitalized and prescribed IV antibiotic therapy. On the second hospital day you are assigned to care for John. He and his wife have multiple questions about the drug therapy prescribed.
1. Why did the first antibiotic prescribed not cure the infection?
2. The patient has been told that a sputum specimen is needed for a “C and S” and asks what that is. What will the nurse teach him about this test and why it is needed?
3. John has been told that laboratory personnel will be collecting blood for a peak and trough level this afternoon and in the morning. How would the nurse explain this laboratory test to the patient?
4. What symptoms would indicate that the patient’s condition is worsening?