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Difficulty: MediumBasic Care and Comfort

A 72-year-old individual is receiving treatment on the medical-surgical floor for right-sided bacterial pneumonia. The client exhibits shallow breathing, generalized weakness, and expresses feeling exhausted from continuous coughing. What is the most appropriate action for the registered nurse to take?

  1. Place the individual in a left-side-lying position with the head of the bed elevated.Answer
  2. B
    Assist the individual into a right-side-lying position to utilize gravity for draining the infected lung secretions.
  3. C
    Instruct the unlicensed assistive personnel (UAP) to auscultate lung sounds every two hours to monitor for increasing consolidation.
  4. D
    Reassure family members that the individual's new-onset agitation is an expected, age-related response to a hospital environment.

Answer

The most appropriate action is to place the client in a left-side-lying position with the head of the bed elevated.
For a client with unilateral pneumonia, the nurse should position the client with the unaffected lung dependent (down). Gravity directs greater blood flow to the dependent lung. By placing the healthy left lung down, blood flow is directed to the area with the best ventilation, which optimizes the ventilation-perfusion (V/Q) ratio and improves oxygenation.

Step-by-Step Solution

1
Analyze the client's clinical presentation.
The client is an older adult with right-sided pneumonia, shallow breathing, and fatigue.
Understanding the location of the pulmonary pathology (right lung) is essential for determining safe and effective positioning.
2
Evaluate the physiological impact of positioning on oxygenation.
Positioning the client with the healthy lung dependent (left side down) maximizes blood flow to the well-ventilated lung due to gravity.
This 'good lung down' strategy optimizes the ventilation-perfusion (V/Q) match, thereby improving systemic oxygenation and reducing respiratory distress.
3
Identify and eliminate contraindicated actions.
Right-side-lying worsens hypoxia; assessing lung sounds cannot be delegated to a UAP; and acute agitation is a sign of hypoxia, not normal aging.
Ensuring safe delegation, recognizing signs of clinical deterioration, and avoiding harmful positions are core nursing responsibilities.

Key Concept

Therapeutic positioning to optimize ventilation-perfusion matching in unilateral lung disease.
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Topics

Basic Care and Comfort

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