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Difficulty: HardBasic Care and Comfort

A nurse is caring for an older adult client who is admitted with right-sided lobar pneumonia. The client is receiving oxygen at 2 L/min via nasal cannula but continues to experience significant dyspnea, pleuritic chest pain, and increasing restlessness. The client's oxygen saturation is 88%. Which of the following actions should the nurse take to best promote the client's oxygenation and comfort?

  1. A
    Delegate the unlicensed assistive personnel (UAP) to assess the client's respiratory effort every 30 minutes.
  2. Assist the client into a left side-lying (lateral decubitus) position.Answer
  3. C
    Reassure the family that the client's acute restlessness is an expected age-related response to hospitalization.
  4. D
    Place the client in a right side-lying (lateral decubitus) position to splint the affected lung.

Answer

Assist the client into a left side-lying (lateral decubitus) position.
In the management of unilateral lung disease such as right-sided lobar pneumonia, the priority is to optimize ventilation-perfusion (V/Q) matching. Placing the client in the lateral decubitus position with the unaffected 'good' lung dependent (down) utilizes gravity to direct more pulmonary blood flow to the healthy lung. Because the healthy lung has better alveolar ventilation, increasing its perfusion significantly improves overall oxygenation. Since this client has right-sided pneumonia, the left lung is the healthy lung, making the left side-lying position the most appropriate and effective basic care intervention.

Step-by-Step Solution

1
Identify the primary physiological problem presented in the scenario.
The client has right-sided lobar pneumonia with signs of worsening hypoxia, including dyspnea, pleuritic pain, restlessness, and an SpO2 of 88%.
Recognizing the severity of the respiratory compromise dictates the urgency and type of nursing interventions required.
2
Evaluate the clinical significance of the client's increasing restlessness.
Restlessness is identified as an early neurological sign of inadequate oxygenation to the brain, requiring immediate intervention to improve gas exchange.
Accurate interpretation of clinical signs prevents the misattribution of symptoms to benign causes, such as typical aging or hospital delirium.
3
Determine the optimal positioning strategy for unilateral lung disease.
Apply the physiological principle of 'good lung down', which uses gravity to increase pulmonary blood flow to the most ventilated lung segments, thereby improving ventilation-perfusion (V/Q) matching.
Therapeutic positioning is a primary basic care intervention that directly impacts physiological adaptation and oxygenation.
4
Select the correct nursing action based on the location of the pathology.
Because the pneumonia is right-sided, the left lung is the healthy lung. Therefore, assisting the client into the left lateral decubitus position is the correct action.
This specific position maximizes oxygenation while avoiding interventions that could worsen the patient's status.

Key Concept

Ventilation-perfusion (V/Q) matching and therapeutic positioning in unilateral lung disease
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Topics

Basic Care and Comfort

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