The 32-year-old patient presents to the emergency department complaining of difficulty breathing, cough, and chills. Vital signs are notable for a temperature of 38.4°C, heart rate 118 bpm, respiratory rate 24, oxygen saturation 87% on room air, and blood pressure of 98/62 mmHg. Upon assessment, the nurse notes nasal flaring, diminished breath sounds in the right upper lobe, and subcostal retractions. Capillary refill time is 4 seconds. The patient admits waking up in a pool of vomit after binge drinking 3 nights ago. Which orders does the nurse anticipate? Select all that apply.

Question

The 32-year-old patient presents to the emergency department complaining of difficulty breathing, cough, and chills. Vital signs are notable for a temperature of 38.4&deg;C, heart rate 118 bpm, respiratory rate 24, oxygen saturation 87% on room air, and blood pressure of 98/62 mmHg. Upon assessment, the nurse notes nasal flaring, diminished breath sounds in the right upper lobe, and subcostal retractions. Capillary refill time is 4 seconds. The patient admits waking up in a pool of vomit after binge drinking 3 nights ago. Which orders does the nurse anticipate? Select all that apply.

Accepted Answer

Administer 1L 0.9% NaCl STAT , Provide 5L 100% oxygen via high flow nasal cannula , Administer intravenous ceftriaxone and azithromycin. The patient likely aspirated gastric contents while intoxicated and is now experiencing aspiration pneumonia. The patient is hypoxic, so oxygen should be provided to decrease respiratory distress. The patient&rsquo;s circulation is poor and is likely dehydrated due to fever and illness, so aggressive fluid resuscitation should be started. Ceftriaxone and azithromycin are drugs of choice for ill-appearing patients with aspiration pneumonia acquired in the community. The patient is at risk for cardiorespiratory collapse and must remain on continuous monitoring. The patient&rsquo;s fever is related to the inflammatory response to the infection and does not necessarily need to be treated initially. Further, the patient may have some degree of liver injury from the binge drinking that should be investigated before administration of the hepatotoxic drug, acetaminophen. Although the patient is hypotensive, this is likely related to hypovolemia. If the patient remains hypotensive after fluid volume status is corrected, then a vasopressor may be indicated.

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