Chest x-ray results reveal right lower lobe consolidation, presence of apical bullae, flattened diaphragm, and a small pleural effusion in the right lower lobe. ABGs on room air are pH 7.30, PaO2 55, PaCO2 50, HCO3 25. The CBC is as follows: WBC 12,500, platelets 350,000, HCT 30%, and Hgb 10 g/dL. The admission vital signs are as follows: blood pressure 90/50 mm Hg, heart rate 101 bpm, respiratory rate 28 breaths/min, and temperature 101.5☏. The family stated that this is a new change for the patient. The patient presents with confusion as to time and place. The patient has a history of hypertension, and diabetes controlled with oral diabetic agents. The patient smoked cigarettes one pack per day for 55 years and quit 3 years ago. He was diagnosed with paraseptal emphysema 3 years ago. Harry Smith, 70 years of age, is a male patient who is admitted to the medical-surgical unit with acute community-acquired pneumonia.
The patient coughs weakly, but he does not raise any sputum. The patient is diaphoretic and is using accessory muscles. The patient complains of fatigue and shortness of breath and cannot finish a short sentence before the respiratory rate increases above the baseline and his nail beds and lips turn a bluish tinge and the pulse oximetry decreases to 82%. The breath sounds in the rest of the lungs are slightly decreased. Lung auscultation reveals severely diminished breath sounds in the right lower lobe and absence of breath sounds at the base.
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