Consolidated Carl — Pneumonia
Crackles, rusty sputum, confusion in the elderly
Carl aspirates a mouthful of dinner and by morning the right lower lobe of his lung is packed solid. His family says nothing is wrong except that grandpa is suddenly confused.
Carl's alveoli fill with pus. Fever, productive cough, pleuritic pain and crackles over the affected lobe. In older adults the only sign may be new confusion or a fall. Cultures before antibiotics, antibiotics on time, and pulmonary hygiene.
Read Consolidated Carl's full story →The story arc
The setup
A stroke left Carl with a weak swallow. He eats reclined and coughs at every meal.
The turn
Two days later he is febrile with a productive cough and crackles that do not clear when he coughs.
The crisis
At 84 years old his temperature is only 37.4°C — but he is confused, tachypneic and his SpO₂ is 88%.
The save
Sputum and blood cultures, then antibiotics; incentive spirometry, hydration, and head of bed up for every meal.
NCLEX study section — Pneumonia
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Respiratory
Take this chapter into practice questions on the same topic.