The client diagnosed with Parkinson's Disease (PD) is being admitted with a fever and patchy infiltrates in the lung fields on the chest x-ray. Which clinical manifestations of PD would explain this assessment data?

Mask-like face and shuffling gait

Lack of arm swing and bradykinesia

Pill rolling of fingers and flat affect

Difficulty swallowing and immobility

Answer and Explanation

The Correct Answer is D

A) Mask-like face and shuffling gait:
While the mask-like face and shuffling gait are common clinical features of Parkinson's Disease (PD), they do not directly explain the fever or the patchy infiltrates seen on the chest x-ray. The mask-like face is due to reduced facial muscle activity and is associated with the motor symptoms of PD, while the shuffling gait results from bradykinesia (slowness of movement).

B) Lack of arm swing and bradykinesia:
Lack of arm swing and bradykinesia are motor symptoms of PD that are indicative of decreased movement and muscle rigidity. While they impact a patient’s mobility and dexterity, they are not directly associated with lung infiltrates or fever.

C) Pill rolling of fingers and flat affect:
Pill rolling (a characteristic tremor where patients move their fingers as if rolling a pill) and flat affect (a reduced emotional expression) are hallmark features of Parkinson's Disease, but again, they do not explain the fever or lung infiltrates.

D) Difficulty swallowing and immobility:
Difficulty swallowing (dysphagia) is a common and serious symptom in patients with Parkinson's Disease. Due to the loss of control over the muscles involved in swallowing, patients with PD are at high risk for aspiration (food, liquids, or saliva entering the lungs), which can lead to aspiration pneumonia. This condition often presents with fever, chest infiltrates, and respiratory distress, which directly correlates with the patient's fever and lung infiltrates seen on the chest x-ray.

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Correct Answer is D

Explanation

A) Respiratory acidosis:
Respiratory acidosis occurs when there is an accumulation of carbon dioxide (CO2) in the blood, leading to a decrease in pH. In the given blood gas values, the PaCO2 is 28 mmHg, which is lower than the normal range (35-45 mmHg), indicating that CO2 is being exhaled more than usual, not accumulating.

B) Metabolic acidosis:
Metabolic acidosis results from a decrease in bicarbonate (HCO3-) or an increase in acid in the body. However, in the provided values, the bicarbonate (HCO3-) is normal at 24 mEq/L, and the pH is elevated at 7.51, indicating alkalosis rather than acidosis

C) Metabolic alkalosis:
Metabolic alkalosis occurs when there is an increase in bicarbonate levels or excessive loss of acids, often associated with vomiting or diuretic use. However, in this case, the bicarbonate level (HCO3-) is normal, and the pH is more consistent with alkalosis due to respiratory factors, not metabolic causes.

D) Respiratory alkalosis:
Respiratory alkalosis occurs when there is excessive exhalation of CO2, leading to a rise in blood pH (alkalosis). The pH is 7.51, which is above the normal range (7.35-7.45), indicating alkalosis. Additionally, the PaCO2 is low at 28 mmHg, which suggests that the client is hyperventilating and exhaling too much CO2, confirming respiratory alkalosis as the correct interpretation.

A. Prepare for chest tube insertion B. Chart assessment findings C. Administer lorazepam D. Initiate IV fluid resuscitation

Correct Answer is A

Explanation

A) Prepare for chest tube insertion:
The priority treatment for a hemothorax, which is a collection of blood in the pleural space, is to address the loss of intravascular volume and to relieve the pressure on the lungs. The insertion of a chest tube is the first step in draining the blood and restoring proper lung function and ventilation. This intervention directly addresses the cause of obstructive shock (increased pressure on the lungs and impaired cardiac output) by re-expanding the lung and preventing further complications such as respiratory distress or cardiovascular collapse.

B) Chart assessment findings:
While accurate documentation of the patient's condition is important for ongoing care and legal purposes, it is not the priority action in this situation. Immediate treatment to address the hemothorax, such as chest tube insertion, takes precedence over documentation. Charting should be done after stabilizing the patient.

C) Administer lorazepam:
Lorazepam is an anxiolytic medication that might be used for anxiety or agitation, but it is not an immediate priority in this situation. The patient's life-threatening condition (hemothorax) needs to be addressed first, and sedation or anxiety management should be considered once the patient is stabilized and receiving appropriate interventions.

D) Initiate IV fluid resuscitation:
While fluid resuscitation is essential in trauma patients with hypovolemic shock, the primary concern in hemothorax is relieving the intrathoracic pressure by draining the blood from the pleural space. IV fluid resuscitation should be initiated shortly after or simultaneously with the chest tube insertion, but addressing the hemothorax directly is the first priority in treating obstructive shock.

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The client diagnosed with Parkinson's Disease (PD) is being admitted with a fever and patchy infiltrates in the lung fields on the chest x-ray. Which clinical manifestations of PD would explain this assessment data?

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Correct Answer is D

Explanation

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