As a day shift nurse on a patient-care unit, the nurse performs assessments on the patients at the beginning of the shift. The first patient that the nurse assesses is an 85-year-old man admitted yesterday with pneumonia. During shift handoff, the night nurse stated the patient had a fever on admission but that the patient’s temperature was normal during the night shift. The patient had an elevated white blood cell count of 12.4 (10,000 mm3) on admission and received three doses of IV antibiotics since admission. As the nurse assesses the patient’s vital signs, the patient is noted to have a temperature of 101.1 °F (38.4 °C). The nurse finds upon patient assessment a respiratory rate of 20 and a pulse oximeter reading of 95% on 1.5 L of oxygen delivered through a nasal cannula. His repeat white blood cell count on the morning of care is 13.2 (10,000 mm3). As the nurse continues the patient assessment, the healthcare team enters the patient’s room. One of the providers asks, “Is he improving?”

1.

How should the nurse respond to the physician?

2.

What questions should the nurse have asked during the handoff shift report when it was reported that the patient had a normal temperature during the night shift?

3.

Is a temperature finding of 101.1 °F or a white blood cell count of 13.2 (10,000 mm3) an improvement?