Mr. Hernandez is hospitalized with left lower lobe pneumonia. Arterial blood gas results are: pH–7.47, pO2–60, pCO2–48, and HCO3–28. The nurse has completed a health history and a physical exam of the head, eyes, ears, nose, and throat. Now, the nurse must perform an assessment of the respiratory system. The nurse begins the physical assessment by conducting a brief history of the symptoms Mr. Hernandez has experienced related to the respiratory system. The nurse gathers the following history:

He developed a productive cough with thick, yellow-green mucous, shortness of breath, and chest pain over the past week. The healthcare provider ordered a chest x-ray which showed left lower lobe pneumonia. He was admitted for treatment of his left lower lobe pneumonia. He has a history of Gastroesophageal Reflux Disease (GERD), and Chronic Obstructive Pulmonary Disease (COPD). His home medications are Zantac 150mg 1 tablet by mouth twice a day, Proventil inhaler 2 puffs as needed for shortness of breath, and Advair Diskus 1 puff three times a day. He denies having a flu shot this year and has not had a pneumonia vaccine for 5 years. He has frequent sinus congestion whenever there is a change in the weather. He usually takes over-the-counter sinus medicine which will take care of the problem. He notes that he started with sinus congestion about two weeks ago which continued to get worse and made his throat sore from the drainage and the frequent coughing. He thinks this is why he developed the pneumonia that caused him to be admitted to the hospital this time.

1. Based on the history, what physical assessment findings would the nurse expect to find on examination?
2. Are there any risk factors that could have contributed to the patient’s development of pneumonia?