Final answer:
The respiratory therapist should recommend antibiotic therapy for the patient who developed a fever, right lower lobe infiltrate, and elevated white blood cell count post-intubation, as these symptoms suggest a bacterial lung infection requiring such treatment.
Step-by-step explanation:
Twenty-four hours after a patient was intubated, she develops a fever of 99.9°F, a right lower lobe infiltrate, and her white blood cell count is 12,000 per mm³. Given these clinical signs, including the fever and radiographic evidence of an infiltrate suggestive of pneumonia, and an elevated white blood cell count, it is prudent for the respiratory therapist to recommend antibiotic therapy. This recommendation is based off the provided case studies in which patients presenting with similar symptoms of fever and lung infiltrates were diagnosed with bacterial infections that necessitated antibiotic treatment, such as the case of John and Barbara.
Antiviral therapy would be considered if there was strong evidence for a viral infection, but the presentation of a lobe-specific infiltrate and fever post-intubation often points towards a bacterial source, such as ventilator-associated pneumonia. In cases where there's a suspicion of influenza, like that of John, RIDTs could be used to confirm influenza A or B, which if negative and accompanied by a lobe-specific infiltrate, further supports bacterial infection. The rise in white blood cell count indicates that the patient's body is attempting to fight off what is likely a bacterial infection, thus suggesting antibiotics over antiviral agents.
Meanwhile, a SABA (short-acting beta agonist) by small volume nebulizer may be used for symptomatic relief if the patient has bronchospasm or wheezing in conjunction with the infection, but it is not a treatment for the infection itself. A blood transfusion is not indicated in this scenario as there is no evidence of significant blood loss or anemia.