SIM lab drug admin/precautions part 4
A client with a urinary tract infection (UTI) is being discharged in phenazopyridine (Pyridium) and ciprofloxacin hydrochloride (Cipro). Which of the following statements by the client should indicate to the nurse a need for further teaching?
"I should notify the health provider immediately if my urine turns a red or orange color."
A nurse is providing teaching to the parent of a child with asthma who is prescribed cromolyn sodiun (Intak) via metered dose inhaler. Which of the following statements by the child's parent should indicate to the nurse the need for further instruction?
"I will give my child a dose as soon as wheezing starts."
A client has been taking isoniazid (INH) and rifampin (Rifadin) for 3 weeks after being diagnosed with active pulmonary tuberculosis (TB). The client calls the clinic to report that his urine is a reddish orange color. Which of the following is an appropriate response by the nurse?
"Rifampin may turn all body fluids orange-red. This is a harmless side effect."
clinical manifestations of pneumonia
-Productive cough HALLMARK- typically green, yellow, or rust colored sputum -Fever, shaking and chills (fever because of an infection) -Dyspnea, tachypnea HUGE -Pleuritic chest pain-tightness in chest -Rhonchi and wheezing lung sounds -use of accessory muscles for breathing -Change in mental status may be indicated for older or debilitated pts *MAY BE THE ONLY SYMPTOM*
what do we need to teach patients with pneumonia for home care
-YOU NEED TO TAKE THE ENTIRE COURSE OF MEDS -watch for interactions with bacterial infections and food •Adequate rest •Adequate hydration •Avoid alcohol and smoking. •Cool mist humidifier to loosen secretions •Chest x-ray, vaccinations
what are the nursing implications for pneumonia
-acute intervention -prompt initiation of antibiotics asap -oxygen therapy -HYDRATION -nutritional support: adequate hydration to thin and loosen the secretions, high calories and small frequent meals -breathing exercise -early ambulation -therapeutic position: sit up semi fowlers at least 30 degrees -pain management
how do we prevent pneumonia for at risk patients
-early mobilization-•mobilization-patients we want to keep them up as quick as possible, get them moving get lungs filled have effective expansion of lungs to prevent pneumonia -Incentive spirometry -2X daily oral hygiene -strict adhearence to ventilator bundle to prevent VAP-routine oral care, suction catheter, strict suction technique
how to prevent pneumonia in patients with swallowing problems
-elevate head of bed to at least 30 degrees and sit up for meals, no exceptions -assist with eating, drinking, taking meds as needed -assess for gag reflex. If they don't have a gag reflex, they need to be NPO until they get a speech evaluation -Positioning patients with altered LOC upright or side lying so no vomit/coughing and aspirating them into the lungs
what do we need to do to manage a chest tube
-prepare the damage unit by adding water-seal chamber and suction control chamber as indicated -keep tubing loosely coiled, tape connections -don't elevate above chest -change when full -measure fluid level -report if over 100 mL/hr -if there's bubbling, that indicates a leak -tidaling (rise and fall) reflects change in pressure, disappears as lung re-expands -do water suction control-the amount of water in the chamber controls suction to lungs, typically filled to 20 cm of water, turn suction up if gentle bubbling -don't milk or strip the chest tube, but if health care provider orders, do so GENTLY -encourage deep breathing, ROM exercises, incentive spirometry
different types of pneumothorax
-spontaneous (rupture of blebs, primary or secondary (from like COPD or asthma), risk factors, chest trauma -iatrogenic: caused by medical procedures
The nurse must calculate the daily dosage of a new medication for a child weighing 69 lb. The primary care provider has prescribed 10 mcg/kg/day PO in 3 divided doses. The nurse has on hand 0.1 mg tablets. Which of the following should the nurse calculate to be the daily dosage in milligrams?
0.31 mg
how do we use intraprofessional care to take care of pneumonia
1. antibiotic therapy-get these right away like a broad spectrum first and then narrow it down once the cultures come back 2. repeat chest xray for consolidation and see if it's getting worse or better 3. supportive care especially if SpO2 is below or at 90% 4. antivirals for influenza pneumonia-we don't treat with antibiotics but other means like cough suppressants, tylenol for fever/pain meds, if antivirals have symptoms for less than 2 days we give & if not it runs its course 5. encourage the pneumonia vaccine
what diagnostic studies do we use for PE
1. arterial blood gasses-helpful to see if they're hypoxic or have oxygenation issues or are hyperkepnic (high CO2 levels) or if they have respiratory acidosis, but not diagnostic 2. chest xray if the clot is big enough 3. D dimer lab- measures about of fiber & fragments in blood. Fragments result of clot degradation, but if small it'll be a false negative. It also elevates with any clot degradation in general, so we don't know for sure if it's a PE or something else 4. Spiral (helical) CT scan-you would go onto this after a D dimer. Requires contrast media, circles around the lungs. Complications is it's hard on the kidneys & you need to hold 5. ventilation-perfusion (V/Q) scan- if unable to get the contrast. Inject radioactive dye into the patient and look for perfusion issues. or inhale radioactive aerosol and see if they are ventilating correctly 6. pulmonary angiography- they go in like a cardiac catheterization and go in with an instrument and go into the lung cavity and look with a camera in the lungs and look at the vessels to see if theres a clot in the pulmonary cavity
how to classify pneumonia (different types)
1. causitive organisms (bacteria, viral, fungal) 2. mode of transmission (aspiration, opportunistic) 3. location of acquisition (community, hospital, ventilator, health care associated)
what type of anticoagulants do we give for PE
1. low molecular weight heparin (LMWH) is what we see frequently, usually lovonox subq injection 2. unfractioned IV heparin- this one is weight based. We use this sometime, but the problem is it takes a lot of titrating and a lot of time to get it in the therapeutic range 3. warfarin/coumadin-needs to be started at the very beginning as well. Usually on this for 3 months after PE dissolved to prevent any further accumulation & prevent it from coming back. Need frequent INR checks. 4. Novel anticoagulants-eloquis, perdaxa, cervesa, pixaban is the general name for eloquis. Don't require as frequent of INR checks
what are the 3 ways etiologies of pneumonia
1. most common is aspiration from the mouth or nose because pathogens sit in our mouth and nose & sometimes they get into our lungs when we breathe it in 2. inhaling microbes that are present in the air 3. secondary infection-spread from primary infection elsewhere in the body like staph or endocarditis
what type of tests do we do for pneumonia
1. past medical history 2. physical exam 3. chest xrays-look for consolidation (the normally air filled alveoli becomes filled with fluid/water/some sort of debris, pretty typical with pneumonia) 4. sputum analysis-give them an albuterol or broad spectrum treatment then narrow down after the C&S test comes back 5. CBC count- see what the WBC count is. it'd be >15,000 because it's an infection, normal is between 4-11k 6. pulse ox (good understanding of oxygenation and their ventilation-perfusion mismatch & if the blood is efficiently carrying oxygen) or ABG (oxygen in arterial blood, assess for CO2) 7. blood cultures-maybe do this depending on if they have a fever accompanying it and if they have signs of sepsis
how to assess for pneumonia
1. past medical history first and foremost-find any risk factors that could have lead to the diagnosis of pneumonia 2. see when and how they first started having symptoms-pneumonia is usually sudden onset, first felt fine then suddenly have a productive cough/fever/chills/SOB 3. assess symptoms-pneumonia is fever, chills, SOB 4. see if they have a productive cough with sputum- "are you coughing up anything & if so what color" should be green, yellow 5. see if they have any chest pain following a deep breath or cough 6. see if the elderly are confused 7. physical exam-tachypnea, coarse crackles with possible rhonchi or wheezing
what are the complications with pneumonia
1. pericarditis- inflammation/infection around the heart 2. Meningitis-can travel to meninges in the spinal column or brain 3. Sepsis-multi drug resistant organisms eventually travels to blood stream, can cause shock 4. Acute respiratory failure-depending on how bad it becomes and how much the lung is affected, the age of the patient, any comorbidities, may need ventilator support in order to get appropriate gas exchange 5. Pneumothorax-air or fluid collection in the pleural space of the lungs 6. Pleural effusion-fluid buildup in the pleural space
how do we evaluate if a pneumonia patient has impaired gas exchange:
1. pulse ox: tells you the amount of RBC also carrying oxygen (good indicator)-if it falls below 90% that's bad. we want 92-95 ideally 2. if your SpO2 drops below 90% your PaO2 (measurement of oxygen pressure in arterial blood-partial pressure O2) falls rapidly 3. your blood pH & body temperature affects oxygen carrying capacity of hemoglobin, so good idea to get an ABG
A nurse if preparing to administer a morphine sulfate IV to a client for pain. The nurse should expect the onset of pain relief for the client to take place in?
10-15 minutes
A primary care provider has prescribed 250 mg PO Q6H of a medication for a client. The label reads 50 mg/ml. How many ml should the client receive in a 24 hour period?
20 ml
The client is to receive 1 L of Ringer's Lactate (LR) IV over 8 hr. The drip factor on the IV tubing is 10 gtt/ml. What rate should the nurse set the IV to deliver the fluid as prescribed?
21 gtt/min
The primary care provider has prescribed a continuous enteral feeding of half strength Ensure, which comes in 8 oz cans to begin infusing at 75 ml/hr. How much water should the nurse add to the can of Ensure to complete the health care provider's prescription?
240 ml
The health care provider prescribes IV therapy for a client with deep vein thrombosis (DVT). The prescription states: heparin sodium 20,000 units in 1,000 ml 0.9% sodium chloride IV to infuse at 1,000 units/hour via IV pump. How many ml per hour should be administered by the nurse to give the dose prescribed?
50 ml/hr
A nurse receives a prescription to increase a procainamide (Pronestyl) IV infusion to 4 mg/min. The IV bag is labeled Pronestyl 2 g in 500 ml D5W. The nurse will adjust the IV pump to what rate?
60 ml/hr
A nurse is caring for a client with peptic ulcer disease. Which of the following medications should the nurse expect to administer for a headache?
Acetaminophen (Tylenol)
expected outcomes of caring for a patient with PE
Adequate tissue perfusion & respiratory function Adequate cardiac output Increased level of comfort No recurrence of PE
A client who is taking chlorpromazine hydrochloride (Throazine) is experiencing extreme restlessness and involuntary movements. To treat these side effects, the nurse should anticipate administering which of the following medications?
Amantadine (Symetrel)
open pneumothorax
An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound; also referred to as a sucking chest wound.
A nurse is assessing a client in the clinic who is on tamoxifen (Nolvadex). The nurse should recognize that tamoxifen has which of the following actions?
Anti-estrogenic
A nurse is reviewing the admission prescriptions for a client who has just been admitted from the emergency room with a prescription for clopidogrel (Plavix). Which of the following precautions should the nurse plan to implement?
Bleeding
When administering the first dose of enalapril maleate (Vasotec) to a client, which of the following should the nurse recognize as the priority assessment?
Blood pressure
A nurse is caring for an older adult client who is prescribed zolpidem (Ambien) at bedtime to help promote sleep. The nurse should plan to monitor the client for which of the following?
Confusion
what happens if there is a break in the system of your chest tube or it is accidentally pulled out
DONT CLAMP—if break in system, place distal end in sterile water to maintain water-seal •If the chest tube is accidentally pulled out, cover the site with a 4X4, but do not tape occlusive because we want air to be able to escape from the pleural cavity during exhalation.
most common cause of PE
DVT
A primary care provider prescribes an infusion of a hypertonic solution. Which of the following intravenous solutions should the nurse anticipate administering?
Dextrose 5% in lactated ringer's (D5LR)
A nurse is caring for an older client who has been diagnosed with depression and is prescribed tricyclic antidepressant amitriptyline (Elavil). Which of the following diagnostic tests should the nurse anticipate will be ordered prior to starting the client on this medication?
ECG (electrocardiogram)
A nurse is providing teaching to a client who is to start taking allopurinol (Zyloprim). For which of the following side effects should the nurse instruct the client to discontinue taking the medication?
Fever
A nurse should be aware that metoclopramide (Reglan) is contraindicated for a client who?
Has an intestinal obstruction
A nurse is providing teaching to a client who is prescribed hydrochlorothiazide (Oretic) for hypertension. The nurse should instruct the client to taken the medication?
In the morning
what is pneumonia what is the morbidity of it
Inflammation of the lungs, caused by an acute infection (bacteria, viral or sometimes fungal) associated with significant morbidity and mortality rates, even though we knew about it for a long time
A nurse is providing teaching to a client receiving gemfibrozil (Lopid). The nurse evaluates effectiveness of the teaching when the client states he will have which of the following evaluated periodically?
Liver function
A nurse is caring for a client who is prescribed ergotamine tartrate (Ergomar). The nurse should recognize that ergotamine tartrate is indicated for which of the following?
Migraine headaches
The nurse is caring for a client who has had an acute myocardial infarction. The client is taking chlorothiazide (Diuril) 500 mg and digoxin (Lanoxin) 0.25 mg daily. The nurse should plan to monitor the client for which of the following?
Muscle weakness
A nurse is caring for a client taking filgrastim (Neupogen) and is reviewing the client's morning complete blood count (CBC) and differential. In evaluating the client's response to filgrastim, the nurse should review the?
Neutrophil count
A nurse is caring for a pregnant client who is schedules to have a contraction stress test (CST). The nurse should anticipate administering which of the following medications?
Oxytocin
A nurse is taking the medication history on a client who is to receive a first dose of ceftriaxone (Rocephin). Which of the following allergies should the nurse report to the primary care provider?
Piperacillin sodium
A nurse is providing teaching to the parents of a child who is prescribed valproic acid (Depakene) for seizures. The nurse instructs the parents that it will be necessary for the child to return to the clinic in 2 weeks to have which of the following diagnostic tests performed (SATA)?
Platelet function Aspartate aminotransferase (ASTL) Alanine aminotransferase (ALT)
A client is being treated with a 10-day course of gentamicin sulfate (Garamycin). Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of this medication?
Proteinuria
A nurse is caring for a client with pregnancy induced hypertension (PIH) who is started on a magnesium sulfate IV. Which of the following should the nurse recognize as the priority assessment finding?
Respiratory rate: 10 breaths/min
A nurse should recognize that aspirin therapy is contraindicated for children with viral illnesses due to the increased risk of which of the following?
Reye's syndrome
A nurse is caring for a client prescribed amphotericin B (Fungizone). Which of the following should the nurse recognize as the best indicator of renal function?
Serum creatinine levels
When preparing the discharge plan for a client who has been on long term prednisone (Deltasone) therapy, the nurse should be aware that such clients are at risk for which of the following?
Stress fractures
After taking erythromycin (Erythrocin) PO for 7 days, a client develops oral candidiasis. The nurse should recognize that this is most likely due to which of the following?
Superinfection
A nurse is caring for a pre-school age child in the emergency department who has dyspnea, wheezing, and a history of severe asthma. The health care provider prescribes epinephrine hydrochloride (Adrenalin) subcutaneously stat. After the drug is administered, the nurse should assess the client for?
Tachycardia
A client who is admitted with cirrhosis is prescribed lactulose (Cephulac) PO. For which of the following actions should the nurse administer lactulose?
To reduce serum ammonia levels
hemopneumothroax
The accumulation of blood and air in the pleural space of the chest
A nurse is caring for a client receiving heparin for deep vein thrombosis (DVT) prophylaxis. The nurse correctly delivers the heparin by?
Using the subcutaneous sites in the abdomen
When administering diphenoxylate and atropine (Lomotil) to a client with ulcerative colitis, the nurse should monitor the client for the development of?
Toxic megacolon
A nurse is caring for a client who is to start epoetin alfa (Epogen) for chronic renal failure. The nurse should recognize that the epoetin alfa is used to do which of the following?
Treat anemia
A nurse is caring for a client who is receiving heparin IV therapy. The morning aPTT is 90 seconds (control of 26). Which of the following actions should the nurse take first?
Turn off the infusion
clinical manifestations of PE
Variable-depends on the size and extent of clot. If small, pretty asymptomatic may have a little sob. If big, you see tachypnea, cough, all that one Dyspnea is most common Tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, tachycardia, syncope, change in LOC Dependent on size & extent of emboli May feel "sense of doom" HALLMARK WITH MASSIVE PE.
what is ventilator associated pneumonia (VAP)?
pneumonia that occurs at least 48 hours after endotracheal intubation patients suspected of having VAP should undergo lower respiratory tract sampling, followed by microscopic analysis and culture of the specimen
what is hospital acquired pneumonia (HAP)?
pneumonia that occurs more than 48 hours after admission to the hospital. You get admitted, 2-5 days later develop symptoms of pneumonia. If within 2 days it would be community because you wouldn't get the symptoms that quick
what is tension pneumothorax
arises with penetrating chest wall injury. trachea pushed to opposite side of injury & this is a medical emergency •Accumulation of air in pleural space that does not escape •Causes mediastinal shift and hemodynamic instability. •Can occur with open or closed pneumothorax.
hemothorax & how we treat
blood in the pleural space treat with a chest tube
what is clotting? the process
clotting is required for bleeding to stop vascular response to an opening/cut --> platelet plug --> fibrin clot on the platelet plug --> lysis of the clot
what is pneumothorax (ptx)
collapsed lung air enters the lung pleural cavity, positive pressure in the cavity causes the lung to collapse can be open (an open or penetrating chest wall wound) or closed (no associated external wound)
function of collection bottle of a chest tube
collects fluid and debris delivered by chest tube. Connected to water seal chamber
pleural effusion
fluid/exudate in the pleural space
how do you use an incentive spirometer
for patients with pneumonia •Assist client to sitting or upright position •Close lips tightly around mouth piece •Inhale slowly and then blow, maintain flow rate to get the little ball up •Repeat 10 times every hour!
risk factors of HCAP
health care associated pneumonia •: Receiving hemodialysis, receives IV antibiotics, chemo, or wound care within the last 30 days, Lives in a nursing home, hospitalized for 2 or more days in the last 90 days. All of these things increase risk of getting hospitalized. •Usually a bacterial organism that is more likely to be drug resistant and has the highest risk of death. MORE LIKELY TO BE RESISTANT IF HEALTH CARE ACQUIRED
What are the 3 main nursing diagnoses for pneumonia
impaired gas exchange, ineffective breathing pattern, acute pain fluid imbalance may be a factor, hyperthermia with a fever, then activity intolerance because really SOB and can't do a lot of physical activity
risk factors of PE
majority is DVT (usually 90%) •Immobility or reduced mobility •Surgery • History of DVT •Malignancy—cancer often causes •Obesity •Oral contraceptives/ hormones •Smoking •Heart failure-if heart isnt adequately pumping you get pooling for clots •Pregnancy/delivery •Clotting disorders •Atrial fibrillation-can cause pooling of blood in the right ventricle •Central venous catheters •Fractured long bones
function of water seal bottle of a chest tube
one way valve for air to escape from the pleural space when the patient exhales, but prevents atmospheric air from entering the pleural cavity during inhalation. It also measures negative pressure and determines if there's a leak.
what are the 2 types of pneumothorax
occurs when a weak area of the lungs rupture in the absence of majory. could be primary (when a small air blister (bleb) on the top of the lung ruptures, usually mild) or secondary
what is community acquired pneumonia (CAP)?
positive bacterial respiratory culture that is acquired from a community/nursing home. you don't get it while in the hospital so if you show up to the hospital and get symptoms less than 48 hours after then it's still community acquired. doesn't meet VAP, HAP, HCAP criteria meaning that the patient has not been in the hospital within 2 weeks of onset
empyema
pus between the lung and pleural space
what is curb-65
scale used to determine if the patient with pneumonia needs to be hospitalized (consider if 1-2 points, hospital 3) or go to the ICU (4-5 points) C: confusion (compared to baseline) U: urea- BUN > 20 mg/dL R: respiratory rate > or = to 30 breaths. B: BP- systolic <90 mm hg or diastolic < or = 60 mm hg 65: if patients age is greater than or equal to 65
what would you expect to find on a with a physical exam for pneumonia
tachypnea use of accessory muscles listen to the heart/lungs you hear coarse crackles with possibly rhonchi or wheezing
What is the lung pleura?
the parietal and visceral pleura - separated by a tiny amount of fluid that helps prevent friction during breathing
function of suction control bottle of chest tube
volume of water determines amount of negative pressure in the pleural space
what finbrinolytic agents do we put patients with PE on
we put them on this when we worry about potential death •Tissue plasminogen activator (tPA)-something we give stroke patients to prevent clots, we can also give for PE. •Alteplase (Activase)-busts in and busts clots.
how do we care (intraprofessional) for pneumothorax
•Dependent on severity •May resolve spontaneously •Treatment •Thoracentesis •Chest tubes •Pleurodesis •Urgent needle decompression for tension pneumothorax
what is a PE & in general what happens when you have a PE
•Blockage of pulmonary arteries by thrombus, fat or air embolus, or tumor tissue the PE obstructs alveolar perfusion-one or more arteries in the lungs become blocked
how do we evaluate for pneumonia so they can go home/are getting better
•Clear breath sounds •Normal breathing patterns •No signs of hypoxia: no SOB, no cyanosis, SPO2 high •Normal chest x-ray •No complications related to pneumonia •Effective respiratory rate, rhythm, and depth of respirations-good respiratory assessment •Lungs clear to auscultation •Reports pain control-figure out what works for their pain and continue it •SpO2 ≥ 95% •Free of adventitious breath sounds- don't want crackles, weezing, rhonchi •Clear sputum effectively from airway
how to treat a PE (intraprofessional care)
•Goals of treatment: prevention is key! we need to prevent DVT in order to prevent PE -sequential compression devices (SCDs) -early ambulation -prophylactic anticoagulation: typically a subq heparin injection to prevent DVT but this is strictly for prevention purposes, if it already formed we gotta do other things -prevent further growth or extension of thrombi -prevent further embolization to pulmonary system -provide cardiopulmonary support -supportive care: oxygen! turn cough deep breathe. pulmonary toilet/pulmonary hygiene, fluids help dissolve secretions, diuretics if a heart failure patient, analgesics
chylothorax and how to treat it
•Lymphatic fluid in pleural space •Treat conservatively, with meds, surgery, or pleurodesis.
indications that you need a chest tube and pleural drainage
•Pneumothorax •Hemothorax •Pleural Effusion •Empyema
what surgical therapy can we give to patients with PE
•Pulmonary embolectomy for massive PE that takes up most of the lung cavity •Inferior vena cava (IVC) filter-if patients have reoccurant PE or DVT or factor 5 disorder they may opt to get one of these put in place, or if they have contraindications to heparin (heparin induced thrombocytopenia), if they have kidney or liver disease/disorder. Complications can be misplacement, can migrate to different areas of the heart and cause problems. Prevents migration of clots in pulmonary system
what are complications of chest tubes
•Re-expansion pulmonary edema •Vasovagal response •Subcutaneous emphysema
what do we need to teach patients about PE
•Regarding long-term anticoagulant therapy- if going home on coumadin, talk to them about how they need to get labs & other measures •Measures to prevent DVT- ambulation and position changes, sequential stockings •Importance of follow-up exams and labs!
how do nurses manage PE (therapeutic care)
•Semi-Fowler's position •IV access •Oxygen therapy •Frequent assessments •Monitor laboratory results. •Emotional support and reassurance-not being able to breathe is very anxiety provoking, that's why you need to keep them supported and keep them updated with their care plan, provide emotional support
what type of dressing do we need for chest tubes
•Sterile occlusive dressing
how do we assess drainage of chest tubes? Sudden drainage increases could be indicative of Changes in drainage from serosanguinous to red could indicate Consistency changes from thin, clear fluid to milky could be evidence of Decreased drainage may be a sign of
•Sudden drainage increases could be indicative of hemorrhage •Changes in drainage from serosanguinous to red could indicate hemorrhage •Consistency changes from thin, clear fluid to milky could be evidence of evolving infection •Decreased drainage may be a sign of tube displacement, kinked tubing or a clot
what do we need to teach patients to prevent CAP
•Teach hygiene, nutrition, rest, regular exercise to maintain natural resistance (maintain cough reflex) •Cough or sneeze into elbow! not hands. •Avoid cigarette smoke. •Prompt treatment of URIs. As soon as they start feeling they have one going on, seek treatment because the earlier we start the lesser chance of hospitalization or mortality from that •Influenza and pneumococcal vaccination
what is the function of a chest tube & pleural drainage for pneumothorax
•To remove air or fluid from pleural and/or mediastinal space •Reestablishes negative pressure •Lung re-expands •Pleural and/or mediastinal
clinical manifestations of pneumothorax
•Variable •Mild tachycardia and dyspnea → severe respiratory distress •Sharp Chest pain •Cough •Absent breath sounds over affected area •Asymmetric chest expansion •Trachea deviation •A sucking sound with inspiration •Paradoxical movement of the chest with respirations
aspiration pneumonia risk factors
↓ LOC, difficulty swallowing, head injury, stroke, massive alcohol intake, seizures Dependent portion of the lung usually affected by aspiration pneumonia we need to take precautions to prevent these people with these factors from getting pneumonia
