CHAPTER 20

UNIT 3 NURSING CARE OF CLIENTS WHO HEALTH PROMOTION AND

HAVE RESPIRATORY DISORDERS
SECTION: RESPIRATORY SYSTEM DISORDERS
DISEASE PREVENTION
Perform hand hygiene to prevent the spread of infection

Acute Respiratory
●●

by bacteria and viruses.

CHAPTER 20

Disorders
The airway structures permit air to enter and
provide for adequate oxygenation and tissue
●● Encourage immunizations that prevent respiratory disorders,
especially immunizations for influenza and pneumonia to
younger children and older adults, and people who have
chronic illnesses or who are immunocompromised.
●● Limit exposure to airborne allergens, which trigger a
hypersensitivity reaction.
●● Promote smoking cessation.

perfusion. Common acute and chronic disorders

affect these airway structures. RISK FACTORS
●● Extremely young or advanced age
A nursing priority for clients who have acute ●● Recent exposure to viral, bacterial, or influenza infections
●● Lack of current immunization status (pneumonia, influenza)
respiratory disorders is to maintain a patent ●● Exposure to plant pollen, molds, animal dander, foods,
airway to promote oxygenation. medications, and environmental contaminants
●● Tobacco smoke
Acute respiratory disorders include rhinitis, ●● Substance use (alcohol, cocaine)
●● Chronic lung disease (asthma, emphysema)
sinusitis, influenza, and pneumonia. ●● Immunocompromised status
●● Presence of a foreign body
Pneumonia is an inflammatory process in the ●● Conditions that increase the risk of aspiration (dysphagia)
lungs that produces excess fluid. Pneumonia is ●● Impaired ability to mobilize secretions (decreased level
of consciousness, immobility, recent abdominal or
triggered by infectious organisms or by the thoracic surgery)
aspiration of an irritant, such as fluid or a foreign ●● Inactivity and immobility
●● Mechanical ventilation (ventilator‑acquired pneumonia)
object. The inflammatory process in the lung
parenchyma results in edema and exudate that
fills the alveoli. Pneumonia can be a primary Rhinitis
disease or a complication of another disease or Rhinitis is an inflammation of the nasal mucosa and often
the mucosa in the sinuses that can be caused by infection
condition. It affects people of all ages, but (viral or bacterial) or allergens.
young clients, older adult clients, and clients ●● The common cold (coryza) is caused by viruses spread

from person to person in droplets from sneezing and

who are immunocompromised are more coughing, or by direct contact.
susceptible. Immobility is a contributing factor in ●● This disorder often coexists with other disorders, such

as asthma and allergies, and can be acute or chronic,

the development of pneumonia. nonallergic or allergic (seasonal or perennial).
●● The presence of an allergen causes histamine release and

There are two types of pneumonia.
Community‑acquired pneumonia (CAP) is
the most common type and often occurs
as a complication of influenza. Health
care‑associated pneumonia (HAP) has a higher
mortality rate and is more likely to be resistant
EXPECTED FINDINGS
to antibiotics. It usually takes 24 to 48 hr from ●●
the time the client is exposed to acquire HAP.
●●
Older adult clients are more susceptible to ●●
●●
infections and have decreased pulmonary ●●
reserves due to normal lung changes, including ●●
●●
decreased lung elasticity and thickening alveoli. ●●
other mediators from WBCs in the nasal mucosa. The
mediators bind to blood vessel receptors causing capillary
leakage, which leads to local edema and swelling.
ASSESSMENT
Excessive nasal drainage, runny nose (rhinorrhea), and
nasal congestion
Purulent nasal discharge
Sneezing and pruritus of the nose, throat, and ears
Itchy, watery eyes
Sore, dry throat
Red, inflamed, swollen nasal mucosa
Low‑grade fever
Diagnostic testing can include allergy tests to identify
possible allergens.

RN ADULT MEDICAL SURGICAL NURSING CHAPTER 20  Acute Respiratory Disorders 117

 PATIENT‑CENTERED CARE Sinusitis
Sinusitis, often called rhinosinusitis, is an inflammation
NURSING CARE of the mucous membranes of one or more of the sinuses,
usually the maxillary or frontal sinus. Swelling of the
●● Encourage rest (8 to 10 hr/day) and increased fluid
mucosa can block the drainage of secretions, which can
intake (at least 2,000 mL/day).
cause a sinus infection.
●● Encourage the use of a home humidifier or breathing ●● Sinusitis often occurs after rhinitis and can be

steamy air after running hot shower water.

●● Promote proper disposal of tissues and use of cough
etiquette (sneeze or cough into tissue, elbow or shoulder
and not the hands).
associated with a deviated nasal septum, nasal polyps,
inhaled air pollutants or cocaine, facial trauma, dental
infections, or loss of immune function.
●● The infection is commonly caused by Streptococcus

pneumoniae, Haemophilus influenzae, diplococcus,

MEDICATIONS and bacteroides.

Antihistamines, such as brompheniramine/

pseudoephedrine; leukotriene inhibitors, such as
montelukast; and mast cell stabilizers, such as cromolyn,
ASSESSMENT
are used to block the release of chemicals from WBCs that
bind with receptors in nasal tissues, which prevent edema EXPECTED FINDINGS
and itching. ●● Nasal congestion
NURSING CONSIDERATIONS: Older adults should be aware ●● Headache
of adverse effects such as vertigo, hypertension, and ●● Facial pressure or pain (worse when head is
urinary retention. tilted forward)
●● Cough
Decongestants, such as phenylephrine, constrict blood ●● Bloody or purulent nasal drainage
vessels and decrease edema. ●● Tenderness to palpation of forehead, orbital, and
NURSING CONSIDERATIONS: Encourage clients to use as facial areas
prescribed for 3 to 4 days to avoid rebound nasal congestion. ●● Low‑grade fever

Intranasal glucocorticoid spraysare the most effective for

prevention and treatment of seasonal and perennial rhinitis. DIAGNOSTIC PROCEDURES
Antipyreticsare used if fever is present. ●● CT scan or sinus x‑rays confirm the diagnosis, which is
typically based upon findings and physical assessment.
Antibioticsare given if a bacterial infection can be identified. ●● Endoscopic sinus cavity lavage or surgery to relieve the
obstruction and promote drainage of secretions may
CLIENT EDUCATION be done.
●● Review hand hygiene as a measure to
prevent transmission.
●● Complementary therapies such as echinacea, large doses
of vitamin C, and zinc preparations (lozenges and nasal
sprays) can be useful in promoting improved immune
response.
●● Limiting exposure to others will prevent and reduce
transmission. This is especially important for
vulnerable populations such as the very young, older
adults, and people who are immunosuppressed.

118  CHAPTER 20  Acute Respiratory Disorders CONTENT MASTERY SERIES

 PATIENT‑CENTERED CARE Influenza
Seasonal influenza, or “flu,” occurs as an epidemic,
NURSING CARE usually in the fall and winter months.
●● It is a highly contagious acute viral infection that occurs
●● Encourage the use of steam humidification, sinus
in children and adults of all ages.
irrigation, saline nasal sprays, and hot and wet packs to ●● Influenza can be caused by one of several virus families,

relieve sinus congestion and pain.

●● Teach the client to increase fluid intake and rest.
●● Discourage air travel, swimming, and diving.
●● Encourage cessation of tobacco use in any form.
●● Instruct the client on correct technique for sinus
irrigation and self‑administration of nasal sprays.
MEDICATIONS
Nasal decongestants, such as phenylephrine, are used to
reduce swelling of the mucosa.
and this can vary yearly. Adults are contagious from
24 hr before manifestations develop and up to 5 days
after they begin.
Pandemic influenzarefers to a viral infection among
animals or birds that has mutated and is becoming highly
infectious to humans. The resulting viral infection has the
potential to spread globally, such as H1N1 (“swine flu”)
and H5N1 (“avian flu”).

NURSING CONSIDERATIONS
ASSESSMENT
●● Clients should be encouraged to begin over‑the‑counter
decongestant use at the first manifestation of sinusitis. EXPECTED FINDINGS
●● Signs of rebound nasal congestion may occur if ●● Severe headache and muscle aches
decongestants are used for more than 3 to 4 days. ●● Chills
Broad‑spectrum antibiotics, such as amoxicillin, are ●● Fatigue, weakness
used on a limited basis for a confirmed causative bacterial ●● Severe diarrhea and cough (avian flu)
pathogen. ●● Fever
●● Hypoxia (avian flu)
Pain relief medicationsinclude NSAIDs, acetaminophen,
and aspirin.
DIAGNOSTIC PROCEDURES
CLIENT EDUCATION AV Avantage A/H5N1 Flu Test
●● Sinus irrigation and saline nasal sprays are an effective
alternative to antibiotics for relieving nasal congestion.
●● Contact the provider for manifestations of a severe
PATIENT‑CENTERED CARE
headache, neck stiffness (nuchal rigidity), and high
fever, which can indicate possible complications. NURSING CARE
●● Maintain droplet and contact precautions for
hospitalized clients who have pandemic influenza.
COMPLICATIONS ●● Provide saline gargles.
Meningitis and encephalitis can occur if pathogens enter ●● Monitor hydration status, intake, and output.
the bloodstream from the sinus cavity. ●● Administer fluid therapy as prescribed.
●● Monitor respiratory status.

MEDICATIONS
Antivirals
●● Amantadine, rimantadine, and ribavirin may be
prescribed for treatment and prevention of influenza.
●● Duration of the influenza infection can be shortened by
antivirals such as the oral inhalant zanamivir and the
oral tablet oseltamivir. In cases of pandemic influenza,
these medications may be distributed widely among
the population.
●● CLIENT EDUCATION: Encourage clients to begin
antiviral medications within 24 to 48 hr after the onset
of manifestations.

RN ADULT MEDICAL SURGICAL NURSING CHAPTER 20  Acute Respiratory Disorders 119

 Influenza vaccines Pneumonia
●● Trivalent vaccines are prepared yearly depending upon
the suspected strain of influenza expected to appear.
They include an IM injection of Fluvirin or Fluzone and
ASSESSMENT
a live attenuated influenza vaccine by intranasal spray.
◯◯ Vaccination is encouraged for everyone older than EXPECTED FINDINGS
6 months of age. ●● Anxiety
◯◯ Clients who have a history of pneumonia, chronic
●● Fatigue
medical conditions, and those over age 65, pregnant ●● Weakness
women, and health care providers are at higher risk ●● Chest discomfort due to coughing
and require vaccination. ●● Confusion from hypoxia is the most common
●● H1N1 vaccine is available for the general population.
manifestation of pneumonia in older adult clients.
●● H5N1 vaccine is stockpiled for distribution if a
pandemic occurs. PHYSICAL ASSESSMENT FINDINGS
●● Fever
Chills
INTERPROFESSIONAL CARE
●●

●● Flushed face
●● Respiratory services should be consulted for ●● Diaphoresis
respiratory support. ●● Shortness of breath or difficulty breathing
●● Community health officials are notified of ●● Tachypnea
influenza outbreaks. ●● Pleuritic chest pain (sharp)
●● State and federal public health officials are consulted ●● Sputum production (yellow‑tinged)
for containment and prevention directives during ●● Crackles and wheezes
pandemic influenza. ●● Coughing
●● Dull chest percussion over areas of consolidation
Decreased oxygen saturation levels (expected reference
CLIENT EDUCATION
●●

range is 95% to 100%)

●● Encourage annual influenza vaccination when vaccines ●● Purulent, blood‑tinged or rust‑colored sputum, which
become available. may not always be present
●● Reduce the risk for spreading viruses by thoroughly
washing hands and following cough etiquette.
●● Avoid places where people gather. Avoid close personal
LABORATORY TESTS
contact (handshaking, kissing and hugging). Sputum culture and sensitivity
●● If flu manifestations develop, increase fluid intake, rest ●● Obtain specimen before starting antibiotic therapy.

and stay home from work or school. ●● Obtain specimen by suctioning if the client is unable

●● Avoid travel to areas where pandemic influenza to cough.

is identified. ●● Older adult clients have a weak cough reflex and

●● Be aware of public health announcements and activation decreased muscle strength. Therefore, older adult clients
of the early warning system by public health officials in have trouble expectorating, which can lead to difficulty in
case of pandemic influenza. breathing and make specimen retrieval more difficult.

CBC:Elevated WBC count (might not be present in older

adult clients)
COMPLICATIONS
ABGs:Hypoxemia (decreased PaO2 less than 80 mm Hg)
Pneumonia is a complication of influenza and affects older
adults and clients who are debilitated or Blood culture:To rule out organisms in the blood
immunocompromised.
Serum electrolytes:To identify causes of dehydration

DIAGNOSTIC PROCEDURES
Chest x‑ray
●● A chest x‑ray will show consolidation (solidification,
density) of lung tissue. (20.1)
●● Chest x‑ray might not indicate pneumonia for a few
days after manifestations.
●● A chest x‑ray is an important diagnostic tool because
the early manifestations of pneumonia are often vague
in older adult clients.

120  CHAPTER 20  Acute Respiratory Disorders CONTENT MASTERY SERIES

 Pulse oximetry CLIENT EDUCATION: Encourage clients to take penicillins
and cephalosporins with food. Some penicillins should be
Clients who have pneumonia usually have oximetry levels
taken 1 hr before meals or 2 hr after.
less than the expected reference range of 95% to 100%.

Bronchodilators
PATIENT‑CENTERED CARE ●● Bronchodilators are given to reduce bronchospasms and
reduce irritation.
Short‑acting beta2 agonists, such as albuterol, provide
NURSING CARE
●●

●● Position the client to maximize ventilation
(high‑Fowler’s = 90%) unless contraindicated.
●● Encourage coughing or suction to remove secretions.
●● Administer breathing treatments and medications.
●● Administer oxygen therapy.
●● Monitor for skin breakdown around the nose and mouth
from the oxygen device.
●● Encourage deep breathing with an incentive spirometer
to prevent alveolar collapse.
●● Determine the client’s physical limitations and
structure activity to include periods of rest.
●● Promote adequate nutrition and fluid intake.
◯◯ The increased work of breathing requires
rapid relief.
●● Cholinergic antagonists (anticholinergic medications),
such as ipratropium, block the parasympathetic nervous
system, allowing for increased bronchodilation and
decreased pulmonary secretions.
●● Methylxanthines, such as theophylline, require close
monitoring of serum medication levels due to the
narrow therapeutic range.
NURSING CONSIDERATIONS
●● Monitor serum medication levels for toxicity for clients
taking theophylline. Adverse effects will include
tachycardia, nausea, and diarrhea.
●● Watch for tremors and tachycardia for clients

taking albuterol.
additional calories. ●● Observe for dry mouth in clients taking ipratropium,
◯◯ Proper nutrition aids in the prevention of secondary

and monitor heart rate. Adverse effects can include

respiratory infections.
headache, blurred vision, and palpitations, which can
◯◯ Encourage fluid intake of 2 to 3 L/day to promote

indicate toxicity.
hydration and thinning of secretions, unless
contraindicated due to another condition. CLIENT EDUCATION
●● Provide rest periods for clients who have dyspnea. ●● Encourage clients to suck on hard candies to moisten
●● Reassure the client who is experiencing dry mouth while taking ipratropium.
respiratory distress. ●● Encourage increased fluid intake unless contraindicated.

MEDICATIONS
Antibiotics
20.1 Pneumonia
●● Antibiotics are given to destroy
infectious pathogens. Commonly
used antibiotics include
penicillins and cephalosporins.
●● Antibiotics are often initially
given via IV and then switched
to an oral form as the
condition improves.
●● It is important to obtain any
culture specimens prior to giving
the first dose of an antibiotic.
Once the specimen has been
obtained, the antibiotics can
be given while waiting for the
results of the prescribed culture.

NURSING CONSIDERATIONS
●● Observe clients taking
cephalosporins for
frequent stools.
●● Monitor kidney function,
especially older adults who are
taking penicillins and
cephalosporins.

RN ADULT MEDICAL SURGICAL NURSING CHAPTER 20  Acute Respiratory Disorders 121

 Anti‑inflammatories CLIENT EDUCATION
●● Anti‑inflammatories decrease airway inflammation. ●● Educate the client on the importance of continuing
●● Glucocorticosteroids, such as fluticasone and prednisone, medications for treatment of pneumonia.
are prescribed to reduce inflammation. Monitor for ●● Encourage rest periods as needed.
immunosuppression, fluid retention, hyperglycemia, ●● Encourage the client to maintain hand hygiene to
hypokalemia, and poor wound healing. prevent infection.
●● Encourage the client to avoid crowded areas to reduce
NURSING CONSIDERATIONS
the risk of infection.
●● Monitor for decreased immunity function. ●● Remind the client that treatment and recovery from
●● Monitor for hyperglycemia.
pneumonia can take time.
●● Advise the client to report black, tarry stools. ●● Encourage immunizations for influenza and pneumonia.
●● Observe for fluid retention and weight gain. This can ●● Promote smoking cessation if needed.
be common.
●● Monitor the throat and mouth for aphthous lesions
(canker sores).
COMPLICATIONS
CLIENT EDUCATION
Atelectasis
●● Encourage the client to drink plenty of fluids to ●● Airway inflammation and edema lead to alveolar

promote hydration.
collapse and increase the risk of hypoxemia.
●● Encourage the client to take glucocorticosteroids ●● The client reports shortness of breath and exhibits

with food.
findings of hypoxemia.
●● Encourage the client to avoid discontinuing ●● The client has diminished or absent breath sounds over

glucocorticosteroids without consulting the provider.

the affected area.
●● A chest x‑ray shows an area of density.

INTERPROFESSIONAL CARE Bacteremia (sepsis): This occurs if pathogens enter the

●● Respiratory services should be consulted for
inhalers, breathing treatments, and suctioning for
airway management.
●● Nutritional services can be contacted for weight loss or
bloodstream from the infection in the lungs.
Acute respiratory distress syndrome
●● Hypoxemia persists despite oxygen therapy.
●● Dyspnea worsens as bilateral pulmonary edema

gain related to medications or diagnosis.

develops that is noncardiac related.
●● Rehabilitation care can be consulted if the client ●● A chest x‑ray shows an area of density with a

has prolonged weakness and needs assistance with

ground‑glass appearance.
increasing level of activity. ●● Blood gas findings demonstrate high arterial blood

levels of carbon dioxide (hypercarbia) even though pulse

oximetry shows decreased saturation.

122  CHAPTER 20  Acute Respiratory Disorders CONTENT MASTERY SERIES


1. A nurse is monitoring a group
of clients for increased risk for
developing pneumonia. Which
of the following clients should
the nurse expect to be at
risk? (Select all that apply.)
A. Client who has dysphagia
B. Client who has AIDS
C. Client who was vaccinated
for pneumococcus and
influenza 6 months ago
Application Exercises
2. A nurse in a clinic is caring for a client
whose partner states the client woke
up this morning, did not recognize
him, and did not know where she
was. The client reports chills and
chest pain that is worse upon
inspiration. Which of the following
actions is the nursing priority?
A. Obtain baseline vital signs
and oxygen saturation.
B. Obtain a sputum culture.
4. A nurse in a clinic is assessing a
client who has sinusitis. Which
of the following techniques
should the nurse use to identify
manifestations of this disorder?
A. Percussion of posterior
lobes of lungs
B. Auscultation of the trachea
C. Inspection of the conjunctiva
D. Palpation of the orbital areas

D. Client who is postoperative C. Obtain a complete 5. A nurse is teaching a group of

and has received
local anesthesia
E. Client who has a closed
head injury and is
receiving ventilation
F. Client who has
myasthenia gravis
history from the client. clients about influenza. Which of the
D. Provide a pneumococcal following client statements indicates
vaccine. an understanding of the teaching?
A. “I should wash my hands
3. A nurse is caring for a client who has after blowing my nose to
pneumonia. Assessment findings prevent spreading the virus.”
include temperature 37.8° C (100° F),
B. “I need to avoid drinking fluids
respirations 30/min, blood pressure
if I develop symptoms.”
130/76, heart rate 100/min, and
SaO2 91% on room air. Prioritize C. “I need a flu shot every
the following nursing interventions. 2 years because of the
different flu strains.”
A. Administer antibiotics.
D. “I should cover my mouth with
B. Administer oxygen therapy.
my hand when I sneeze.”
C. Perform a sputum culture.
D. Administer an antipyretic
medication to promote
client comfort.

PRACTICE  Active Learning Scenario

A nurse in a clinic is discussing health promotion and disease management with
a client who has rhinitis. What should the nurse include in this discussion? Use
the ATI Active Learning Template: System Disorder to complete this item.
RISK FACTORS: Identify three risk factors for rhinitis.
EXPECTED FINDINGS: Describe at least four.
CLIENT EDUCATION: Describe two client self‑care activities.
MEDICATIONS: Identify two over‑the‑counter medications the client can use.

RN ADULT MEDICAL SURGICAL NURSING CHAPTER 20  Acute Respiratory Disorders 123

 Application Exercises Key
1. A. CORRECT: The client who has difficulty swallowing is
at increased risk for pneumonia due to aspiration.
B. CORRECT: The client who has AIDS is immunocompromised, which
increases the risk of opportunistic infections, such as pneumonia.
C. The client who has recently been vaccinated in the past
few months has a decreased risk to acquire pneumonia.
D. A client who is postoperative and has received local
anesthesia has a decreased risk to acquire pneumonia.
E. CORRECT: Mechanical ventilation is invasive
and increases the risk of pneumonia.
F. CORRECT: A client who has myasthenia gravis has
generalized weakness and can have difficulty clearing airway
secretions, which increases the risk of pneumonia.
NCLEX® Connection: Health Promotion and Maintenance,
Health Promotion/Disease Prevention
2. A. CORRECT: The first action the nurse should take
using the nursing process is to assess the client, which
is essential in planning client‑centered care.
B. The nurse should obtain a sputum culture to determine
sensitivity for antibiotic therapy. However, there is
another action the nurse should take first.
C. The nurse should obtain a complete history from the
client to determine the plan of care. However, there
is another action the nurse should take first.
D. The nurse should provide for a pneumococcal vaccination
to decrease the risk of pneumonia in the future. However,
there is another action the nurse should take first.
NCLEX® Connection: Physiological Adaptation,
Alterations in Body Systems
3. Correct order
B. The client’s respiratory and heart rates are elevated, and her
oxygen saturation is 91% on room air. Using the ABC priority
framework, providing oxygen is the first intervention.
C. Obtaining a sputum culture is the second nursing intervention.
It should be done prior to administering oral medications
to obtain an appropriate and adequate specimen.
A. Administration of antibiotics is the third action the nurse should take.
The sputum culture should be obtained prior to antibiotic administration.
D. Administering an antipyretic medication
is the fourth nursing intervention.
NCLEX® Connection: Physiological Adaptation,
Illness Management
4. A. Lung percussion is not an appropriate technique
to identify manifestations of sinusitis; it is appropriate
for a client who has pneumonia.
B. Auscultation of the trachea is not an appropriate technique to identify
manifestations of sinusitis; it is appropriate for a client who has bronchitis.
C. Inspection of the conjunctiva is not an appropriate
technique to identify manifestations of sinusitis; it
is appropriate for a client who has anemia.
D. CORRECT: Palpation of the orbital, frontal, and facial areas will elicit a
report of tenderness, which is a manifestation in a client who has sinusitis.
NCLEX® Connection: Reduction of Risk Potential,
Therapeutic Procedures
5. A. CORRECT: Hand hygiene decreases the risk of
the client spreading influenza viruses.
B. Fluid intake should be increased if findings develop to maintain
hydration and effectiveness of expectoration of mucous.
C. Influenza vaccines are administered yearly. The
client should receive a vaccination yearly.
D. Cough etiquette includes the client to sneeze into
the shoulder or elbow rather than the hands.

NCLEX® Connection: Physiological Adaptation,

Illness Management

PRACTICE Answer

Using the ATI Active Learning Template: System Disorder

RISK FACTORS EXPECTED FINDINGS CLIENT EDUCATION

●●
Recent exposure to viral, bacterial Excessive nasal drainage, runny nose
●●
Rest (8 to 10 hr/day), increased fluid
●●

or influenza infections (rhinorrhea), nasal congestion intake (at least 2,000 mL/day)
●●
Lack of current immunization Purulent nasal drainage
●●
Use of a home humidifier or breathing
●●

status (pneumonia, influenza) Sneezing and pruritus of the

●● steamy air after running hot shower water
●●
Exposure to plant pollen, molds, nose, throat, and ears Proper disposal of tissues and
●●

animal dander, foods, medications, Itchy, watery eyes

●● use of cough etiquette
and environmental contaminants Sore, dry throat
●●
MEDICATIONS: Brompheniramine/
●●
Tobacco smoke Red, inflamed, swollen nasal mucosa
●●
pseudoephedrine, cromolyn sodium,
●●
Substance use (alcohol, cocaine) Low‑grade fever
●●
phenylephrine, antipyretics
●●
Presence of a foreign body
●●
Inactivity and immobility
NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention

124  CHAPTER 20  Acute Respiratory Disorders CONTENT MASTERY SERIES