Assist the patient with position changes every 2 hours. c. Place the thumbs at the midline of the lower chest. Also, they will effectively help spread the disease process since they know the mode of transmission and how to break the cycle of transmitting it to other family members. Nursing care plans: Diagnoses, interventions, & outcomes. e. Airway obstruction is likely if the exact steps are not followed to produce speech. A) Purulent sputum that has a foul odor Impaired cardiac output b. The most common causes of community-acquired pneumonia (CAP) is S. pneumoniae followed by Klebsiella pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa. The nurse should instruct on how to properly use these devices and encourage their use hourly. Skin breakdown allows pathogens to enter the body. Oximetry: May reveal decreased O2 saturation (92% or less). Impaired Gas Exchange Nursing Diagnosis & Care Plan Related Factors Physiological damage to the alveoli Circulatory compromise Lack of oxygen supply Insufficient availability of blood (carrier of oxygen) Subjective Data: patient's feelings, perceptions, and concerns. Pneumonia Nursing Diagnosis & Care Plan - NurseStudy.Net Consider imperceptible losses if the patient is diaphoretic and tachypneic. Atrial Fibrillation Nursing Diagnosis and Nursing Care Plan, Readiness for Enhanced Coping Nursing Diagnosis and Nursing Care Plans, Cystic Fibrosis Nursing Diagnosis Care Plan - NurseStudy.Net. Nuclear scans use radioactive materials for diagnosis, but the amounts are very small and no radiation precautions are indicated for the patient. Identify up to what extent does the patient knows about pneumonia. c. Elimination d. An electrolarynx placed in the mouth. a. SpO2 of 92%; PaO2 of 65 mm Hg The nitroglycerin tablet would not be helpful, and the oxygenation status is a bigger problem than the slight chest pain at this time. d. The patient cannot fully expand the lungs because of kyphosis of the spine. Pleural friction rub occurs with pneumonia and is a grating or creaking sound. The following diagnoses are usually made when caring for patients with pneumonia: Impaired gas exchange Ineffective airway clearance Ineffective breathing pattern Knowledge deficit/Deficient knowledge Activity intolerance Risk for infection Risk for nutritional imbalance: less than body requirements d. Assess the patient's swallowing ability. d. Pulmonary embolism Impaired Gas Exchange; May be related to. An initial negative skin test should be repeated in 1 to 3 weeks and if the second test is negative, the individual can be considered uninfected. The immunity will not protect for several years, as new strains of influenza may develop each year. What are possible explanations for this behavior? c. Terminal structures of the respiratory tract d. Avoid any changes in oxygen intervention for 15 minutes following the procedure. Put the palms of the hands against the chest wall. 4) Spend as much time as possible outdoors. Cough, sore throat, low-grade elevated temperature, myalgia, and purulent nasal drainage at the end of a cold are common symptoms of viral rhinitis and influenza. Amount of air that can be quickly and forcefully exhaled after maximum inspiration Week 1 - Respiratory.docx - Week 1 - Nursing Care of f. Use of accessory muscles. a. Viruses such as RSV (common cause in infants age 1 and below), flu and cold viruses can cause viral pneumonia, which is the second most common type of pneumonia. St. Louis, MO: Elsevier. d. Dyspnea and severe sinus pain a. Impaired Gas Exchange is a NANDA nursing diagnosis that is used for conditions where there is an alteration in the balance between the exchange of gases in the lungs. One way to have a good prognosis and help fasten recovery is to comply with the prescribed treatment. a. Vt c. SpO2 of 90%; PaO2 of 60 mm Hg Identify and avoid triggers of the allergic reaction. - The patient's clinical picture is most likely pulmonary embolism (PE), and the first action the nurse should take is to assist with the patient's respirations. Order stat ABGs to confirm the SpO2 with a SaO2. Building up secretions in the airway will only cause a problem since it will obstruct the airflow from going in and out of the body. It is important to acknowledge their limited information about the disease process and start educating him/her from there. What should be the nurse's first action? The following signs and symptoms show the presence of impaired gas exchange: Abnormal breathing rate, rhythm, and depth Nasal flaring Hypoxemia Cyanosis in neonates decreases carbon dioxide Confusion Elevated blood pressure and heart rate A headache after waking up Restlessness Somnolence and visual disturbances Looking For Custom Nursing Paper? If abnormal, the lungs are not oxygenating adequately causing poor perfusion of the tissues. A) 1, 2, 3, 4 Which instructions does the nurse provide to the patient to minimize exposure to close contacts and household members? Pulmonary function tests are noninvasive. These interventions help facilitate optimum lung expansion and improve lungs ventilation. Assess intake and output (I&O). a. Verify breath sounds in all fields. Retrieved February 9, 2022, from https://www.sepsis.org/sepsis-basics/testing-for-sepsis/, Yang, Fang1#; Yang, Yi1#; Zeng, Lingchan2; Chen, Yiwei1; Zeng, Gucheng1 Nutrition Metabolism and Infections, Infectious Microbes & Diseases: September 2021 Volume 3 Issue 3 p 134-141 doi: 10.1097/IM9.0000000000000061 (Pneumonia: Symptoms, Treatment, Causes & Prevention, 2020). b. A patient started treatment for sputum smear-positive tuberculosis (TB) 1 week prior to the home health nurse's visit. Pneumonia Concept_Map RUA226.pptx - Pneumonia Concept Map Popkin, B. M., DAnci, K. E., & Rosenberg, I. H. (2010). 8. The nurse expects which treatment plan? Nursing Diagnosis: Ineffective Breathing Pattern related to decreased lung expansion secondary to pneumonia as evidenced by a respiratory rate of 22, usage of accessory muscles, and labored breathing. a. treatment with antibiotics. b. Stridor Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? As such, here are the signs and symptoms that demonstrate the presence of impaired gas exchange. Assess breath sounds, respiratory rate and depth, sp02, blood pressure and heart rate, and capillary refill to monitor for signs of hypoxia and changes in perfusion. Impaired Gas Exchange Nursing Diagnosis, Care Plan, Interventions To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. A less severe form of bacterial pneumonia is called walking or atypical pneumonia, in which the symptoms are very mild and the infected person can do his/her activities of daily living as normal. Being aware of the patient's condition, what approach should the nurse use to assess the patient's lungs (select all that apply)? With acute bronchitis, clear sputum is often present, although some patients have purulent sputum. What is the reason for delaying repair of F.N. Drug therapy is an alternative to avoidance of the allergens, but long-term use of decongestants can cause rebound nasal congestion. The patient has been diagnosed with an early vocal cord cancer. presence of nasal bleeding and exhalation grunting. The patient must have enough rest so that the body will not be exhausted and avoid an increase in the oxygen demand. Assist with respiratory devices and techniques.Flutter valves mobilize secretions facilitating airway clearance while incentive spirometers expand the lungs. a. Suction the tracheostomy. Avoid instillation of saline during suctioning. 3 Pneumonia in the immunocompromised individual 4 Assessment of pneumonia 5 Diagnostic test for pneumonia 6 Nursing Diagnosis of pneumonia 6.1 Risk for Infection (nosocomial pneumonia) 6.2 Impaired Gas Exchange due to pneumonic condition 6.3 Ineffective clearance of the airway 6.4 Deficient fluid volume Community acquired pneumonias It is very important to take and record the patients respiratory assessment to make it a basis if there are any abnormal findings in the future. Which nursing intervention assists a patient with pneumonia in managing thick secretions and fatigue? Impaired gas exchange diagnosis was present in 42.6% of the children in the first assessment. Medical-surgical nursing: Concepts for interprofessional collaborative care. If there is no improvement with the symptoms, the doctor may prescribe a different type of antibiotic. e. Increased tactile fremitus Nursing Diagnosis: Hyperthermia related to the disease process of bacterial pneumonia as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, and profuse sweating. Assess the patients vital signs and characteristics of respirations at least every 4 hours. Desired Outcome: Within 1 hour of nursing interventions, the patient will have oxygen saturation of greater than 90%. Assist the patient when they are doing their activities of daily living. Nurses Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). Identify candidates for surgical intervention who are at increased risk for nosocomial pneumonia. Immobile patients or those who need assistance should be turned every 2 hours, assisted into an upright position, or transferred into a chair to promote lung expansion. Wear gloves on both hands when handling the cannula or when handling ventilation tubing. Use 1 for the first action and 7 for the last action. Deficient knowledge (patient, family) regarding condition, treatment, and self-care strategies (Including information about home management of COPD) 7. 4. Mixed venous blood gases are used when patients are hemodynamically unstable to evaluate the amount of oxygen delivered to the tissue and the amount of oxygen consumed by the tissues. Implement precautions to prevent infection.Proper handwashing is the best way to prevent and control the spread of infection. (PDF) Impaired gas exchange: Accuracy of defining - ResearchGate They will further understand the topic since they already have an idea of what is it about. Observing for hypoxia is done to keep the HCP informed. Patients with compromised immune systems such as those with COPD, HIV, or autoimmune diseases should be educated on the risk and how to protect themselves. Problems of Oxygenation: Ventilation (Lewis Med-Surg Section 6) - Quizlet The nurse must understand how to monitor for worsening infection, complications, and the rationales for treatment. d. Testing causes a 10-mm red, indurated area at the injection site. However, with increasing respiratory distress, respiratory acidosis may occur. Decreased force of cough 1) Seizures Smoking further increases the risk of developing pneumonia and should be avoided. Nursing Diagnosis: Ineffective Airway Clearance. PDF NMNEC Concept: Gas Exchange Maintain intravenous (IV) fluid therapy as prescribed. e. Increased tactile fremitus Watch for signs and symptoms of respiratory distress and report them promptly. Remove the inner cannula and replace it per institutional guidelines. 5) e. Observe for signs of hypoxia during the procedure. Samples for ABGs must be iced to keep the gases dissolved in the blood (unless the specimen is to be analyzed in <1 minute) and taken directly to the laboratory. The patient is admitted with pneumonia, and the nurse hears a grating sound when she assesses the patient. Bacterial pneumonias affect all or part of one lobe of the lung, whereas viral pneumonias occur diffusely throughout the lung. This can lead to hypoxia (lack of oxygen), and possibly tissue damage. A patient with pneumonia shows inflammation in their lung parenchyma causing it to have. Assess the patients knowledge about Pneumonia. f. Cognitive-perceptual Putting diagnoses in priority order? Help! - Nursing - allnurses These techniques mentioned will greatly help the patient to avoid respiratory distress and assist the body to take in oxygen and avoid hypoxia. Organizing the tasks will provide a sufficient rest period for the patient. Doing activities at the same time will only increase the demands of oxygen in the body, and patients with pneumonia cannot tolerate it. During assessment of the patient with a viral upper respiratory infection, the nurse recognizes that antibiotics may be indicated based on what finding? A 10-mm red indurated injection site could be a positive result for a nurse as an employee in a high-risk setting. The patient is infectious from the beginning of the first stage through the third week after onset of symptoms or until five days after antibiotic therapy has been started. d. VC They are as follows: Ineffective Airway Clearance Impaired Gas Exchange Ineffective Breathing Pattern Risk for Infection Acute Pain Decreased Activity Tolerance Hyperthermia Risk for Deficient Fluid Volume Risk for Imbalanced Nutrition: Less Than Body Requirements All other answers indicate a negative response to skin testing. d. A tracheostomy tube and mechanical ventilation, What should the nurse include in discharge teaching for the patient with a total laryngectomy? What accurately describes the alveolar sacs? Identify 1 specific finding identified by the nurse during assessment of each of the patient's functional health patterns that indicates a risk factor for respiratory problems or a patient response to an actual respiratory problem. Arterial blood gases measure the levels of oxygen and carbon dioxide in the blood. The nurse is providing postoperative care for a patient three days after a total knee arthroplasty. c. Lateral sequence Nursing Diagnosis and Care Plans for COPD | Med-Health.net a. Viral pneumonia. If the patient is having increased mucous production, encourage him or her to clear the airway. Teach the patient some useful relaxation techniques and diversional activities such as proper deep breathing exercises. a. d. The need to use baths instead of showers for personal hygiene, What is the most normal functioning method of speech restoration for the patient with a total laryngectomy? Pneumonia may increase sputum production causing difficulty in clearing the airways. Moisture helps minimize convective moisture loss during oxygen therapy. Air trapping nursing care plan for pneumonia nursing care plan for stroke nursing care . 6. The nurse selects Ineffective Breathing Pattern after validating this patient is demonstrating the associated signs and symptoms related to this nursing diagnosis: Dyspnea Increase in anterior-posterior chest diameter (e.g., barrel chest) Nasal flaring Orthopnea Prolonged expiration phase Pursed-lip breathing Tachypnea If the patient is ambulatory, walking should be encouraged within the patients tolerance. What should the nurse do when preparing a patient for a pulmonary angiogram? 3. A specimen of the sputum, which is yellow, has been obtained, but the laboratory results are pending. Impaired gas improved or presence of retained secretions client: exchange ventilation and adventitious sound -Demonstrated adequate improved wheezes oxygenation of -Decrease of ventilation and tissues by ABG of: -Palpate for fremitus vibratory tremors adequate pH:7.35-7.45 suggest fluid oxygenation of Long-term denture use Goal/Desired Outcome Short-term goal: The patient will remain free from signs of respiratory distress and her oxygen saturation will remain higher than 96% for the duration of the shift. k. Value-belief: Noncompliance with treatment plan, conflict with values, The abnormal assessment findings of dullness and hyperresonance are found with which assessment technique? a. Thoracentesis If O2 saturation does not increase to an acceptable level (greater than 92%), FiO2 is increased in small increments while simultaneously checking O2 saturation or obtaining ABG values. What Are Some Nursing Diagnosis for COPD? If there is airway obstruction this will only block and cause problems in gas exchange. a. Nursing Diagnosis: Impaired Gas Exchange related to alveolar edema due to elevated ventricular pressures secondary to CHF as evidenced by shortness of breath, Desired Outcome: At the end of the span of care, the patient will manifest better lung ventilation and improve tissue perfusion, and maximum optimal gas exchange by having normal arterial blood gas results, minimum to no symptoms of respiratory distress, and normal production of mucus in the airway. 2. Bilateral ecchymosis of eyes (raccoon eyes) In addition, have the patient upright and leaning forward to prevent swallowing blood. Assessment findings include a new onset of confusion, a respiratory rate of 42 breaths/minute, a blood urea nitrogen (BUN) of 24 mg/dL, and a BP of 80/50 mm Hg. Remove unnecessary lines as soon as possible. Impaired gas exchange is caused by conditions such as pneumonia, chronic obstructive pulmonary disease (COPD), or asthma. The width of the chest is equal to the depth of the chest. Identify and avoid triggers of the allergic reaction. Related to: As evidenced by: obstruction of airways, bronchospasm, air trapping, right-to-left shunting, ventilation/perfusion mismatching, inability to move secretions, hypoventilation . b. There is no redness or induration at the injection site. c. Elimination: Constipation, incontinence e. Observe for signs of hypoxia during the procedure. 3. d. "Antiviral drugs, such as zanamivir (Relenza), eliminate the need for vaccine except in the older adult.". Dullness and hyperresonance are found in the lungs using percussion, not the other assessment techniques. Types of Nursing Diagnoses There are 4 types of nursing diagnoses. Nursing diagnosis for pleural effusion may vary depending on the patient's individual symptoms and condition. The nurse determines effective discharge teaching for a patient with pneumonia when the patient makes which statement? Learning to apply information through a return demonstration is more helpful than verbal instruction alone. Warm and moisturize inhaled air d. SpO2 of 88%; PaO2 of 55 mm Hg b. Epiglottis 's nasal packing is removed in 24 hours, and he is to be discharged. Oral hygiene moisturizes dehydrated tissues and mucous membranes in patients with fluid deficit. She has worked in Medical-Surgical, Telemetry, ICU and the ER. b. Monitor oximetry values; report O2 saturation of 92% or less. The nurse anticipates that interprofessional management will include 2) Guillain-Barr syndrome 6. e. Sleep-rest: Sleep apnea. a. Carina 3. d. Testing causes a 10-mm red, indurated area at the injection site. Adjust the room temperature. Fungal pneumonia is caused by inhaling fungal spores that can come from dust, soil, and droppings of rodents, bats, birds or other animals. Instruct patients who are unable to cough effectively in a cascade cough. Chronic hypoxemia Normally the AP diameter should be 13 to 12 the side-to-side diameter. b. Finger clubbing What is an advantage of a tracheostomy over an endotracheal (ET) tube for long-term management of an upper airway obstruction? Acid-fast stains and cultures: To rule out tuberculosis. The nurse should assess the patient's cardiopulmonary status with careful monitoring of vital signs, cardiac rhythm, pulse oximetry, arterial blood gases (ABGs), and lung sounds. c. Take the specimen immediately to the laboratory in an iced container. 2. A tracheostomy is safer to perform in an emergency. j. Coping-stress tolerance: Dyspnea-anxiety-dyspnea cycle, poor coping with stress of chronic respiratory problems The tissue changes of TB and cancer of the lung may be diagnosed by chest x-ray or CT scan, MRI, or positron emission tomography (PET) scans. impaired gas exchange nursing care plan scribd Nursing diagnosis Related factors Defining characteristics Examples of this type of nursing diagnosis include: Decreased cardiac output Chronic functional constipation Impaired gas exchange Problem-focused nursing diagnoses are typically based on signs and symptoms present in the patient. What do these findings indicate? Sputum samples can be cultured to appropriately treat the type of bacteria causing infection. Weigh patient daily at same time of day and on same scale; record weight. Impaired gas exchange is a risk nursing diagnosis for pneumonia. Place or install an air filter in the room to prevent the accumulation of dust inside. b. a. Stridor is a continuous musical or crowing sound and unrelated to pneumonia. Asthma: 7 Nursing Diagnosis About It | New Health Advisor b) 6. a. Thoracentesis The patient receives 1 point for each criterion: confusion (compared to baseline); BUN greater than 20 mg/dL; respiratory rate greater than or equal to 30 breaths/min; systolic BP of less than 90 mm Hg; and age greater than or equal to 65 yrs. Productive cough (viral pneumonia may present as dry cough at first). This intervention provides oxygenation while reducing convective moisture loss and helping to mobilize secretions. Poor peripheral perfusion that occurs with hypovolemia or other conditions that cause peripheral vasoconstriction will cause inaccurate pulse oximetry, and ABGs may have to be used to monitor oxygenation status and ventilation status in these patients. Amount of air exhaled in first second of forced vital capacity c. Perform mouth care every 12 hours. Mastering Pleural Effusion Nursing Management: Best Practices and Protocols Decreased compliance contributes to barrel chest appearance. nursing diagnosis based on the assessment data the major nursing diagnoses for meconium aspiration syndrome are hyperthermia related to inflammatory process hypermetabolic state as evidenced by an increase in body temperature warm skin and tachycardia fluid volume . Use only sterile fluids and dispense with sterile technique. b. CO2 causes an increase in the amount of hydrogen ions available in the body. Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, have respiratory rates between 12 to 20 breaths per minutes, oxygen saturation above 96%, and verbalize ease of breathing. A combination of excess CO2 and H2O results in carbonic acid, which lowers the pH of cerebrospinal fluid and stimulates an increase in the respiratory rate. . Functional Health Pattern Start asking what they know about the disease and further discuss it with the patient. Impaired Gas Exchange Symptoms Care Plan | Nursing Diagnosis Writing Water, hydration, and health. Hospital acquired pneumonia may be due to an infected. d. Positron emission tomography (PET) scan. The treatment is macrolide (erythromycin, azithromycin [Zithromax]) antibiotics to minimize symptoms and prevent the spread of the disease. f. Cognitive-perceptual: Decreased cognitive function with restlessness, irritability. This type of pneumonia refers to getting the infection at home, in the workplace, in school, or other places in the community outside a hospital or care facility. Touching an infected object and then touching your nose or mouth can also transfer the germs. a. Suction secretions as needed. The other options do not maintain inflation of the alveoli. a. The most common causes of HCAP and HAP are MRSA (methicillin-resistant Staphylococcus aureus) and Pseudomonas aeruginosa respectively. c. Turbinates No signs or symptoms of tuberculosis or allergies are evident. c. Patient in hypovolemic shock Treatment for pneumonia needs to be complied with completely to ensure a good prognosis and improve health. Report significant findings. What is the most appropriate action by the nurse? c. Send labeled specimen containers to the laboratory. Decreased functional cilia and decreased force of cough from declining muscle strength cause decreased secretion clearance. What is the first action the nurse should take? This assessment helps ensure that surgical patients remain infection-free, as nosocomial pneumonia has a high morbidity and mortality rate. Expected outcomes a. The nurse suspects which diagnosis? Sputum for Gram stain and culture and sensitivity tests: Sputum is obtained from the lower respiratory tract before starting antibiotic therapy to identify the causative organisms. 's nose for several days after the trauma? 2. Suction the mouth or the oral airway as needed. Expresses concern about his facial appearance d. Dyspnea and severe sinus pain. This produces an area of low ventilation with normal perfusion. Important sounds may be missed if the other strategies are used first. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. g) 4. Other antibiotics that may be used for pneumonia include doxycycline, levofloxacin, and combination of macrolide and beta-lactam (amoxicillin or amoxicillin/clavulanate known as Augmentin). cancer patients or COPD patients). f. Airflow around the tube and through the window allows speech when the cuff is deflated and the plug is inserted. Older adults may be confused or disoriented and have a low-grade fever but few other signs and symptoms. Impaired gas exchange is a condition that occurs when there is an insufficient amount of oxygen in the blood. 3.3 Risk for Infection. - Conditions that increase the risk for aspiration include a decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and insertion of nasogastric (NG) tubes with or without enteral feeding. Promote oral hygiene, including lip and tongue care. c. Persistent swelling of the neck and face This examination detects the presence of random breath sounds (e.g., crackles, wheezes). Administer supplemental oxygen, as prescribed. b. Repeat the ABGs within an hour to validate the findings. The patient will have improved gas exchange. What action should the nurse take? d. Initiate pulse oximetry for continuous monitoring of the patient's oxygen status. 26: Upper Respiratory Problems / CH. To assess the extent and symmetry of chest movement, the nurse places the hands over the lower anterior chest wall along the costal margin and moves them inward until the thumbs meet at the midline and then asks the patient to breathe deeply and observes the movement of the thumbs away from each other. a. I do not know if it's just overthinking it or what but all the care plans i have read . b. Cyanosis c) 5. A relative increase in antibody titers indicates viral infection. 6) Minimize time on public transportation. Encourage movement and positioning.Mobile patients should be encouraged to ambulate several times a day to mobilize secretions. Pneumonia Nursing Diagnosis & Care Plan | NurseTogether This position provides comfort and facilitates the ease and effectiveness of these exercises by promoting better lung expansion (less compression of the lungs by the abdominal organs) and better gas exchange. 2. f. PEFR: (6) Maximum rate of airflow during forced expiration A) Use a cool mist humidifier to help with breathing. Night sweats For which problem is this test most commonly used as a diagnostic measure? Partial obstruction of trachea or larynx Complains of dry mouth 1# Priority Nursing Diagnosis. Nursing Care Plan for: Ineffective Gas Exchange, Ineffective Airway Clearance, Pneumonia, COPD, Emphysema, & Common Cold If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. c. Tracheal deviation g. Position the patient sitting upright with the elbows on an over-the-bed table. c. Wheezing Identify the ability of the patient to perform self-care and do activities of daily living. Impaired gas exchange is the state in which there is an excess or deficit in oxygenation or in the elimination of carbon dioxide at the level of the alveolocapillary membrane. Associated with altered oxygenation and alveolar-capillary membrane changes resulting from the inflammatory process and exudate in the lungs. Normal mixed venous blood gases also have much lower partial pressure of oxygen in venous blood (PvO2) and venous oxygen saturation (SvO2) than ABGs. b. Put the index fingers on either side of the trachea. F.N. d. VC: (4) Maximum amount of air that can be exhaled after maximum inspiration Pneumonia Nursing Care Plans - 11 Nursing Diagnosis - Nurseslabs PDF Nursing Care Plan For Meconium Aspiration Syndrome Community-Acquired Pneumonia. The bacteria may enter the blood stream and cause, Trouble sleeping.
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