Which action would the nurse take first for a patient with a tracheostomy who appears anxious and is having difficulty in coughing up thick respiratory secretion?

A. Have the client refrain from talking for 24 hr.: This is unnecessary; the client may talk once the effects of the local anesthetic wear off, typically within an hour or two after the procedure.
B. Withhold food and liquids until the client's gag reflex returns: This is the most important action to prevent aspiration. After a bronchoscopy, the throat is anesthetized, and eating or drinking before the gag reflex returns increases the risk of aspiration.
C. Irrigate the client's throat every 4 hr.: This is not a routine post-procedure intervention and could be uncomfortable for the client.
D. Suction the client's oropharynx frequently: Suctioning should only be performed if the client has difficulty clearing secretions. There is no routine need for frequent suctioning after a bronchoscopy unless clinically indicated.

A. Tachypnea, or rapid breathing, is a common finding in pneumonia due to hypoxia and the body's attempt to compensate for impaired gas exchange in the lungs. It is one of the hallmark signs of pneumonia.
B. Bradycardia is uncommon in pneumonia. Tachycardia (increased heart rate) is more frequently observed as the body compensates for the infection and reduced oxygenation.
C. Hypothermia is not typically associated with pneumonia; more commonly, fever (hyperthermia) is present as a sign of infection.
D. A pulse deficit is a sign of a heart condition, such as atrial fibrillation, not typically related to pneumonia.