ARDS / Mechanical Ventilation

You are an RN in the ICU and hear a high pressure alarm coming from an intubated patient. The monitor shows increased PIP, PaO2 75, & PaCO2 49. Upon assessment, the patient is displaying decreased breath sounds & unequal chest excursion. What priority intervention should occur next?

• Call a code & stay with the patient

• Call the physician & prepare for chest tube insertion

• Perform manual ventilation with an ambu bag

• Turn down vent settings & call the physician

• Disconnect the patient from the vent

What equipment is needed for intubation? (9)

A patient that was previously on an assist/control (A/C) vent mode has now been switched to SIMV. The patient is alert, has an O2 sat that has risen to 70%, a RR of 31 with normal breath sounds, & has a normal sinus rhythm. What order does the nurse anticipate the MD will make next?

• Switch the patient to A/C mode

• Decrease the ventilation rate for more spontaneous breaths

• Order a new set of ABGs

• Have the RT attach the patient to a CPAP adjunct to the vent

Which of the following patients would be the best candidate for PEEP?

• Heart failure patient with decreased lung compliance

• An ARDS patient at 70% FiO2

• A covid patient with an EF of 24%

• An ARF patient that needs more hemodynamic stability

List the 5 components of the VAP bundle.

A patient with a history of COPD is receiving oxygen via nasal cannula at 6 L/min. ABG results are as follows: pH 7.28, PaCO2 60 mm Hg, PaO2 51 mm Hg, HCO3 18 mEq/L. Which priority intervention is indicated?

• Place the patient on a simple mask at 40% FiO2

• Intubate & place on mechanical ventilation

• Place the patient on BiPAP

• Place the patient on a non-rebreather mask

A client with acute respiratory distress syndrome (ARDS) is on a ventilator. The client’s peak inspiratory pressures and spontaneous respiratory rate are increasing, and the PO2 is not improving. Using SBAR, the nurse calls the physician with the recommendation for:

• Initiation IV sedation

• Starting a high-protein diet

• Providing pain medication

• Increasing the ventilator rate

List 5 parameters that would indicate the patient may be ready for weaning.

Which of the following modes of ventilation may be used to help strengthen the client's respiratory muscles?

• Synchronized intermittent mechanical ventilation (SIMV)

• Pressure support ventilation (PSV)

• High frequency oscillation ventilation (HFOV)

• Assist / Control ventilation (A/C)

Name 4 risk factors that put the patient at risk for ventilator-associated pneumonia.