Four hours after mechanical ventilation is initiated for a ...

[Kikoku]

Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD),
 
  the patient's arterial blood gas (ABG) results include a pH of 7.51, PaO2 of 82 mm Hg, PaCO2 of 26 mm Hg, and HCO3 of 23 mEq/L (23 mmol/L). The nurse will anticipate the need to
  a. increase the FIO2.
  b. increase the tidal volume.
  c. increase the respiratory rate.
  d. decrease the respiratory rate.

Question 2

The nurse notes thick, white secretions in the endotracheal tube (ET) of a patient who is receiving mechanical ventilation. Which intervention will be most effective in addressing this problem?
 
  a. Increase suctioning to every hour.
  b. Reposition the patient every 1 to 2 hours.
  c. Add additional water to the patient's enteral feedings.
  d. Instill 5 mL of sterile saline into the ET before suctioning.

[ebe]

Answer to Question 1

ANS: D
The patient's PaCO2 and pH indicate respiratory alkalosis caused by too high a respiratory rate. The PaO2 is appropriate for a patient with COPD and increasing the respiratory rate and tidal volume would further lower the PaCO2.

Answer to Question 2

ANS: C
Because the patient's secretions are thick, better hydration is indicated. Suctioning every hour without any specific evidence for the need will increase the incidence of mucosal trauma and would not address the etiology of the ineffective airway clearance. Instillation of saline does not liquefy secretions and may decrease the SpO2. Repositioning the patient is appropriate but will not decrease the thickness of secretions.

[Kikoku]

Thank you

[ebe]

Happy to help you