A patient who is intubated is having difficulty being weaned from ...

[kshipps]

A patient who is intubated is having difficulty being weaned from the ventilator. What actions should the nurse take to successfully wean this patient?
 
  Select all that apply.
 
  1. weaning in the morning
  2. placing in high-Fowler's position
  3. limiting activities during weaning
  4. coaching on coughing during weaning
  5. administering a sedative before weaning

Question 2

After an assessment the nurse is concerned that a patient is experiencing cor pulmonale associated with right-heart failure. What findings led the nurse to make this clinical decision?
 
  Select all that apply.
 
  1. ankle edema
  2. ruddy cheeks
  3. nasal drainage
  4. cyanotic nail beds
  5. distended neck veins

[poopface]

Answer to Question 1

Correct Answer: 1, 2, 3
Interventions to facilitate the weaning process include weaning in the morning when the patient is well-rested and alert. Weaning may be discontinued overnight to provide rest. The work of breathing increases during the weaning process and adequate rest is important. The patient should be placed in Fowler's or high-Fowler's position to facilitate lung expansion and reduce the work of breathing. Procedures and activities should be limited during weaning periods. Reducing energy expenditures and cardiac work facilitates the weaning process. The patient is intubated. Coughing will not be effective or encouraged at this time. Administering drugs that may depress respirations during the weaning process should be avoided, except as ordered at night to facilitate rest when ventilator support is provided. Sedatives or analgesics that depress respirations can impair the weaning process.

Answer to Question 2

Correct Answer: 1, 2, 4, 5
The manifestations of cor pulmonale are those of the underlying pulmonary disorder and right-sided heart failure. With right-sided heart failure, peripheral edema and distended neck veins are seen. The skin is both ruddy and cyanotic because of increased numbers of RBCs and hypoxemia. Nasal drainage is not a manifestation of cor pulmonale associated with right-heart failure.