A patient has been on mechanical ventilation with an endotracheal ...

[Wadzanai]

A patient has been on mechanical ventilation with an endotracheal tube for 1 week. Which intervention by the nurse will help prevent ventilator-associated pneumonia (VAP)?
 
  a. Providing oral care with a toothbrush at least twice daily
  b. Changing the ventilator circuits at least every 72 hours
  c. Removing subglottal secretions before every position change
  d. Maintaining endotracheal cuff pressures at 10 cm H2O

Question 2

During the secondary survey of the code event, the nurse realizes that the patient is not breathing on his own. What should the nurse do next?
 
  a. Immediately intubate the patient.
  b. Have a laryngoscope handle and curved blades available.
  c. Ensure that the light source on the laryngoscope is functional.
  d. Have a laryngoscope handle and straight blades available.

[vickybb89]

Answer to Question 1

C
Subglottal secretions should be removed every 4 to 6 hours or before position changes. Oral care should be provided with a chlorhexidine swab or toothbrush (if chlorhexidine is contraindicated) every 8 hours. The ventilator circuits should be changed every 48 hours because of potential bacteria within the tubing condensation. The endotracheal cuff pressures should be maintained at 20 cm H2O to decrease movement of secretions into the lower airways.

Answer to Question 2

C
Ensure that the light source on the laryngoscope is functional. Light is necessary on the laryngoscope to visualize the vocal cords and intubate the trachea. Batteries may have to be changed. If respirations are absent, assist the code team with endotracheal intubation. Have available a laryngoscope handle, curved and straight blades, endotracheal (ET) tubes, a stylet, suction and tape, or an ET tube holder.