A nurse is caring for a patient with ARDS who is being treated ...

[theo]

A nurse is caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP). Which assessment finding by the nurse indicates that the PEEP may need to be reduced?
 
  a. The patient's PaO2 is 50 mm Hg and the SaO2 is 88.
  b. The patient has subcutaneous emphysema on the upper thorax.
  c. The patient has bronchial breath sounds in both the lung fields.
  d. The patient has a first-degree atrioventricular heart block with a rate of 58.

Question 2

A patient with acute respiratory distress syndrome (ARDS) is placed in the prone position. When prone positioning is used, which information obtained by the nurse indicates that the positioning is effective?
 
  a. The patient's PaO2 is 89 mm Hg, and the SaO2 is 91.
  b. Endotracheal suctioning results in clear mucous return.
  c. Sputum and blood cultures show no growth after 48 hours.
  d. The skin on the patient's back is intact and without redness.

[jaygar71]

Answer to Question 1

ANS: B
The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns and will need to be addressed, but they are not specific indications that PEEP should be reduced.

Answer to Question 2

ANS: A
The purpose of prone positioning is to improve the patient's oxygenation as indicated by the PaO2 and SaO2. The other information will be collected but does not indicate whether prone positioning has been effective.