A patient being mechanically ventilated suddenly develops cardiac ...

[LaDunn]

A patient being mechanically ventilated suddenly develops cardiac dysrhythmias from increasingly higher PEEP. What underlying issue should the nurse suspect in this patient?
 
  1. decreased cardiac output and acidosis
  2. increased cardiac output and alkalosis
  3. decreased cardiac output and renal failure
  4. increased cardiac output and electrolyte disturbance

Question 2

A patient is being mechanically ventilated with SIMV at a rate of 25 breaths per minute. Why should the nurse question this order?
 
  1. The rate could be too high for this mode.
  2. The patient would be more comfortable with a different mode.
  3. The patient is not receiving enough sedation.
  4. SIMV is always used in combination with PEEP.

[Missbam101]

Answer to Question 1

Correct Answer: 1
Increasingly higher PEEP with decreased cardiac output and acidosis may predispose the patient to cardiac arrhythmias. Increased cardiac output does not occur with PEEP. Renal failure and electrolyte disturbances are not the likely causes for the cardiac dysrhythmias.

Answer to Question 2

Correct Answer: 1
SIMV is usually set so that the patient can breathe over the set rate to exercise the respiratory muscles. A rate of 25 breaths per minute would not allow this and could also establish auto PEEP. The patient would not necessarily be more comfortable with a different mode; SIMV is the most commonly used mode in an ICU setting. Too much sedation is contraindicated in SIMV, to allow the patient to initiate breaths on his or her own. PEEP can be used with any of the modes.