A child is being mechanically ventilated and is very agitated and ...

[robinn137]

A child is being mechanically ventilated and is very agitated and fighting the ventilator despite receiving fentanyl citrate (Sublimaze) and midazolam (Versed). Which action by the nurse is the most appropriate?
 
  A.
  Restrain the hands so child does not pull out the endotracheal tube.
  B.
  Request an order for vecuronium bromide (Norcuron).
  C.
  Slow the frequency and depth of mandatory ventilations.
  D.
  Tell the family that someone must stay at the bedside.

Question 2

A mechanically ventilated adolescent has a RASS score of -3. The child is receiving pain medication and sedation by intravenous infusion. Which action by the nurse is the most appropriate?
 
  A.
  Assess the child for uncontrolled pain.
  B.
  Document findings and continue to monitor.
  C.
  Increase the fentanyl (Sublimaze) infusion.
  D.
  Suction the patient in case of tube obstruction.

[lindahyatt42]

Answer to Question 1

ANS: B
After ensuring the child has adequate pain control and sedation, the next step would be to administer a neuromuscular blocking agent such as for vecuronium bromide (Norcuron). This will paralyze the child's skeletal muscles and reduce the agitation and fighting of the ventilator. Restraints may be necessary but should be used as a last resort. Changing ventilator settings is not appropriate for agitation control. Putting the responsibility of maintaining the child's airway on the family is a huge burden that may cause distress, and family members may not be able to stay at the bedside at all times.

Answer to Question 2

ANS: B
A RASS score of -3 indicates moderate sedation, which would be appropriate for a child being mechanically ventilated. The nurse should document the findings and continue to monitor. This score does not indicate agitation, so uncontrolled pain should not be an issue. The fentanyl infusion does not need adjustment. There is no indication that the child needs to be suctioned.