A patient receiving mechanical ventilation is experiencing ...

[OSWALD]

A patient receiving mechanical ventilation is experiencing uncontrolled pain. How can associated gastrointestinal complications adversely influence this patient's time on the mechanical ventilator?
 
  A. O2 delivery may become impaired.
  B. Bacterial translocation may increase.
  C. Motility of the colon increases.
  D. Airway obstruction may acutely develop.

Question 2

A mechanically ventilated patient continues to exhibit distress despite the fact that all life-threatening causes of patient disturbance have been determined and alleviated. Why should the therapist next consider this disturbance to be neuropsychiatric?
 
  A. because the pain-induced stress response may lead to a hypercoagulable state
  B. because uncontrolled disturbances can lead to complications of the gastrointestinal tract
  C. because the optimal management of pain, delirium, and, anxiety is not the same
  D. because inappropriate treatment may lead to nosocomial infections

[tennis14576]

Answer to Question 1

ANS: B
A. Incorrect response: See explanation B.
B. Correct response: Uncontrolled pain is known to produce complications of the gastrointestinal tract. Bowel motility is a function of the balance of sympathetic and parasympathetic tone. A result of increased sympathetic tone associated with stress responses is decreased gastric and colonic motility causing elevated gastric residual volumes, ileus, constipation, and nausea. As a consequence, the risk of aspiration results in suboptimal nutrition and increased bacterial translocation.
Bacterial translocation is the passage of viable indigenous bacteria from the intestinal tract through the epithelial mucosa to the mesenteric lymph nodes, and then to the systemic circulation. Infections, through translocation of intestinal bacteria, are a major cause of morbidity and mortality. Bacterial translocation is as a source of systemic infections and multiple system organ failure in critically ill patients. Various studies have shown that bacterial translocation can be caused by a breach of the mucosal barrier, impaired host immune defense mechanisms, and/or bacterial overgrowth, creating an ecologic imbalance in the indigenous intestinal microflora. The host's nutritional status influences these factors.
C. Incorrect response: Uncontrolled pain may produce decreased colonic motility.
D. Incorrect response: See explanation B.

Answer to Question 2

ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: The first step in management of patient distress is to rule out any life-threatening abnormalities, particularly of the cardiac, pulmonary, and central nervous systems. Acute onset of patient distress may be a sign of myocardial ischemia, hypoxia, hypercarbia, pneumothorax, cerebral hemorrhage or infarction, an acute abdomen, or
hypoglycemia. Once life-threatening causes are excluded, the next step should be the determination of the underlying cause for the neuropsychiatric disturbance, as the optimal management of pain, delirium, and anxiety is not the same. Attempting to simply medicate for agitation can potentially aggravate the problem if the wrong therapy is administered. Or, it may merely mask the signs without providing effective treatment, which can lead to further complication.
D. Incorrect response: See explanation C.