FREE Prioritization, Delegation, and Assignment Questions and Answers
The ventilator of a patient sounds the high-pressure alarm. The oxygen saturation meter in the patient's room indicates 87% when you walk in to evaluate the ARDS patient, who is also having trouble sitting up. Which move ought to you make next?
You can give the patient 100% FiO2 by manually ventilating them while you try to figure out what's causing the high-pressure alarm. Safe ventilation parameters for each patient and their conditions should be taken into account while using proper ventilation strategies with the BVM.
A 16-year-old cystic fibrosis adolescent is admitted with worsening breathlessness and potential pneumonia. Which nursing task must be included in the patient's care the most?
For people with cystic fibrosis, airway clearance procedures are essential and should come first. Mucus dehydrates as a result of the Cystic Fibrosis Transmembrane Conductance Regulator deficiency. In cystic fibrosis, the secretions are typically thick, gooey, and more challenging to remove. Both the treatment of acute exacerbations and the maintenance of health in cystic fibrosis depend heavily on frequent airway clearance.
Despite using a non-rebreather mask to deliver oxygen to a patient with acute respiratory distress syndrome (ARDS), arterial blood gas readings still indicate low oxygenation. You would anticipate a doctor's order for what action as the nurse in charge of this patient's care, wouldn't you?
A non-rebreather mask can provide almost all of the oxygen needed. Refractory hypoxemia is observed when the patient's oxygenation status does not significantly improve in response to the supply of oxygen at this high dosage. The patient is typically exerting a lot of effort to breathe at this point and risking respiratory arrest unless medical professionals step in and administer intubation and mechanical ventilation to lessen the patient's labor of breathing.
A nursing diagnostic of sleep deprivation due to a disrupted sleep cycle is given to a patient with sleep apnea. Which task ought to you assign the nursing assistant?
The nursing assistant can remind patients to perform tasks that are specified in their care plan and have already been taught to them by the nurse. The appropriate person must be given the appropriate tasks and responsibilities under the appropriate conditions. Following that, the nurse who assigned the tasks and jobs must interact with and supervise the person performing them. The nurse oversees the individual and judges whether or not the task was completed in a proper, suitable, safe, and competent manner.
A patient suffering from chronic obstructive pulmonary disease (COPD). Which airway management procedure should a nursing assistant handle?
The educational background and scope of practice of a nursing assistant include helping patients with positioning and activities of daily life. Under the direct supervision of the nurse, nonprofessional, unlicensed assistive nursing personnel may legally be assigned certain tasks and aspects of care, provided they are competent in those areas, such as assistance with transfers, range of motion, feeding, ambulation, and other tasks like making beds and assisting with bowel and bladder functions.
A patient who is getting oxygen through a nasal cannula at a flow rate of 6 L/min complains of nasal passage irritation, the nursing assistant informs you. What course of action might you recommend to enhance the patient's comfort in light of this issue?
The mucous membranes may dry out when the oxygen flow rate exceeds 4 L/min. The best course of action is to upgrade the oxygen delivery system with humidification. For patients who need high-flow oxygen systems for longer than 24 hours or who complain of upper airway irritation owing to dryness, it is permissible to utilize humidified oxygen. It can also be beneficial to apply a water-soluble jelly to the nares to lessen mucosal irritation. None of the alternative solutions will address the issue.
The nursing assistant takes the patient's vital signs after the respiratory therapist suctions an intubated patient. Which vital sign value needs to be reported right away to the licensed nurse by the nursing assistant?
The risk of infection for a patient undergoing mechanical breathing never goes away. Bypassing the body's natural air-filtering systems, the endotracheal tube gives bacteria and viruses a direct path to the lower respiratory system.