Page 68 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 53

patient the desired tidal volume, but when a preset pressure limit is reached,
it will trip an alarm requiring the nurse to assess the patient. If the patient is
fighting the ETT or bucking against the delivery of gas, it will trip the high
alarm. Calming patients by talking to them, and keeping them informed of
their progress and that someone will come to their aid goes a long way in reas-
suring them. Sometimes a sedative or, in extreme cases, a neuromuscular block-
ing agent may be needed to calm the patient.
Perhaps the patient’s lung compliance has changed. Compliance is the degree
or ease of expansion of the lungs. When the lungs are fluid filled or blocked
with thick sputum, the compliance or distensibility of the lungs is harder. This
requires more pressure from the ventilator to overcome resistance to pumping
air into the lungs. This will trip the high-pressure alarm. Most of the time, an
increase in pressure can be caused by mucus and the patient will need to be
suctioned. A thorough pulmonary assessment is imperative if this continues;
the patient could be developing a pneumothorax, heart failure, or pneumonia.
It also may require notification of the health care provider to order a chest x-ray
and ABGs to assist with confirming assessment findings.

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If the ventilator alarms keep sounding and you can not determine the cause support
the patient with a BVM. NURSING ACTION: A BVM with oxygen connection is kept at
the bedside at all times. Attach the bag to the patient’s airway, turn the oxygen up
as far as it will go, and ventilate the patient with one breath every 5 seconds. Then
calmly call for help! You are not expected to know everything about a ventilator, but
you are expected to support the patient. NEVER IGNORE ALARMS!

APPLYING IT
You have been assigned Jose Mendez, a 35-year-old patient who was in a
motor vehicle accident. You hear his ventilator alarming. Proceeding to his
bedside, you note alarms going off on the ventilator. What should be your
FIRST nursing action?

✔ANSWER
Observe the patient to see if he is attached to the ventilator; look at the tubing
to see if it is kinked. Then auscultate his lung sounds to see if they have
changed from the morning assessment. If you can not find the problem
quickly, remove the manual resuscitation bag, turn the oxygen up high, and
give the patient one breath every 5 seconds, then call for help.