Medical Surgical ARDS & Acute Respiratory Failure #3

Question

The nurse is caring for a client in acute respiratory failure who has been placed on mechanical ventilation assistance. Which action by the nurse is the best way to protect the client from infection?

Answers

  1. Obtain order for prophylactic antibiotic therapy.
    • Rationale:

      This answer is not correct because it is not the best way to prevent an infection. Although, prophylactic antibiotics can be prescribed in clients on ventilatory support.

  2. Institute measures to reduce ventilator-associated pneumonia.
    • Rationale:

      This answer is correct because nosocomial infections like ventilator-associated pneumonia are the leading cause of death in hospitals, yet the most preventable complication. Persistent handwashing before and after client care such as suctioning reduces germ transmission. Utilizing a continuous subglottic suction ET tube for intubation will prevent secretion accumulation as well as sterile suctioning procedures. Frequent oral care and chlorhexidine rinses will reduce pathogens that can be aspirated.

  3. Observe for signs of barotrauma.
    • Rationale:

      This answer is not correct because although observing for barotrauma is an important intervention for the client on mechanical ventilation, it will not reduce the risk of infection. Breathing compressed air is a risk factor for barotrauma.

  4. Consult respiratory therapy for chest physiotherapy.
    • Rationale:

      This answer is not correct since it is not the best way to protect against infection for the client on respiratory support. However, it is a method used to help prevent infection by postural drainage and loosening and mobilizing secretions.

Overview

The client on mechanical ventilation is at risk for ventilator-associated pneumonia. Nosocomial infections are the leading cause of death in the hospital. Instituting measures to reduce ventilator-associated pneumonia is the best way to protect the client from infection.

Explanation

Learning Outcomes

Ventilator-associated pneumonia is a nosocomial infection and the most preventable. Nosocomial infections are the leading cause of death in hospitals. Persistent handwashing before and after client care such as suctioning reduces germ transmission. Utilizing a continuous subglottic suction ET tube for intubation will prevent secretion accumulation. Always practice sterile suctioning procedures. Frequent oral care and chlorhexidine rinses will reduce pathogens that can be aspirated into the lungs. Antibiotics are usually only indicated when there is an infection, although can be used to prevent as well. Barotrauma does not increase the risk for infection. Chest physiotherapy is used to loosen and mobilize secretions in the lungs.

Test Taking Tip

Remember that VAP is the leading cause of mortality in hospitals and yet the most preventable.

Video Rationale