A nurse is teaching a patient about home oxygen therapy. Which statement by the patient indicates a need for further education?

A. Increase PEEP: Positive end-expiratory pressure helps keep alveoli open at the end of expiration, improving oxygenation by increasing functional residual capacity and preventing alveolar collapse. Since the patient’s PaO2 is low (58 mmHg), increasing PEEP is the most effective first step to enhance oxygenation.

B. Increase respiratory rate: Increasing the respiratory rate primarily improves CO2 elimination rather than oxygenation. In this patient, hypoxemia is the priority concern, so adjusting rate will not adequately address low PaO2.

C. Increase FIO2: Increasing the fraction of inspired oxygen can raise PaO2, but prolonged high FIO2 levels increase the risk of oxygen toxicity. PEEP adjustments are generally prioritized before raising FIO2 to high levels.

D. Increase tidal volume: Raising tidal volume mainly improves CO2 removal and ventilation but has limited effect on oxygenation in a patient with alveolar collapse or shunting. Additionally, increasing VT carries a risk of volutrauma.

A. Adjust ventilator settings when feeling it is necessary: Ventilator adjustments require a healthcare provider’s order or protocol-guided changes; the RN does not independently alter settings based solely on judgment.

B. Remove endotracheal tube when patient is improving: Extubation is a provider-driven procedure and requires clinical assessment and order; the RN cannot remove the tube independently.

C. Mark/record position of the tube at the lip or teeth: Monitoring and documenting the position of the endotracheal tube is a key nursing responsibility. This ensures the tube remains in the correct position and helps detect accidental displacement.

D. Record patient's oxygen saturation every 15 minutes: While monitoring SpO2 is important, the RN should continuously monitor and document according to facility policy. Recording is a routine assessment but does not replace critical tasks like securing and assessing tube position.