The nurse understands the primary assessment for a patient following a major trauma:

A) Assess the respiratory status hourly and as needed
It is essential for the nurse to frequently monitor and assess the respiratory status of a client on a ventilator, as changes can occur rapidly. Regular assessments allow the nurse to detect any early signs of respiratory distress, hypoxia, or ventilator malfunction. Hourly assessments are standard practice in the intensive care unit (ICU), and additional assessments may be necessary if there are concerns about the patient’s respiratory condition.

B) Ensure that a manual resuscitation bag is at the bedside
A manual resuscitation bag (Ambu bag) is a critical piece of emergency equipment that should always be available at the bedside of a patient on mechanical ventilation. In the event of ventilator failure, accidental extubation, or sudden respiratory distress, the nurse needs to be able to provide manual ventilation.
C) Check the patient's pulse oximetry once every shift
Although monitoring pulse oximetry is important in ICU patients on a ventilator, checking it only once per shift is insufficient. Continuous monitoring of oxygen saturation via pulse oximetry is a much more appropriate approach to ensure the patient is adequately oxygenated, especially when on a ventilator.

D) Adjust the ventilator settings based on the client’s level of consciousness
Adjusting the ventilator settings should be done by the healthcare provider or respiratory therapist, not the nurse, unless directed by the provider. While the patient's level of consciousness can influence their respiratory drive, the nurse does not have the authority or expertise to modify ventilator settings based on consciousness levels.

E) Collaborate frequently with the respiratory therapist
Collaboration with the respiratory therapist is essential for managing a patient on a ventilator. Respiratory therapists have specialized training in ventilator management and can assist with adjusting ventilator settings, monitoring the patient’s lung function, and troubleshooting ventilator malfunctions.

A) Ice packs may be applied to the site for 30 minutes every hour for comfort:
This is not an appropriate recommendation for skin care related to radiation therapy. Applying ice packs to the skin can cause vasoconstriction and might worsen skin irritation or damage from radiation. Instead, the patient should be advised to avoid extreme temperatures, including hot or cold compresses, which could exacerbate skin issues in the radiation field.

B) Incorporate rest periods throughout the day:
While rest is important for overall well-being during radiation therapy, this instruction does not directly address the skin care needs associated with radiation. The primary concern with radiation therapy is protecting the skin from further irritation and damage, so specific skin care measures are more crucial in this context than general rest periods.

C) Do not share bathrooms/toilets with others for 48 hours after treatment:
This instruction is not necessary for most patients undergoing radiation therapy, especially for lung cancer. The concern about not sharing bathrooms or toilets generally applies to patients receiving brachytherapy or radioactive implants, where radiation is placed inside the body. For external radiation, there is no risk of contamination through shared bathroom use.

D) Wear loose, soft clothing over the treated area:
This is the most appropriate instruction for skin care during radiation therapy. Radiation therapy can cause the skin to become tender, red, and irritated, so wearing loose, soft clothing will help minimize friction and pressure on the skin. Tight or rough clothing can irritate the radiation site, increasing the risk of skin breakdown. Loose, breathable fabrics like cotton can help keep the skin comfortable and allow it to heal while protecting it from further damage.