Which information about a patient who is receiving cisatracurium (Nimbex) to prevent asynchronous breathing with the positive pressure ventilator requires action by the nurse?

B. Endotracheal intubation and positive pressure ventilation are indicated in patients with severe respiratory failure who are unable to maintain adequate oxygenation and ventilation on their own. This intervention provides mechanical support to the patient's breathing by delivering positive pressure to the lungs via an endotracheal tube. Given the patient's respiratory rate of 6 breaths/min, low oxygen saturation (SpO2 of 78%), and increasing lethargy, endotracheal intubation and positive pressure ventilation are the most appropriate interventions to ensure adequate oxygenation and ventilation.

A. CPAP is a form of non-invasive positive pressure ventilation that helps keep the airways open and improves oxygenation. However, in a patient with severe respiratory failure and impending respiratory arrest, CPAP alone may not be sufficient to adequately support ventilation and oxygenation. CPAP is typically used in patients with milder forms of respiratory failure or as a step-down therapy from invasive mechanical ventilation.

C. Insertion of a mini-tracheostomy is not typically indicated in a patient with severe respiratory failure and impending respiratory arrest. While tracheostomy may be considered in certain cases for long-term ventilation or airway management, it is not the first-line intervention in an acute situation like this.

Additionally, frequent suctioning may not address the underlying cause of respiratory failure or improve oxygenation.

D. Administering 100% oxygen via a non-rebreather mask can help improve oxygenation temporarily. However, in a patient with severe respiratory failure and impending respiratory arrest, non-invasive oxygen therapy alone may not be sufficient to maintain adequate oxygenation and ventilation.

Endotracheal intubation and positive pressure ventilation are more definitive interventions to ensure adequate support for the patient's breathing.

C. Hypovolemia, or low blood volume, can lead to decreased venous return to the heart and reduced filling pressures. Consequently, CVP may decrease in hypovolemic states. Low CVP may indicate inadequate preload and reduced cardiac output, which are characteristic of hypovolemia.

A. Left ventricular failure typically results in elevated filling pressures rather than low CVP. In left ventricular failure, blood backs up into the pulmonary circulation, leading to increased pulmonary venous pressure and potentially elevated pulmonary capillary wedge pressure (PCWP), which is a surrogate marker for left atrial pressure. This elevated pressure is reflected in the CVP as well, resulting in increased CVP rather than low CVP.

B. Fluid overload typically results in elevated filling pressures and increased CVP rather than low CVP. Excess fluid volume increases venous return to the heart, leading to increased pressure within the central veins and elevated CVP.

D. Intracardiac shunts may cause alterations in cardiac pressures, but they typically do not result in consistently low CVP. Depending on the type and severity of the shunt, the direction and magnitude of pressure changes may vary. However, in the absence of other pathophysiological factors, intracardiac shunts are less likely to cause consistently low CVP.