Which of the following are appropriate while suctioning a patient with an artificial airway on mechanical ventilation?
Suction as needed only.
Hyperoxygenate the patient beforehand.
Suction for no longer than 20 seconds on each pass.
Perform hand hygiene prior to suctioning.
Suction as you slide the catheter into the airway.
Correct Answer : A,B,D
Choice A rationale
Suctioning should be performed only when clinically indicated, such as in the presence of visible secretions, adventitious breath sounds, or a decline in oxygen saturation. Routine, unnecessary suctioning can cause mucosal trauma, hypoxemia, and increased risk of infection. This "as needed" approach minimizes potential complications and preserves airway integrity.
Choice B rationale
Hyperoxygenating the patient with 100% oxygen for 30-60 seconds prior to suctioning helps to create an oxygen reserve in the lungs and minimize the risk of hypoxemia during the procedure. Suctioning can transiently reduce lung volumes and gas exchange, and pre-oxygenation mitigates this by saturating hemoglobin and dissolved plasma oxygen.
Choice C rationale
Suctioning for longer than 10-15 seconds on each pass significantly increases the risk of hypoxemia, atelectasis, and vagal stimulation leading to bradycardia. Prolonged suctioning depletes oxygen from the airways and can cause physiological distress. Brief passes allow for reoxygenation between attempts and minimize adverse events.
Choice D rationale
Performing hand hygiene prior to suctioning is a critical infection control measure. This practice reduces the transmission of microorganisms from the healthcare provider's hands to the patient's airway, thereby preventing healthcare-associated infections like ventilator-associated pneumonia. Adherence to strict aseptic technique is paramount in airway management.
Choice E rationale
Suctioning should never be performed while inserting the catheter into the artificial airway. Applying negative pressure during insertion can cause significant mucosal trauma, bleeding, and increased risk of infection by pulling tissue into the catheter lumen. Suction should only be applied intermittently and during withdrawal of the catheter, to remove secretions effectively and safely.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Diabetes mellitus is a metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. It typically presents with polyuria, polydipsia, and polyphagia, which contrasts with the patient's current presentation of decreased urine output and hyponatremia. The underlying pathophysiology involves pancreatic beta cell dysfunction or insulin resistance, not directly related to brain tumor removal.
Choice B rationale
Hypertonic agonism is not a recognized medical term or complication. The concept of tonicity relates to the osmotic pressure of a solution, and an "agonist" refers to a substance that binds to a receptor and initiates a physiological response. This option does not align with the patient's symptoms of decreased urine output and hyponatremia following brain surgery.
Choice C rationale
Diabetes insipidus (DI) is a condition characterized by the inability of the kidneys to conserve water, leading to excessive urination (polyuria) and thirst (polydipsia). This is often due to insufficient production of antidiuretic hormone (ADH) or renal insensitivity to ADH. The patient's presentation of *decreased* urine output directly contradicts the hallmark symptom of DI.
Choice D rationale
Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by excessive secretion of ADH, leading to water retention, dilutional hyponatremia (serum sodium 124 mEq/L, normal range 135-145 mEq/L), and decreased urine output. Brain surgery can stimulate ADH release. This aligns with the patient's symptoms of decreased urine output and low serum sodium.
Correct Answer is B
Explanation
Choice A rationale
Respiratory acidosis is characterized by a low pH and an elevated PaCO2. The patient's pH is elevated (7.61), indicating alkalosis, and the PaCO2 is low (22 mmHg). These findings are the opposite of what would be seen in respiratory acidosis.
Choice B rationale
The pH of 7.61 is significantly elevated, indicating alkalosis. The PaCO2 of 22 mmHg is markedly decreased below the normal range (35-45 mmHg). This decrease in carbon dioxide, a potent acid, directly causes the alkalosis. The bicarbonate (HCO3) level of 25 mEq/L is within the normal range (22-26 mEq/L), indicating that the renal system has not yet initiated any compensatory response. Therefore, this pattern is consistent with uncompensated respiratory alkalosis, primarily driven by hyperventilation.
Choice C rationale
Metabolic alkalosis would present with an elevated pH and an elevated bicarbonate level. While the pH is elevated, the bicarbonate (25 mEq/L) is within the normal range, and the PaCO2 is low, which is inconsistent with metabolic alkalosis as the primary imbalance.
Choice D rationale
Metabolic acidosis is characterized by a low pH and a low bicarbonate level. The patient's pH is high (alkalotic) and the bicarbonate is normal. This contradicts the diagnostic criteria for metabolic acidosis.
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