Which of the following is a nursing intervention that is helpful in preventing ventilator associated pneumonia (VAP)
Oral care
Ordering antibiotics for the patient
Giving patient cough medications
Monitoring patient for a fever and letting the healthcare provider know if there is one
The Correct Answer is A
A. Oral care: Regular oral hygiene helps reduce the bacterial load in the mouth and oropharynx, which can prevent aspiration of pathogens into the lungs. This is one of the most effective nursing interventions to reduce the risk of ventilator-associated pneumonia.
B. Ordering antibiotics for the patient: Nurses do not independently order antibiotics, and prophylactic antibiotics are not routinely recommended for VAP prevention. Unnecessary antibiotic use can lead to resistance and other complications.
C. Giving patient cough medications: Suppressing cough in ventilated patients is not recommended, as effective coughing helps clear secretions. Cough medications do not prevent VAP and may interfere with natural airway clearance.
D. Monitoring patient for a fever and letting the healthcare provider know if there is one: While monitoring for infection is important, this is a reactive intervention rather than a preventive measure. Oral care and other hygiene measures directly reduce VAP risk before infection occurs.
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Related Questions
Correct Answer is B
Explanation
A. Labetalol: Labetalol is an antihypertensive used to lower blood pressure. It does not directly treat acute respiratory failure or improve oxygenation or ventilation.
B. Solumedrol: Solumedrol (methylprednisolone) is a corticosteroid that reduces inflammation in the lungs. In acute respiratory failure, especially if caused by conditions like COPD exacerbation, asthma, or ARDS, steroids help decrease airway inflammation and improve gas exchange.
C. Rosuvastatin: Rosuvastatin is a lipid-lowering agent and has no role in managing acute respiratory failure. It does not affect oxygenation, ventilation, or airway inflammation.
D. Plavix: Plavix (clopidogrel) is an antiplatelet used to prevent clot formation. It does not treat the underlying causes of acute respiratory failure and is not part of routine ARF management.
Correct Answer is C
Explanation
A. Slight movement of the ET tube during repositioning: Minor movement of the ET tube can occur when repositioning the patient and is usually expected. It should be monitored, but it does not typically require immediate intervention if the tube remains secure.
B. Occasional bubbling in the oral secretions: Small amounts of bubbling in secretions can be normal and may indicate mild saliva accumulation or humidified air from the ventilator. This finding is not immediately dangerous but should be suctioned as needed.
C. Asymmetrical chest rise during mechanical ventilation: Unequal chest expansion suggests possible tube displacement, obstruction, or a pneumothorax. This is a serious finding that can compromise oxygenation and ventilation, requiring immediate assessment and intervention to ensure airway safety.
D. Minor redness around the mouth from the ET tube securement: Redness at the securing site is a common skin irritation due to tape or straps. It is important to monitor and provide skin care, but it does not represent an acute airway emergency.
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