Nursing Prioritization Delegation Assignment Q 15

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You are caring for a patient with emphysema and respiratory failure who is receiving mechanical ventilation through an endotracheal tube. To prevent ventilator-associated pneumonia (VAP), which action is most important to include in the plan of care?

  

     A. Administer ordered antibiotics as scheduled

     B. Hyperoxygenate the patient before suctioning

     C. Maintain the head of the bed at a 30 to a 45-degree angle

     D. Suction the airway when coarse crackles are audible

    

    

Correct Answer: C. Maintain the head of the bed at a 30 to a 45-degree angle

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Research indicates that nursing actions such as maintaining the head of the bed at 30 to 45 degrees decrease the incidence of VAP. These actions are part of the standard of care for patients who require mechanical ventilation. Proper positioning (keeping the head of the bed between 30–45 degrees) and encouraging early mobility of mechanically ventilated patients aid in the prevention of VAP.

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Option A: To reduce risk for VAP, the following nurse-led evidence-based practices are recommended: reduce exposure to mechanical ventilation, provide excellent oral care and subglottic suctioning, promote early mobility, and advocate for adequate nurse staffing and a healthy work environment.

Option B: Aspiration of secretions that accumulate around the endotracheal tube of mechanically ventilated patients can lead to VAP. Subglottic secretion suctioning can be performed by both the nurse and respiratory therapist and can aid in prevention.

Option D: A recent meta-analysis of 20 RCTs found that subglottic suctioning reduced the risk for VAP by 45% compared to patients who didn’t receive suctioning. Coordinating subglottic suctioning when conducting oral care may be a good mechanism to cluster care and ensure both of these practices are routinely delivered.

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