Brunner & Suddarth's Textbook of Medical-Surgical Nursing 13th Edition by Kerry Cheever, Janice Hinkle

Exercise 3

A 60-year-old man was admitted to the ICU after being emergently intubatedand placed on mechanical ventilation for respiratory failure. He originally presentedto the emergency department (ED) with mental status changes secondary to chronicliver failure and a history of alcohol abuse.On day 3 in the ICU, a chest x-rayrevealed infiltrates in the patient's right middle lobe, his sputum culture revealedgram-positive cocci in clusters, and his white blood cell count on his complete bloodcount was 17,500/cu mm. Based upon these findings, the patient was diagnosed withVAP and broad-spectrum IV antibiotics were started.List and discuss the evidence-based interventions associated with the VAP bundle as described by the Institute forHealthcare Improvement (IHI) (see Chart 21-13).How does oral care and subglotticsuctioning help prevent VAP?