A nurse is caring for a client on a mechanical ventilator. The ventilator is sounding an alarm and displaying an alert about low tidal volumes. The nurse has checked all connections and the endotracheal tube, but the alarm persists and the client's oxygen saturation is dropping. What should the nurse do next?

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11ecbb05_cb0c_b142_b433_ab25655ae62c_MD0009_00 A low tidal volume alarm indicates that the volume of air the ventilator is delivering is lower than the set volume. This is most often due to a disconnection, loose connection, or leak in the circuit. The nurse should troubleshoot the most common causes of the alarm, but if the client's condition is deteriorating clinically (eg, decreasing oxygen saturation), then the nurse should disconnect the ventilator and manually ventilate the client's lungs with a resuscitation bag device at 10-15 L/min oxygen until the ventilator alarm state can be resolved. (Option A) Respiratory therapists have specialized training in mechanical ventilators. They should be called to the bedside but only after the nurse has begun to stabilize the client's condition using manual ventilation. (Option B) Since the client is intubated, air cannot pass from the nares and oropharynx into the lungs, and ventilation can be achieved only via the endotracheal tube. (Option C) The client would benefit from a higher oxygen level, but the ventilator is unable to deliver the programmed volume to the client, even with an increased oxygen level. The client's lungs must be manually ventilated with a resuscitation bag. Educational objective: Ventilators may sound an alarm when set parameters are not being met (eg, low tidal volumes, high peak pressures). These alarms may indicate a client condition or ventilator malfunction. If a ventilator alarm cannot be readily resolved, the nurse should manually ventilate the client's lungs with a resuscitation bag device.

A Nurse Is Caring for a Client on a Mechanical