The nurse working in the intensive care unit is assigned a patient requiring mechanical ventilation.When responding to the ventilator alarm,the nurse sees a high-pressure alarm.Which nursing action is the priority?

Question

Quizplus · Accepted Answer

The priority nursing action is to assess the patient. The high-pressure alarm could be due to a number of issues, including increased secretions or a kink in the tubing. However, it could also be a sign of a more serious problem, such as a dislodged endotracheal tube or a pneumothorax. Therefore, the nurse must prioritize assessing the patient to determine if any intervention is required. Silencing the alarm or emptying the collected water may be necessary actions, but they should be done after assessing the patient. Removing the patient from the ventilator is only necessary if the patient is in distress and cannot be adequately oxygenated by the ventilator.

The Nurse Working in the Intensive Care Unit Is Assigned