The nurse is caring for a client receiving mechanical ventilation with positive end-expiratory pressure (PEEP). The nurse should monitor the client for which complication?
The nurse is caring for a client receiving mechanical ventilation with positive end-expiratory pressure (PEEP). The nurse should monitor the client for which complication?
A. Decreased mean arterial pressure (MAP)
[47%]
B. Increased preload
[12%]
C. Increased partial pressure of oxygen
[28%]
D. Increased gas exchange
[14%]
Statistics
Subject/Lesson
Subject
Critical Care
Lesson
Critical Care Concepts
Client Need
Test Plan
Reduction of Risk Potential
Related Topic
Potential for Complications of Diagnostic Tests/Treatments/Procedures
Item Type
Item Type
Analysis
Explanation
Choice A is correct. PEEP is a setting that may be added to a mechanical ventilator, CPAP, or BiPAP. PEEP is commonly prescribed for clients with acute respiratory distress syndrome (ARDS) because PEEP prevents alveolar collapse, allowing for better gas exchange, thus, improving oxygenation. The increased intrathoracic pressure can decrease cardiac output because PEEP decreases cardiac preload. The decreased preload decreases the volume discharged by the heart, thus, creating a situation of decreased cardiac output. To calculate the MAP, [(2 x diastolic)+systolic] / 3. The MAP should be at least 60 to ensure perfusion.
Choices B, C, and D are incorrect. Because of the better gas exchange, the partial pressure of oxygen (PaO2) should increase. This therapeutically would help reduce lactic acidosis. PEEP causes increased intrathoracic pressure and adversely decreases preload (the blood returning to the heart via venous return). Blood pressure should be monitored carefully when PEEP is added or increased. Increased gas exchange is a therapeutic finding - not a complication.
Related Videos
3 Key Topics
Ventilators- Critical Care
27.1 Critical Care Respiratory System
Additional Info
✓ PEEP is a setting that may be added to a mechanical ventilator, CPAP, or BiPAP
✓ PEEP is commonly prescribed for clients with acute respiratory distress syndrome (ARDS) because PEEP prevents alveolar collapse, allowing for better gas exchange, thus, improving oxygenation
✓ By improving gas exchange, therapeutically, the client will enjoy increased oxygen and less lactic acid from the stress of breathing (clients with low pulmonary compliance will have an increase in their breathing, thus, creating lactate and sending the client into acidosis
✓ PEEP can cause decreased venous return and lower the mean arterial pressure
✓ The blood pressure should be monitored closely for a client receiving PEEP because of the risk of hypotension
✓ PEEP also raises the client's risk for a stress ulcer
✓ 5-15 cm H2O is the range for PEEP that may be adjusted
