The nurse is caring for a client requiring mechanical ventilation who is deeply sedated and receiving paralytic medications. Which nursing intervention would assist the client to optimize oxygenation?
1. Hyperventilating the client once an hour
2. Hyperoxygenating the client once an hour
3. Encouraging coughing and deep breathing
4. Frequent repositioning
Correct Answer: 4
An important nursing intervention to prevent atelectasis is frequent repositioning, and this client may be placed on a specialized bed to move him continuously. If he is not placed on a specialized bed, the nurse should reposition the client at least every 2 hours. Hyperoxygenating and hyperventilating the client would be important prior to suctioning, but would not be routine interventions or the most important interventions to improve oxygenation. Because the client is receiving a paralytic medication, coughing and deep breathing would not be possible.
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