A patient being mechanically ventilated requires increasing PEEP for worsening ARDS. The order for PEEP is now at 20 cm of H2O. The nurse will need to contact the physician immediately if which condition develops?
1. Lung sounds greater on one side than the other
2. Lung sounds with crackles
3. Diminished peripheral pulses
4. High-pressure alarm
1
Rationale 1: A potential complication from increasing PEEP is a pneumothorax. The nurse needs to be alert to diminishing or absent lung sounds on one side of the chest.
Rationale 2: Crackles relate to increased fluid in the lungs, which would not occur in this instance.
Rationale 3: Diminished peripheral pulses are not related to the use of PEEP.
Rationale 4: A low-pressure alarm would be more likely to sound.
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