A patient is being mechanically ventilated with SIMV at a rate of 25. The nurse would question this order for which reason?
1. The rate could be too high for this mode.
2. The patient will be more comfortable with a different mode.
3. The patient is not receiving enough sedation.
4. SIMV is always used in combination with PEEP.
1
Rationale 1: SIMV is usually set so that the patient can breathe over the set rate to exercise the respiratory muscles. A rate of 25 will not allow this and could also establish auto PEEP.
Rationale 2: The patient will not necessarily be more comfortable with a different mode. SIMV is the most commonly used mode in an ICU setting.
Rationale 3: Too much sedation is contraindicated in SIMV so that the patient will initiate breaths on his or her own.
Rationale 4: PEEP can be used with any of the modes.
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