A client is on SIMV with a rate of 24. The nurse may question this order since:
1. The rate could be too high for this mode.
2. The client will be more comfortable with a different mode.
3. The client is not receiving enough sedation.
4. SIMV is always used in combination with PEEP.
The rate could be too high for this mode.
Rationale: SIMV is usually set so that the client can breathe over the set rate to exercise the respiratory muscles. A rate of 24 will not allow this and could also establish autoPEEP. The client will not necessarily be more comfortable with a different mode—SIMV is the most commonly used mode in an ICU setting. Too much sedation is contraindicated in SIMV, so that the client will initiate breaths on his or her own. PEEP can be used with any of the modes.
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