A patient has been on mechanical ventilation with an endotracheal tube for 1 week. Which intervention by the nurse will help prevent ventilator-associated pneumonia (VAP)?
a. Providing oral care with a toothbrush at least twice daily
b. Changing the ventilator circuits at least every 72 hours
c. Removing subglottal secretions before every position change
d. Maintaining endotracheal cuff pressures at 10 cm H2O
C
Subglottal secretions should be removed every 4 to 6 hours or before position changes. Oral care should be provided with a chlorhexidine swab or toothbrush (if chlorhexidine is contraindicated) every 8 hours. The ventilator circuits should be changed every 48 hours because of potential bacteria within the tubing condensation. The endotracheal cuff pressures should be maintained at 20 cm H2O to decrease movement of secretions into the lower airways.
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