After change-of-shift report on a ventilator weaning unit, which patient should the nurse assess first?

After change-of-shift report on a ventilator weaning unit, which patient should the nurse assess first?

• A. Patient who failed a spontaneous breathing trial and has been placed in a rest mode on the ventilator.
• B. Patient who is intubated and has continuous partial pressure end-tidal CO2 (PETCO2) monitoring.
• C. Patient who was successfully weaned and extubated 4 hours ago and has no urine output for the last 6 hours.
• D. Patient with a central venous O2 saturation (ScvO2) of 69% while on bilevel positive airway pressure (BiPAP).

Answer: (C)

The patient who was successfully weaned and extubated 4 hours ago but has not had any urine output for the last 6 hours presents a significant concern. This lack of urine output may indicate acute kidney injury or dehydration, both of which require prompt assessment and intervention, especially following extubation. After a patient has been extubated, monitoring for complications is crucial, as respiratory difficulties or changes in hemodynamic status can arise suddenly. The fact that this patient has been without urine output for an extended period signals a potential problem that could complicate their recovery post-extubation. Adequate kidney function is essential for maintaining fluid and electrolyte balance, and any compromise in renal function can exacerbate existing respiratory issues or complicate ventilation weaning. In contrast, the patient who failed a spontaneous breathing trial may already be stabilized but requires ongoing monitoring, while the one with continuous PETCO2 monitoring is likely being managed closely. The patient on BiPAP with a ScvO2 of 69% may also need attention, but the lack of urine output post-extubation signals a more urgent situation that could affect multiple systems, making it the priority to assess first.

The patient who was successfully weaned and extubated 4 hours ago but has not had any urine output for the last 6 hours presents a significant concern. This lack of urine output may indicate acute kidney injury or dehydration, both of which require prompt assessment and intervention, especially following extubation. After a patient has been extubated, monitoring for complications is crucial, as respiratory difficulties or changes in hemodynamic status can arise suddenly.

The fact that this patient has been without urine output for an extended period signals a potential problem that could complicate their recovery post-extubation. Adequate kidney function is essential for maintaining fluid and electrolyte balance, and any compromise in renal function can exacerbate existing respiratory issues or complicate ventilation weaning.

In contrast, the patient who failed a spontaneous breathing trial may already be stabilized but requires ongoing monitoring, while the one with continuous PETCO2 monitoring is likely being managed closely. The patient on BiPAP with a ScvO2 of 69% may also need attention, but the lack of urine output post-extubation signals a more urgent situation that could affect multiple systems, making it the priority to assess first.