Best ICU Nurse Questions to Ask:

Here are some of the best interview questions to ask ICU/ critical care nurses:

1. How do you handle extreme pressure when performing your duties as an ICU nurse?

An ICU nurse is often faced with high stress situations. During your interview, listen for these
positive signs they will thrive in a high stress environment: Do they talk about how they perform
best under pressure? Do they mention that they like taking on additional responsibility, often
without being asked? Feel out whether high-pressure situations phase them or the quality of their
work.

2. What responsibilities have you handled as part of the ICU?

This question gives you an idea of a nurse’s overall responsibilities. Ask for details and
determine whether their experience matches your current opening responsibilities. of your
current opening.

3. What’s your greatest strength as an ICU nurse?

The purpose of this question is to hear your ICU nurse candidate talk about themselves and what
qualities they’re most proud of as a nurse. There is no “right” or “wrong” answer. However, if
they stumble trying to describe their biggest strengths and accomplishments, it could mean
they’re not confident.

4. Why are you leaving your current position?

This is one of the most important questions to ask an ICU nurse (and all nurses). It’s important to
gauge whether they want to leave due to workplace conflict, shorter commute, better hours,
higher salary, etc. How do they describe the situation? Can you sense they are having issues with
coworkers? Are they seeking enhanced challenges or opportunities? Listen closely to their
answer as it may provide clues as to their work style, goals or management abilities. Be sure to
ask follow up questions for more details.

5. What did you not like about your last facility/organization?

This question provides more direct information related to your nurse’s likes/dislikes. They may
say they’re leaving based on a long commute, but there could be workplace conflict or other
factors that came into play. This can also lead into their ability/desire to lead change in your
facility.

6. Can you describe your ideal work week?

Again, if your ICU nurse candidate does not reveal any information regarding their ideal
schedule, you’ll want to use a more direct question. This is important to gauge their expectations
of a new position. For example, what hours or scheduling considerations will they require?
7. What’s your biggest weakness?

Several top candidates actually train for this question, but that’s not a bad thing. The better their
response, the better indication they are a planner who has done their homework and likes to be
prepared.

8. Tell me about a time you were under a lot of pressure. What was going on, and how did
you get through it?

This is a behavioral question that is perfect for ICU nurses. It allows your candidate to describe a
high-stress situation, the challenges they faced, and exactly how they reacted.

Most Common and General ICU Nurse Interview Questions:

These are general questions that you can ask to uncover some surface level information. These
are typically used as “getting to know you” questions and should not be used as your main
criteria for making a hire.

 Why do you want to work for this hospital / organization?

 What are your values?
 What drew you to the nursing profession?
 Tell me about a time you inadvertently caused conflict? How did you resolve it??
 What can you bring to our team?
 What are your weaknesses? / What is your area of greatest opportunity?
 If I called your previous supervisor, what would they tell me about you?
 How would you define a strong leader?
 What are your career goals?
 What questions would like to ask me / us?
 Are you currently interviewing with other hospitals?
 Why did you decide to become a nurse?
 Why did you choose the particular field of nursing that you are in?
 What are the biggest challenges or issues that nurses face today?
 Why do you feel you are qualified for the job?
 When do you plan to make a decision? / How soon can you start?

Behavioral Interview Questions for ICU Nurses:

As a healthcare employer, you may want to leverage behavioral interview questions when hiring
nurse staff. Behavioral based interview questions will give you a sense of how a nurse will
perform or behave in specific circumstances. Questions related to stress, time management, and
pressure situations are perfect for assessing your ICU nurse candidates.

Sample Behavioral Interview Questions for Nurses:

Questions for Teamwork:

  Describe a situation when you had to work closely with a difficult or confrontational coworker.
How did you handle the situation? Were you able to work together and collaborate with this
person?
 Talk about a conflict within your nursing/ healthcare team. What was the conflict and how did
you handle it?
 Describe a time when you were particularly proud of your nursing/healthcare team? What was
your role in this situation?
 Discuss a time where you stepped into a leadership role. Do you find yourself stepping into
these roles frequently?

Interview Questions for Patient Care:

 Tell me about a time when a patient’s family was dissatisfied with your care. How did you
handle that situation? Were you able to remedy the situation or build some understanding with
them?
 What approach do you take in communicating with people who do not know medical jargon?
Give an example of a time you explained medical terminology to someone who was unfamiliar
with any medical terms.
 Describe a time you provided effective patient and/or family education.
 Describe a time a patient or their family was appreciative of your care and treatments.
 Give an example of a time you had to interact with a hostile patient. How did you handle the
situation? What was the outcome?
 Describe a time you were faced with a patient who chose not to communicate or disclose
important information.

Questions for Adaptability:

 Tell me about a time you were under a lot of pressure. What was going on, and how did you get
through it?
 Discusst a time when you didn’t know the answer to something at work? How did you go about
finding the information?
 Give me an example of an awkward situation at work. How did you remove yourself from the
situation?
 Tell me about a time you failed. How did you deal with this situation?
 Describe a time when you anticipated potential problems with a patient and initiated
preventative measures.

Questions for Time Management:

 Talk about a time you worked in a fast-paced setting. How did you prioritize tasks while
maintaining excellent patient care?
 Describe your experience with a very ill patient who required a lot of your time. How did you
manage this patient’s care while ensuring your other patients were adequately cared for?
 Talk about a time when you felt overwhelmed with your work or patient load. What did you do?
 Give an example of an important goal you set for yourself. Did you accomplish that goal? How
did you ensure that you accomplished it?
Questions to Assess Communication Style:

 Give an example of a time when you were able to successfully persuade a patient to agree to
something. How did your persuade this person?
 Describe a time when you were the resident medical expert. What did you do to make sure
everyone was able to understand you?
 Share a time when you had to rely on written communication to explain yourself to your team
or to a patient.
 Talk about a time when you had not communicated well. How did you correct the situation?
 Describe a time when you received negative feedback and turned it into something positive.

Motivation and Values:

 What is one professional accomplishment that you are most proud of and why?
 Talk about a challenging situation or problem where you took the lead to correct it instead of
waiting for someone else to do it.
 Have you ever felt dissatisfied with your work as a nurse? What could have been done to make
it better?
 Describe a time when you went over and above your job requirements. What motivated you to
put forth the extra effort?
 Give an example of a mistake you’ve made? How did you handle it?
 What do you find most difficult about being a nurse? How do you overcome this difficulty?

Checking ICU Nurse References

After narrowing down your candidate pool to the short list of nurses you’d like interview further,
we recommend checking references to confirm you’re making the best hiring choice.

Valuable reference feedback can weed out bad candidates who are not a good fit for your
organization. One step to gathering detailed, candid, and actionable feedback from references is
through using relevant, consistent reference questions.

The best reference questions to ask are the questions that lead to the highest quality hire.
Checkster’s digital platform provides templates of reference questions that are validated by
independent I/O psychologists and found to be accurate predictors of performance and turnover.

Keep in mind that inconsistencies in reference questions can lead to inconsistent feedback.
Checkster can be used to customize and then standardize questions across all reference checks,
even across the company. It’s an easy way to ensure you remain compliant and legal with all
questions asked by administering a set of digital questionnaires.

Question no. 1: Can you tell me something about yourself?

Hint: This is often the very first question. It helps the HR managers to get a basic idea of your
communication skills, motivation, and interests. It is also an ice breaker, and a good answer will
help you to feel more relaxed in the room. The interviewers do not ask about your education,
experience, personal life, or anything else in particular—you can choose the way to introduce
yourself.

However, your choice reflects what matters to you. In a job interview, you should talk about
your education, working experience, career goals, skills and abilities. You should talk about
things that are relevant for the employer. On the other hand, you can mention one or two
hobbies, or tell them something from your personal life. This shows that you have a life outside
of work. Check one sample answer below.

I am Mario, 25 years old, and I have just finished my Masters in Economy. I enjoy team work,
and I am looking for my first job, ideally in a big company. I want to learn, and meet like-
minded people in work. In my free time I like to run, read, and meet with friends. I try to have
positive outlook of life, and take everything that comes my way as an opportunity to become a
better person.

Question no. 2: Why did you apply for this job?

int: Motivation is one of the deciding factors in every single job interview. Do you apply for a job just
because you want to earn money, or graduated from the field? Do you apply only because you need a
job, or do you really want to have this particular position? Your goal is to convince the employer that
you genuinely want to work for them, and that you have a good reason for choosing their offer (and not
an offer of one of their competitors).

Pre-interview research should help you to find a good answer. You should learn something about
the working environment, their vision and goals, the value they bring to their customers and
business partners. Try to look for something that goes beyond your personal role in the
company, something you can praise, something that resonates with you.

I really like the job description and believe I can fit here, and bring some value to your team of
financial analysts. On the top of that, I have the right education  for this position, and I would
enjoy working in an international environment.

Your store is just ten minute away from my apartment, and I shop here regularly. I like the way
you approach customers, and I would be proud do be a member of your team. On the top of that,
I like the vision of your company, the way this store is organized, and overall I have a good
feeling about the place.

Question no. 3: Why did you leave your last job? / Why are you planning to leave your
present job?

Hint: Changing a job, or even a career, is completely normal. Nevertheless, employers want to
understand why you plan to make a change, or why you were forced to make your move. They
try to understand whether they can count with you in a long run, and how it will feel to work
with you.  Do you look for good things, or for bad things in a job? Do you demand a lot from
your colleagues, or do you demand a lot from yourself?
Regardless of your past experience, you should focus on  good things. Even if they fired you in
your last job (for no real reason), try to speak nicely about your former colleagues and
employers. Nobody wants to hire an employee who will complain about everything, a person
who always looks for the worst…

I had my job in a restaurant for four years. I enjoyed the company of my colleagues, and believe
that I helped the guests to enjoy the place. But I needed a change. The duties were repetitive, and
I felt I was not moving forward anymore. That’s why I left, and decided to apply for your offer,
as I really see a potential for learning and growing in your company.

They fired me because I had a different opinion than the director of the company. Nothing wrong
with him—we just had a different philosophy of leadership, and how things should be done.
Maybe he was right, maybe I was—only time will tell. But I do not want to live in the past. Now
I am here, looking for a new challenge, and an opportunity to help your company to prosper.

Question no. 4: Can you tell me something about your education?

Hint: A degree has never made a good employee of anyone. Nonetheless, HR managers will
often inquire about your education, trying to understand your attitude to learning.

You should focus on the practical skills and abilities that will help you in your new job.
These matter more than the names of degrees and educational institutions–unless you graduated
from Harvard or Cambridge, obviously :).

I have studied at ABC University. I acquired knowledge of statistics, project management and
accounting, beside many other subjects. I took part in projects and competitions we had at
school. I believe that my education and internship that followed prepared me perfectly for a job
in your company.

uestion no. 5: Can you tell us something  about your working experience?

Hint: Employers can read about your experience on your resume. Nevertheless, they want to
hear what matters to you, and they want to see your attitude to work. You should pick one or
two roles that are most relevant for your current job application, and then you should speak about
your duties, achievements, and lessons you learned while having them.

If you had just one job in the past, and it was completely irrelevant to the one you try to get,
you can at least say that the experience helped you to gain basic working habits, and simply to
prepare for an employment in general.

I have worked only at Walmart so far. But I learned a lot there, how to approach the customers,
how to work with other people. It is not such as easy job as it seems, since the workload is heavy
most days. But I do not complain, just I hope to get a better job now, and learn something new
again.
As you can see on my resume, this is my first job application. But I have done some volunteering
for Red Cross, and I worked a lot with my father while we were renovating the house. I believe
that I know what it means to have a job, and I am eager to finally start working somewhere, after
many years of studying, and preparing for employment.

Question no. 6: Why should we hire you (and not someone else)?

Hint: If someone hires you for a job, they will pay you a monthly salary, and they will also pay
money to the government–just for having you onboard. Will you become a great investment,
an asset for their team, or will they just lose money hiring you? HR managers try to find the
answer.

This is arguably one of the most difficult questions. You should focus on something unique, a
value you can bring to their team. Sample answers should give you some inspiration. And
when you can not find anything special, you can at least list relevant skills and abilities that
make from you a great candidate for the job.

I had the very same job with one of your competitors, and I can bring a new perspective to your
team. We can talk about things they did better, and I believe my feedback and experience will
help to improve your own results.

I am young, eager to learn, and motivated to work hard. I have passion for numbers, and I would
really enjoy having this job. Of course I haven’t met the other applicants for the job, and it is
hard to tell whether I am the best one.

Question no. 7: What are your strengths?

Hint: Professional interviewers should identify your strengths—without inquiring about them.
They get their salary for this capacity. Nevertheless, you can meet a variety of bodies in your
interview. Sometimes the person leading the meeting can have little or no experience with
interviewing people for the job (think owners of small business, or HR generalists who are just
starting their career). In this case, the question makes at least some sense.

You should pick relevant strengths. If possible, you should elaborate on your answer, saying how
you demonstrated your strengths in your career, how they helped you in the jobs you had (if you
had any jobs before).

I love to talk to people, and I believe I do understand them well—what they need and desire in
their lives. My empathy helped me in my volunteering experience in a nursing home, and I hope
to use this strength in my career as a social worker.

Responsibility is my greatest strength. I consider my job the first priority, and it has never
happened to me that I came late to work, or that I did not finalize my tasks in time.
Question no. 8: What are your weaknesses?

Hint: I will repeat myself. Professional interviewers should identify your principal weaknesses
after talking to you for five minutes, or even for less. At least I can do that :). But anyone can
lead an interview with you, and good interviewers often also use this question, trying to see what
you think about yourself. Can you admit having a weakness? Are you humble, or over-
confident?

Those who believe to have no weaknesses can hardly move forward in life, since they do not see
any areas for improvement. This is not a picture you want to present in an interview. Show us
your weaknesses, and tell us how you work to improve on them.

I am not very patient. That’s obviously bad. But I am working on it, trying to control myself,
staying tolerant to my colleagues. It is not easy, but I have definitely made some progress in
recent years.

Sometimes I struggle to focus on my duties. However, I practice every day, trying to eliminate
useless thoughts, and my concentration has improved over the years. I still continue working on
it though, trying to eliminate distractions in work.

Question no. 9: What are your goals in five years time?

Hint: Every responsible person has some goals. When recruiters ask you about your goals and
dreams, first of all they want to hear that you have some goals. Secondly, your goals should
somehow relate to their business, or at least they should not interfere with their goals and
dreams.

For example, if you dream about running your own business, or about traveling the world, avoid
mentioning it in your answer. Companies do not want to hire people who will leave them after a
year of employment, to pursue their traveling or entrepreneur dreams…

Goals do change, and nobody can blame you for changing your mind after working in a company
for a few months (or even only for a few weeks). Once in an interview, however, you should say
things that will help you to get the job.

I would like to have a managerial role in five years time. However, I understand that I need to
learn a lot before it can happen, and I believe that this entry-level position in your company is a
perfect starting point for my career.

I do not dream much about the future. If I have a teaching job, and if I do it well and get a good
feedback form my students, it will make me happy in my life. That’s likely my only goal—to be
happy, and to do my best in both professional and personal life.
Question no. 10: Tell us about your greatest achievement.

Hint: Employers try to find out if you have just “gone to the job” (or to the school), or if you
actually tried to achieve something while doing your routine.

Whenever possible, you should speak about your achievements from the perspective of an
employer (helping them to find new customers, helping them to improve their reputation,
building good atmosphere on the workplace, earning more money, etc), rather than achievements
from your own perspective (getting promoted, earning a degree or certification, etc).

If you have no other option, however, you can talk about personal promotion, employee of the
month award, or other recognition of your good work for the employer. If you apply for your
first job, however, you can speak about achievements from your personal life. For example, a
chain smoker who managed to quit smoking recently shows their strong determination and
will.

When I worked in sales at ABC Inc., our sales volume grew by twenty percent or more each
year. It was a team work, and we helped their business a lot.

I have become a better person over the years. I learned to listen to others, and to see the good
things in people, which is something I had struggled to do early in life. I consider this my biggest
achievement, since it made my life better, and I hope people enjoy my company more.

Question no. 11: What characterize a good boss/ colleague from your point of view?

Hint: You won’t work alone. Employees interact with each other, and the interviewers try to find
out if you can fit into the team. You should avoid going for something personal in your answer,
for example saying that you prefer young colleagues, or that you work better under a boss who is
older than you. Such an answer could easily backfire—if a boss was a young man, they would
not hire you. I advise you to mention something general, and to emphasize that you can get
along with anyone.

Ideal boss doesn’t exist, and it doesn’t even matter to me. I want to focus on my job, and on my
duties, and I try to avoid any conflicts with other employees.

Everyone is different, and I respect the individuality of each person. But I do not try to think
much about my colleagues, what they should do better, how they should act in their job. I simply
prefer to focus on my own duties, and good attitude to other people. That is the only thing I can
control.

I can get along with anyone, and I do not have special preferences. The most important thing is
to see that my colleagues try their best in work, day in day out. But whether they are old or
young, whether they like dancing or watching movies doesn’t make any difference to me.
Question no. 12: What motivates you in work?

Hint: Interviewers try to find out whether you work only for money, or are driven by
something else, a meaningful purpose you see in your job, or at least your desire to make
someone else happy. Your motivation is actually tested during the entire interview, and you
should demonstrate it with the enthusiasm for the job offer, for your future, and for the world in
general.

Answering this particular question, however, you should speak openly about your motivation,
something that drives you forward. It can be a desire to help people (great choice for a nurse, a
social worker, a teacher), and it can be a desire to support your own family, simply a goal to
live well. One way or another, a good answer should always exceeds your own personal needs
and desires.

Meaningful purpose of this job motivates me. I would be proud to teach young children, as I
believe I can become a good role model for them. And I do not want to be a bad role model, so
you can be sure I’d try my best in each class.

I have a family, and I love them. I try my best to support them, and this job would help me
greatly. While it is not the most fascinating job one can have, it is definitely fine for me. Even if
it gets boring sometimes in work, I always try my best. It’s not for my own sake…

Question no. 13: What are your salary expectations?

Hint: If they start talking about salary it is mostly a good sign. It means that they consider
hiring you (unless they just blindly follow an interview template, and ask every job candidate
exactly the same questions).

Anyway, you should say that your salary is not a deciding factor, and that you didn’t apply
having a number on your mind. If they insist on hearing a number, however, you should have
something to backup your claim (the statistics about an average salary for the position, the sum
of money you earned in your last job, etc.). Let’s have a look at some answers.

I like the job description, I like your bank, and I would be happy to have this job. But as far as
my knowledge goes, average salary for a teller in your institution starts at $29,000. I would
accept that number for the start.

This is my first job application, and I am motivated to learn. I understand it is an entry level
position, so the salary offer won’t be great. At the same time, however, the possibilities of
promotion are almost endless, so I would accept your standard salary offer for the newcomers.

Question no. 14: When can you start?

Hint: Most employers prefer to see their new hires on board as soon as possible. If you can
start immediately, say it, and stress that you are not waiting for any other interviews. And if you
can not start immediately (bearing in mind notice period requirements, or other reasons), explain
it clearly.

You can even turn this answer to your advantage. You can show you right attitude to work,
saying that it would be irresponsible to leave your current employer without finishing the work
you have started.

I am eager to start as soon as possible. I have applied also for two other job offers, but this one is
my first choice. If you need me tomorrow, I can be here in the morning.

I could possibly start tomorrow, but I want to finish the project I currently work on with my
employer. It would be unprofessional if I just left. I need two or three weeks at least to finish it,
and then I can start working here. But I am ready to sign the contract today, and you can be sure
that I won’t change my mind about your offer.

Question no. 15: Do you have any questions?

Hint: You will get a chance to ask some questions in your interview. It is good to ask one or two
questions at least, since it shows that you still want the job, after everything that has been said
and done in your interview.

But you should not ask about something that was already discussed, or about something that
was clearly explained on the job description. Focus on their working environment, next steps of
recruitment process, company culture, their goals and plans, their product portfolio.

What are the next steps of recruitment process? Is there anything else I can do to improve my
chances of getting this job?

I really like your product ABC. Can you tell me more about the plans you have with the product,
and the innovation you plan in the future?

Do you set any goals for sales managers, such as monthly sales volume?
Top 10 care essentials for ventilator patients

Care essential 1: Review communications

Communication among care providers promotes optimal outcomes. For mechanically ventilated
patients, care providers may include primary care physicians, pulmonary specialists, hospitalists,
respiratory therapists, and nurses.

To make sure you’re aware of other team members’ communications about the patient, find out
the goals of therapy for your patient when obtaining report. Why is she on a ventilator? To
improve oxygenation? Boost ventilation? Permit sedation? Reverse respiratory muscle fatigue?
Why is she on your unit? Because she has an underlying condition that complicates weaning
from the ventilator? What is her do-not-resuscitate status?

Communicating with the patient is essential, too. Provide writing tools or a communication
board so she can express her needs. Ask simple yes/no questions to which she can nod or shake
her head.

Care essential 2: Check ventilator settings and modes

When you enter the patient’s room, take vital signs, check oxygen saturation, listen to breath
sounds, and note changes from previous findings. Also assess the patient’s pain and anxiety
levels.

Read the patient’s order and obtain information about the ventilator. Compare current ventilator
settings with the settings prescribed in the order. Familiarize yourself with ventilator alarms and
the actions to take when an alarm sounds. Locate suction equipment and review its use. Look for
a bag-valve mask, which should be available for every patient with an artificial airway; be sure
you know how to hyperventilate and hyperoxygenate the patient.

Ventilator settings and modes

Generally, ventilators display ordered settings and patient parameters. Check the following
settings:

 respiratory rate, the number of breaths provided by the ventilator each minute. Manually count
the patient’s respiratory rate, because she may be taking her own breaths at a rate above the
ventilator setting.
 fraction of inspired oxygen (FiO2), expressed as a percentage (room air is 21%).
 tidal volume (TV or VT), the volume of air inhaled with each breath, expressed in milliliters
 peak inspiratory pressure (PIP), the pressure needed to provide each breath. Target PIP is below
30 cm H2O. High PIP may indicate a kinked tube, a need for suctioning, bronchospasm, or a lung
problem, such as pulmonary edema or pneumothorax.
To find out which ventilation mode or method your patient is receiving, check the ventilator
itself or the respiratory flow sheet. The mode depends on patient variables, including the
indication for mechanical ventilation.

Modes include those that provide specific amounts of TV during inspiration, such as assist-
control (A/C) and synchronized intermittent mandatory ventilation (SIMV); and those that
provide a preset level of pressure during inspiration, such as pressure support ventilation (PSV)
and airway pressure release ventilation. PSV allows spontaneously breathing patients to take
their own amount of TV at their own rate. A/C and continuous mandatory ventilation provide a
set TV at a set respiratory rate. SIMV delivers a set volume at a set rate, but lets patients initiate
their own breaths in synchrony with the ventilator.

Some patients may receive adjuvant therapy, such as positive end-expiratory pressure (PEEP).
With PEEP, a small amount of continuous pressure (generally from +5 to +10 cm H2O) is added
to the airway to increase therapeutic effectiveness. In many cases, PEEP is added to reduce
oxygen requirements.

Finally, determine if a capnography monitor is recording the patient’s partial pressure of exhaled
carbon dioxide (pCO2). Capnography, which reflects ventilation, can detect adverse respiratory
events, such as tracheal-tube malpositioning, hypoventilation, and ventilator circuit problems.
The capnography waveform should be square; generally, the value should be in the normal pCO2
range of 35 to 45 mm Hg. (See Normal capnography waveform by clicking the PDf icon above.)
To better understand your patient’s ventilation status, check for trends in waveforms and values
rather than focusing solely on single events.

Care essential 3: Suction appropriately

Patients receiving positive-pressure mechanical ventilation have a tracheostomy, endotracheal, or
nasotracheal tube. Most initially have an
endotracheal tube; if they stay on the ventilator for many days or weeks, a tracheotomy may be
done. Tracheotomy decisions depend on patient specifics. Controversy exists as to when a
tracheotomy should be considered; generally, patients have tracheotomies before being managed
on a med-surg unit.

Although specific airway management guidelines exist, always check your facility’s policy and
procedure manual. General suctioning recommendations include the following:

 Suction only as needed—not according to a schedule.

 Hyperoxygenate the patient before and after suctioning to help prevent oxygen desaturation.
 Don’t instill normal saline solution into the endotracheal tube in an attempt to promote
secretion removal.
 Limit suctioning pressure to the lowest level needed to remove secretions.
 Suction for the shortest duration possible.

If your patient has an endotracheal tube, check for tube slippage into the right mainstem
bronchus, as well as inadvertent extubation. Other complications of tracheostomy tubes include
tube dislodgment, bleeding, and infection. To identify these complications, assess the tube
insertion site, breath sounds, vital signs, and PIP trends. For help in assessing and managing tube
complications, consult the respiratory therapist.

If your patient has a tracheostomy, perform routine cleaning and care according to facility
policies and procedures.

Care essential 4: Assess pain and sedation needs

Even though your patient can’t verbally express her needs, you’ll need to assess her pain level
using a reliable scale. Keep in mind that a patient’s acknowledgment of pain means pain is
present and must be treated. Two scales that help you evaluate your patient’s sedation level are
the Richmond Agitation Sedation Scale and the Ramsay Sedation Scale.

Should you restrain an agitated ventilator patient to prevent extubation? Research shows self-
extubation can occur despite physical restraints. It’s best to treat agitation and anxiety with
medication and nonpharmacologic methods, such as communication, touch, presence of family
members, music, guided imagery, and distraction.

Care essential 5: Prevent infection

Ventilator-associated pneumonia (VAP) is a major complication of mechanical ventilation.
Much research has focused on how best to prevent VAP. The Institute for Healthcare
Improvement includes the following components in its best-practices VAP prevention “bundle”:

 Keep the head of the bed elevated 30 to 45 degrees at all times, if patient condition allows.
Healthcare providers tend to overestimate bed elevation, so gauge it by looking at the bed
frame rather than by simply estimating.
 Every day, provide sedation “vacations” and assess readiness to extubate, indicated by vital
signs and arterial blood gas values within normal ranges as well as the patient taking breaths on
her own.
 Provide peptic ulcer disease prophylaxis, as with a histamine-2 blocker such as famotidine.
 Provide deep vein thrombosis prophylaxis, as with an intermittent compression device.
 Perform oral care with chlorhexidine daily.

Other measures that decrease VAP risk include extubating the patient as quickly as possible,
performing range-of-motion exercises and patient turning and positioning to prevent the effects
of muscle disuse, having the patient sit up when possible to improve gas exchange, and
providing appropriate nutrition to prevent a catabolic state. Assess the patient’s tolerance when
she performs an activity by checking vital signs, oxygenation status, and pain and agitation
levels.

Keeping bacteria out of oral secretions also reduces VAP risk. Use an endotracheal tube with a
suction lumen above the endotracheal cuff to allow continuous suctioning of tracheal secretions
that accumulate in the subglottic area. Don’t routinely change the ventilator circuit or tubing.
Brush the patient’s teeth at least twice a day and provide oral moisturizers every 2 to 4 hours.
Care essential 6: Prevent hemodynamic instability
Monitor the patient’s blood pressure every 2 to 4 hours, especially after ventilator settings are
changed or adjusted. Mechanical ventilation causes thoracic-cavity pressure to rise on
inspiration, which puts pressure on blood vessels and may reduce blood flow to the heart; as a
result, blood pressure may drop. To maintain hemodynamic stability, you may need to increase
I.V. fluids or administer a drug such as dopamine or norepinephrine, if ordered.

High levels of inspiratory pressure with PSV and PEEP increase the risk of barotrauma and
pneumothorax. To detect these complications, assess breath sounds and oxygenation status often.
To help prevent these conditions, use the lowest pressure level for ventilator-delivered breaths
and adjust the level as tolerated.

Care essential 7: Manage the airway

The cuff on the endotracheal or tracheostomy tube provides airway occlusion. Proper cuff
inflation ensures the patient receives the proper ventilator parameters, such as TV and
oxygenation. Following hospital policy, inflate the cuff and measure for proper inflation pressure
using the minimal leak technique or minimal occlusive volume. These techniques help prevent
tracheal irritation and damage caused by high cuff pressure; always practice them with an
experienced nurse or respiratory therapist. Never add air to the cuff without using proper
technique.

When performing mouth care, suction oral secretions and brush the patient’s teeth, gums, and
tongue at least twice a day using
a soft pediatric or adult toothbrush. Use a tonsil suction device if your patient needs more
frequent suctioning.

With assistance from an experienced colleague, change the tracheostomy tube or tracheostomy
ties and endotracheal tube-securing devices if they become soiled or loose. Incorrect technique
could cause accidental extubation.

Care essential 8: Meet the patient’s nutritional needs

For optimal outcomes, ventilator patients must be well nourished and should begin taking
nutrition early. But like any patient who can’t swallow normally, they need an alternative
nutrition route. Preferably, they should have feeding tubes with liquid nutrition provided through
the gut. If this isn’t possible, the healthcare team will consider parenteral nutrition.

Patients with tracheostomy tubes may be able to swallow food. Follow the physician’s orders
and consult speech and respiratory therapists.

Care essential 9: Wean the patient from the ventilator

appropriately
As your patient’s indications for mechanical ventilation resolve and she’s able to take more
breaths on her own, the healthcare team will consider removing her from the ventilator. Weaning
methods may vary by facility and provider preference. Although protocols may be used to guide
ventilator withdrawal, the best methods involve teamwork, consistent evaluation of patient
parameters, and adjustment based on these changes.

Some patients may need weeks of gradually reduced ventilator assistance before they can be
extubated; others can’t be weaned at all. Factors that affect ease of weaning include underlying
disease processes, such as chronic obstructive pulmonary disease or peripheral vascular disease;
medications used to treat anxiety and pain; and nutritional status.

Care essential 10: Educate the patient and family

Seeing a loved one attached to a mechanical ventilator is frightening. To ease distress in the
patient and family, teach them why mechanical ventilation is needed and emphasize the positive
outcomes it can provide. Each time you enter the patient’s room, explain what you’re doing.
Reinforce the need and reason for multiple assessments and procedures, such as laboratory tests
and X-rays. Communicate desired outcomes and progression toward outcomes so the patient and
family can actively participate in the plan of care.

Caring for a patient on mechanical ventilation requires teamwork, knowledge of care goals, and
interventions based on best practices, patient needs, and response to therapy. Mechanical
ventilation has become a common treatment, and nurses must be knowledgeable and confident
when caring for ventilator patients.

Impaired Spontaneous Ventilation

Nursing Diagnosis

 Impaired Spontaneous Ventilation

May be related to

 Acute respiratory failure

 Metabolic factors
 Respiratory muscle fatigue

Possibly evidenced by

 Adventitious breath sounds

 Apnea
 Apprehension
 Arterial ph less than 7.35
 Decreased tidal volume
 Decreased oxygen saturation (Sao2 <90%)
 Decreased Pao2 level (>50 to 60 mm Hg)
  Diminished lung sounds
 Dyspnea
 Forced vital capacity less than 10 mL/kg
 Increased Paco2 level (50 to 60 mm Hg or higher)
 Increased or decreased respiratory rate
 Inability to maintain airway (emesis, depressed gag, depressed cough).
 Restlessness

Desired Outcomes

 Client will maintain spontaneous gas exchange resulting in reduced dyspnea, normal oxygen
saturation, normal arterial blood gases (ABGs) within client parameters.
 Client will demonstrate an absence of complications from the mechanical ventilation.

Nursing Interventions Rationale

Prior intubation assessment:

Early signs of hypoxia include disorientation,

Observe for changes in the level of consciousness. irritability, and restlessness. While lethargy, stupor,
and somnolence are considered as late signs.

Changes in the respiratory rate and rhythm are

Assess the client’s respiratory rate, depth, and
pattern, including the use of accessory muscles.
early signs of possible respiratory distress. As
moving air in and out of the lungs becomes more
difficult, the breathing pattern changes to include
the use of accessory muscles to increase chest
excursions.

Tachycardia may result from hypoxia; Increased in

blood pressure happen in the initial phases then
Assess the client’s heart rate and blood pressure.
followed by lowered blood pressure as the
condition progresses.

Adventitious breath sounds such as wheezes and

Auscultate the lung for normal or adventitious crackles are an indication of respiratory difficulties.
breath sounds. Quick assessment allows for early detection of
deterioration or improvement.

Assess the skin color, examine the lips and nailbeds an excessive concentration of deoxygenated blood
for cyanosis.
Monitor oxygen saturation using pulse oximetry.
Monitor arterial blood gases (ABGs) as indicated.
After intubation assessment:
 Assess for correct endotracheal (ET) tube
placement through:
o Observation of a symmetrical rise
of both chest sides.
o Auscultation of bilateral breath
sounds.
o X-ray confirmation.
 Assess for client’s comfort and the ability
to cooperate while on mechanical
ventilation.
Bluish discoloration of the skin (cyanosis) indicates
and that breathing pattern is ineffective to
maintain adequate tissue oxygenation.
Pulse oximetry is useful in detecting early changes
in oxygen. Oxygen saturation levels should be
between 92% and 98% for an adult without any
respiratory difficulties.
Increasing Paco2 and decreasing PaO2 indicates
respiratory failure. If the client’s condition begins
to fail, the respiratory rate and depth decreases
and Paco2 begin to rise.
Correct ET tube placement is important for
effective mechanical ventilation.
Client discomfort may be secondary to incorrect
ventilator settings that result in insufficient
oxygenation. Once intubated and breathing on the
mechanical ventilator, the client should be
breathing easily and not “fighting or bucking” the
ventilator.
  Assess the ventilator settings and alarm Assessment ensures that settings are accurate and
system every hour. alarms are functional.

Therapeutic interventions prior to intubation:

 Maintain the client’s airway. Use the oral An artificial airway is used to prevent the tongue
or nasal airway as needed. from occluding the oropharynx.

This position promotes oxygenation via maximum

chest expansion and is implemented during events
 Maintain client in a High-Fowler’s position
as tolerated. Frequently check the position. of respiratory distress. Do not let the client slide
down; this causes the abdomen to compress the
diaphragm, which could cause respiratory change.

Deep breathing facilitates oxygenation. A deep

 Encourage deep breathing and coughing
exercises. cough is effective in clearing mucus out of the
lungs.

 Use nasotracheal suction as needed if

Suctioning is needed to clients who are unable to
coughing and deep breathing are not
useful. remove secretions from the airway by coughing.

Preparation for endotracheal intubation:

Mechanical ventilators are classified according to

 Notify the respiratory therapist to bring a the method by which they support ventilation. The
mechanical ventilator. two types are negative-pressure and positive-
pressure ventilators (used most frequently).

 If possible, before intubation, explain to

the client the steps and purpose of the
Preparatory information can decrease anxiety and
procedure and the temporary inability to
speak (due to the ET tube passing through promote cooperation with intubation.
the vocal cords).

Prepare the following equipment:

 Endotracheal tubes come in various sizes and
 ET tubes of different sizes. shapes. Adult sizes range from 7 to 9 mm. Selection
is based on the client’s size.

Blades and scopes facilitate the opening of the

upper airway and visualization of the vocal cords
 Blades, laryngoscope, and stylet for placement of oral ET tubes. A stylet makes the
ET tube firmer and gives additional support to
direction during intubation.

A syringe is used to inflate the balloon (cuff) after

 Syringe, benzoin, and waterproof tape or
other securing materials. the ET tube is in position. Tape and benzoin are
used to secure the ET tube.

 Local anesthetic agent (e.g., Xylocaine

These anesthetic agents suppress the gag reflex
spray or jelly, benzocaine spray, cocaine,
lidocaine, and cotton-tipped applicators. and promote general comfort.

Administer sedation as ordered. Sedation facilitates comfort and ease of intubation.

Assist with intubation:

 Place the client in a supine position,

hyperextending the neck unless
This position is necessary to promote visualization
contraindicated and aligning the client’s
oropharynx, posterior oropharynx, and of landmarks for accurate tube insertion.
trachea.

 Apply cricoid pressure as directed by the
physician.
 Provide oxygenation and ventilation using
an Ambu bag and mask as needed before
and after each intubation attempt. If
intubation is difficult, the physician will
stop periodically so that oxygenation is
maintained with artificial ventilation by the
Ambu bag and mask.
Therapeutic interventions after intubation:
 Assist with the verification of correct ET
tube placemen. Use a carbon dioxide
detector as indicated.
 Continue with manual Ambu bag
ventilation until the ET tube is stabilized.
Assist in securing the ET tube once tube
placement is confirmed.
Use of cricoid pressure to prevent passive
regurgitation during rapid sequence intubation. It
may also prevent passive regurgitation of gastric
and oesophageal contents.
This provides assisted ventilation with 100%
oxygen before intubation. Increasing oxygen
tension in the alveoli may result in more oxygen
diffusion into the capillaries.
Correct placement is needed for effective
mechanical ventilation and to prevent
complications associated with malpositioning such
as vomiting, hypoxia, gastric distention, lung
trauma. The carbon dioxide detector is attached to
the ET tube immediately after intubation to verify
tracheal intubation. Other capnography devices
that provide numerical measurements of end-tidal
carbon dioxide (normal value is 35 to 45 mm Hg)
and capnograms may also be used.
Stabilization is necessary before initiating
mechanical ventilation.
 Document the ET tube position, noting the Documentation provides a reference for
centimeter reference marking on the ET determining possible tube displacement, usually 21
tube. cm for the women and 23 cm at the lips for men.

 Insert an oral airway and/or bite block for An oral airway and/or block prevents the client
the orally intubated client. from biting down on the ET tube.

 Use bilateral soft wrist restraints as These restraints may prevent self-extubation of the
needed, explaining the purpose of their ET tube. Although all clients do not require
use. restraints to prevent extubation, many do.

Modes for ventilating (assist/control, synchronized

 Institute mechanical ventilation with
prescribed settings.
intermittent mandatory ventilation), tidal volume,
rate per minute, fraction of oxygen in inspired gas
(FIO2), pressure support, positive end-expiratory
pressure, and the like must be preset and carefully
evaluated for response.

Suction helps remove secretions. A Yankaeur

suction device should be available. Suctioning
 Institute aseptic suctioning of the airway. procedures should not be done frequently but as
needed only in order to lessen the risk for infection
and airway trauma.

Abdominal distention may indicate

 Anticipate the need for nasogastric and/or
oral gastric suction.
gastric intubation and can also occur after
cardiopulmonary resuscitation when the air is
inadvertently blown or bagged into the esophagus,
as well as the trachea. Suction prevents abdominal
distention. Oral gastric suctioning may also reduce
the risk for sinusitis.
  Administer muscle-paralyzing agents, These medications decrease the client’s work of
sedatives, and opioid analgesics as breathing, decrease myocardial work, and may
ordered. facilitate effective gas exchange.

 Examine the cuff volume by checking

whether the client can talk or make sounds Cuff pressure should be maintained at 20 to 30 mm
around the tube or whether exhaled Hg. Maintenance of low-pressure cuffs prevents
volumes are significantly less than volumes many tracheal complications formerly associated
delivered. To correct, slowly reinflate the with ET tubes. Notify the physician if the leak
cuff with air until no leak is detected. persists. The ET tube cuff may be defective,
Notify the respiratory therapist to check
requiring the physician to change the tube.
cuff pressure.

 Respond to alarms, noting that high-

pressure alarms may be of client resistance
or the client’s need for suctioning. A low-
pressure alarm may be a ventilator
disconnection. If the source of the alarm
cannot be located, ventilate the client with
an Ambu bag until assistance arrives.

Ineffective Airway Clearance

Nursing Diagnosis

 Ineffective Airway Clearance

May be related to

 Decreased energy and fatigue

 Endotracheal intubation
 Stasis of secretions

Possibly evidenced by

 Abnormal breath sounds

 Anxiety
 Dyspnea
 Excessive secretions
  Increased peak airway pressure
 Ineffective cough
 Restlessness

Desired Outcomes

 Client will maintain clear, open airways, as evidenced by normal breath sounds after suctioning.

Nursing Assessment

Assessment for Ineffective Airway Clearance for Mechanical Ventilation.

Nursingng Assessment Rationale

Thick, tenacious secretions increase airway

Observe the color, odor, quantity, and consistency
resistance and the work of breathing. A sign of
of sputum.
infection is discolored odoriferous sputum.

Diminished lung sounds or the presence of

Auscultate the lungs for the presence of normal or
adventitious sounds may indicate an obstructed
adventitious breath sounds.
airway and the need for suctioning.

Monitor oxygen saturation prior to and after This assessment provides an evaluation of the
suctioning using pulse oximetry. effectiveness of therapy.

Signs of respiratory compromise including

Assess arterial blood gases (ABGs).
decreasing Pao2 and increasing Paco2.

Increases in these parameters signal the

Monitor for peak airway pressures and airway
accumulation of secretions or fluid and the potential
resistance.
for ineffective ventilation.

Suctioning can be frightening to the client. Reinforce

Explain the suctioning procedure to the client; give
the need to maintain a patent airway. Provide
reassurance throughout the procedure.
sedation and pain relief as indicated.

Nursing Interventions

Interventions for Ineffective Airway Clearance for Mechanical Ventilation.

Nursing Interventions Rationale

Turning mobilizes secretions and helps prevent

Turn the client every 2 hours.
ventilator-associated pneumonia.
 The frequency of suctioning should be based on the
Institute airway suctioning as indicated based on the
client’s clinical status, not on a preset routine such
presence of adventitious breath sounds and/or
as every 2 hours. Oversuctioning can cause hypoxia
increased ventilatory pressure.
and injury to bronchial and lung tissue.

This technique decreases the infection rate, may

Use closed in-line suction. reduce hypoxia, and is often less expensive. Sterile
technique is a priority.

Saline instillation before suctioning has an adverse

Avoid saline instillation before suctioning.
effect on oxygen saturation.

Hyperoxygenation before, during, and after

endotracheal suctioning decreases hypoxia and
Hyperoxygenated as ordered.
cardiac dysrhythmias related to the suctioning
procedure.

Silencing alarms decrease the frequency of false

Silence any ventilator alarms during suctioning. alarms during suctioning and reduces stressful noise
Reset the alarms after suctioning. to the client. Alarms need to be turned on again
after suctioning to ensure safety.

Maintaining hydration increases ciliary action to

Administer an adequate fluid intake (IV and remove secretions and reduces viscosity of
nasogastric, as appropriate). secretions. It is easier to mobilize thinner secretions
with coughing

These medications decrease peak periods of pain

Administer pain medications, as appropriate, before
and assist with an effective cough needed to clear
suctioning.
secretions.

Chest physiotherapy includes the techniques of

Consult a respiratory therapist for chest
postural drainage and chest percussion to loosen
physiotherapy as indicated.
and mobilize secretions.

Risk for Decreased Cardiac Output

Nursing Diagnosis

 Risk for Decreased Cardiac Output

May be related to
  Mechanical ventilation
 Positive-pressure ventilation
Possibly evidenced by
 [not applicable]
Desired Outcomes
 Client will maintain adequate cardiac output, as evidenced by systolic BP within 20 mm Hg of
baseline; HR to 60 to 100 beats per minute with regular rhythm; strong peripheral pulses; urine
output greater than 30 ml/hour, warm, and dry skin; and normal level of consciousness.
Nursing Interventions
Assess the client’s level of consciousness, blood
pressure, heart rate, and hemodynamic
parameters if in place (central venous pressure,
pulmonary artery diastolic pressure (PADP), and
pulmonary capillary wedge pressure, cardiac
output).
Assess the capillary refill, skin temperature, and
peripheral pulses.
Monitor for dysrhythmias.
Monitor fluid balance and urine output.
Rationale
Mechanical ventilation can produce a decreased
venous return to the heart, resulting in decreased
BP, compensatory increased heart rate, and
decreased cardiac output. This may happen abruptly
with ventilator changes: rate, tidal volume, or
positive-pressure ventilation. The level of
consciousness will decrease if cardiac output is
severely compromised. Therefore close monitoring
during ventilator changes is imperative.
Pulses are weak with reduced stroke volume and
cardiac output. Capillary refill is slow with reduced
cardiac output. Cold, pale, clammy skin is secondary
to compensatory sympathetic nervous system
stimulation and associated with low cardiac output
and oxygen desaturation.
Cardiac dysrhythmias may result from the low
perfusion state, acidosis, or hypoxia.
Optimal hydration status is needed to maintain
effective circulating blood volume and counteract
the ventilatory effects on cardiac output. With
positive pressure ventilation, pressure from the
diaphragm decreases blood flow to the kidneys and
could result in a drop in urine output. The brain is
very sensitive to a decrease in blood flow and may
respond by releasing antidiuretic hormone (ADH) (to
increase water and sodium retention), further
 reducing urine output. After the initial decrease in
venous return to the heart, volume receptors in the
right atrium signal a decrease in volume, which
triggers an increase in the release of ADH from the
posterior pituitary and retention of water by the
kidneys.

Vigilant monitoring reduces the risk for

Notify the physician immediately of signs of a complications. Hypotension and decreased cardiac
decrease in cardiac output, and anticipate possible output may be related to positive-pressure
ventilator setting changes. ventilator itself or use of positive end-expiratory
pressure (PEEP) mode.

Volume therapy may be required to maintain

adequate filling pressures and optimize cardiac
Maintain an optimal fluid balance. output. However, if PADP and/or pulmonary
capillary wedge pressure rises and cardiac output
remains low, fluid restriction may be necessary.

Diuretics may be useful to maintain fluid balance if

Administer medications as ordered (diuretics,
fluid retention is a problem. Inotropic agents may be
inotropic agents).
useful to increase cardiac output.

Anxiety

Nursing Diagnosis

 Anxiety

May be related to

 Change in health status

 Change in environment
 Inability to communicate verbally
 Inability to breathe adequately without support
 Inability to maintain adequate gas exchange
 Unknown outcome

Possibly evidenced by

 Facial tension
 Focus on self
 Restlessness
 Tachypnea
  Uncooperative behavior
 Vigilant watch on equipment
 Withdrawal

Desired Outcomes

 Client will use effective coping mechanism.

 Client will describe a reduction in level of anxiety experienced.
 Client will demonstrate reduced anxiety as evidenced by calm manner and cooperative
behavior.

Nursing Interventions Rationale

Assess the client’s understanding of the need for Accurate appraisal can facilitate the development
mechanical ventilation. of appropriate treatment strategies.

Being on a mechanical ventilator can be a drastic

change that will produce a high level of anxiety.
Anxiety can affect the respiratory rate and pattern,
Assess the client for signs of anxiety.
resulting in rapid, shallow breathing and leading to
arterial blood gas abnormalities and the client
“fighting or bucking” the ventilator.

Decreasing stimuli provides a quiet environment

Reduce distracting stimuli. Inform the client of that enhances rest. Anxiety may escalate with
alarms on the ventilatory system, and reassure the excessive noise, conversation, and equipment
client about the close proximity of health care around the client. An informed client who
personnel to respond to alarms. understands the treatment plan will be more
cooperative.

Display a confident, calm manner and The presence of a trusted person may be helpful
understanding attitude. Be available to the client during periods of anxiety. An ongoing relationship
for support, as well as for explanations of the establishes a basis for comfort in communicating
client’s care and progress. anxious feelings.

Using anxiety-reduction techniques enhances the

Provide relaxation techniques.
client’s sense of personal mastery and confidence.

These activities enhance the client’s quality of life

Encourage sedentary diversional activities.
and help pass time.

The presence of significant others reinforces

Encourage visiting family and friends.
feelings of security for the client.

If impaired communication is the problem, provide These tools broaden the opportunity for
the client with word-and-phrase cards, a writing
pad, and pencil, or a picture board. communicating which may reduce frustrations.

Refer to the psychiatric liaison clinical nurse Specialty expertize may provide a wider range of
specialist, psychiatrist, or hospital chaplain, as treatment options and may be needed to achieve
appropriate. successful outcomes.

Deficient Knowledge

Nursing Diagnosis

 Deficient Knowledge

May be related to

 Cognitive limitation
 Decreased motivation to learn
 New treatment
 New environment

Possibly evidenced by

 Anxiety
 Expressing inaccurate information
 Questioning members of health care team

Desired Outcomes

 Client or significant others demonstrate knowledge of mechanical ventilation and care involved.

Nursing Interventions Rationale

Assess the client’s perception and understanding of This information provides an important starting
mechanical ventilation. point in education.

Educational interventions must be designed to meet

the learning limitations, motivation, and needs of
Assess the client’s readiness and ability to learn. the client. Clients in acute care may not be able to
take in much information because of fatigue, pain,
sensory overload, hypoxemia, and the like.

Questions facilitate open communication between

Encourage the client or significant others to express the client and health care professionals and allow
feelings and ask questions. the verification of understanding and the
opportunity to correct misconceptions.
Explain the importance of frequent assessment of
This information also helps reduce anxiety by
vital signs, auscultation of breath sounds, ventilation
providing a basis for actions.
checks.

The endotracheal tube passes through the vocal

Explain to the client the reason for the inability to cords and attempts to talk can cause more trauma
talk while intubated. Explain alternative efforts for to the cords. However, clients must understand how
communicating. to use supplementary methods for communication
such as paper, pen, pictures.

Explain that the client will not be able to eat or drink

The risk for aspiration is high if the client eats or
while intubated but assure him or her that
drinks while intubated. In long-term care settings,
alternative measures (IV fluids, gastric feedings, or
clients may be allowed to eat and drink after a
hyperalimentation) will be taken to provide
swallow evaluation.
nourishment.

Explain that alarms may periodically sound off,

which may be normal, and that the staff will be in Explaining expected events can help reduce anxiety.
close proximity.

This information can help reduce anxiety associated

Explain the need for suctioning as needed.
with the procedure.

Explain the weaning process and explain that

This information aids the client in maintaining some
extubation demonstrates adequate respiratory
control.
function and a decrease in pulmonary secretions.

If long-term ventilation is anticipated, discuss or

plan for long-term ventilator care management and Continuity of care is facilitated through the use of
use appropriate referrals: long-term ventilator specialty resources.
facilitates versus home care management.

Risk for Ineffective Protection

Nursing Diagnosis

 Risk for Ineffective Protection

May be related to

 Decreased pulmonary compliance

 Improper alarm settings
 Improper ventilator settings
 Increased secretions
  Positive-pressure ventilation
 Ventilator dependency
 Ventilator disconnection

Possibly evidenced by

 [not applicable]

Desired Outcomes

Nursing Interventions Rationale

Frequent assessment guarantees that the client is

Review the ventilator settings every hour. Notify receiving correct mode, rate, tidal volume,
the respiratory unit of any discrepancy in the FIo2, positive end-respiratory pressure (PEEP) and
ventilator settings immediately: pressure support. Important attention to details
can prevent problems.

The usual rate is between 10 to 14 breaths per

 Rate of mechanical breaths
minute.

Pressure support (PS) produces positive airway

 Pressure support (PS) pressure during the inspiratory cycle of a
spontaneous inspiratory effort.

Typical ranges for TV are 6 to 8 mL/kg of ideal body

 Tidal volume (TV) weight. Research supports lower standard TVs to
reduce barotrauma.

PEEP serves to improve gas exchange and prevent

 PEEP
atelectasis.

The amount of oxygen prescribed depends on the

 FIO2
client’s condition and ABG results.

Mode: 

Assist control (AC) delivers full ventilatory support

 Assist control (AC) by providing a preset tidal volume for each client-
initiated breath.

CMV ensures a preset rate with no sensitivity to the

  Controlled mandatory ventilation (CMV) client’s respiratory effort. The client cannot initiate
breaths or alter the pattern.

  Synchronized intermittent mandatory SIMV ensures a preset rate in synchronization with

 ventilation (SIMV)
Make sure that the ventilator alarms are on.
Assess respiratory rate and rhythm including the
work of breathing.
Assess arterial blood gases results and monitor
oxygen saturation.
Assess for the signs of pulmonary infection
including increased temperature, purulent
secretions, elevated white blood cell count, positive for these clients. Most ventilator-associated
bacterial cultures, and evidence of pulmonary
infection on chest X-ray studies.
Assess for the signs of barotrauma: the client with
crepitus, subcutaneous emphysema, altered chest
excursion, asymmetrical chest, abnormal ABGs, a
shift in trachea, restlessness, evidence of
pneumothorax on chest x-ray studies.
Monitor chest x-ray reports daily and obtain a stat
portable chest x-ray film if barotrauma is
suspected.
Monitor plateau pressures with the respiratory
therapist.
the client’s own spontaneous breathing.
The alarm alert the caregiver in cases of ventilation
problems. A quick response to alarm ensures the
correction of problems and maintenance of
adequate ventilation.
It is important to maintain the client in synchrony
with the ventilator and not permit “bucking” it.
Objective data guide the ventilator settings and
appropriate interventions.
VAPs occur in up to 28% of clients on ventilators.
Mortality rates of 40% to 50% have been reported
infections are caused by bacterial pathogens, with
gram-negative bacilli being common.
Barotrauma is damage to the lungs from positive
pressure as seen in clients with an acute respiratory
disease when high pressures are needed to
ventilate stiff lungs or when PEEP is used. Frequent
assessments are needed because barotrauma can
occur at any time and the client will not show signs
of dyspnea, shortness of breath, or tachypnea if
heavily sedated to maintain ventilation.
Vigilant monitoring helps to reduce complications.
Monitoring for barotrauma can involve measuring
plateau pressure, which is the pressure after
delivery of the tidal volume but before the client is
allowed to exhale. The ventilator is programmed so
that after delivery of the tidal volume the client is
not allowed to exhale for a half second. Therefore
pressure must be maintained to prevent exhalation.
Elevation of plateau pressures increases both the
risk and incidence of barotrauma when the client is
on mechanical ventilation. There has been less
occurrence of barotrauma since guidelines have
 recommended lower standard tidal volumes.

Listen for alarms. Know the range in which the

The ventilator is a life-sustaining treatment that
ventilator will set off the alarm and how to
requires prompt response to alarms:
troubleshoot:

The apnea alarm is indicative of disconnection or

 Apnea alarm
absence of spontaneous respirations.

The low exhale alarm indicates that the client is not

 Low exhale volume returning delivered TV (through disconnection or
leak).

The low-pressure alarm indicates a possible

 Low-pressure alarm disconnection or mechanical ventilator
malfunction.

The high peak pressure alarm indicates

bronchospasm, retained secretions, obstruction of
 High peak pressure alarm
ET tube, atelectasis, acute respiratory distress
syndrome (ARDS), or pneumothorax, among others.

Nosocomial infections are a leading cause of

Institute measures to reduce VAP.
mortality.

 Keep the head of bed elevated to 30 to 45

Elevation promotes better lung expansion. It also
degrees or perform subglottic suctioning
unless it is medically contraindicated. reduces gastric reflux and aspiration.

 Wash hands before and after suctioning,

An artificial airway bypasses the normal protective
touching ventilator equipment, and/or
coming into contact with respiratory mechanisms of the upper airways. Handwashing
secretions. reduces germ transmission.

 Brush teeth two to three times per day with

Oral care reduces colonization of the oropharynx
a soft toothbrush. Chlorhexidine-based
rinses may also be incorporated into oral with respiratory pathogens that can be aspirated
care protocols. into the lungs.

 Use a continuous subglottic suction

This intervention prevents the accumulation of
endotracheal (ET) tube for intubation that
is expected to be longer than 24 hours. secretions that can be aspirated.

This technique decreases the introduction of

 Use sterile suctioning procedures.
microorganisms into the airway.
Notify the physician of signs of barotrauma If barotrauma is suspected, intervention must
immediately; anticipate the need for chest tube follow immediately to prevent tension
placement, and prepare the client as needed. pneumothorax.

1.Tell me about yourself?

“First and foremost, I am totally dedicated to patient care and find this element of the role the most
rewarding. I am naturally a caring person and enjoy being in a role where I get the opportunity to
make a difference through both the treatment and care I provide, and also through educating patients
to lead better lives. I will make a competent nurse because I am thorough in both my approach to care
and assessment, I am able to follow strict rules and procedures, I have a passion to continually learn
and develop and I am also someone who can work hard under pressure and respond positively to the
challenges the nursing role presents itself. I feel confident that, if you employ me within this nursing
position, you will be impressed with my strong work ethics and my ability to contribute positively to
the nursing team.”

2. how do you manage stress?

“The first aspect of dealing with the stress of the nursing job is to understand exactly what is involved
in the role, the environment you will be working in, and also the situation most patients will find
themselves in. The nursing role requires you to work in a pressurized environment whereby people
are often anxious and under stress based on their illness or their upcoming treatment. On that basis,
you have to understand that people are not their normal self, and you have to take this into account
when helping them, caring for them and also treating them. I naturally have a calm nature and I will
not be put off by stressful situations whereby I have to perform under pressure. I can handle the
stress of the job because I believe I am a strong communicator who has the confidence in my own
abilities. The truth is, I would rather work in a pressurized and stressful environment because it is
times like these where I can really put my skills and experiences to good use.”

1. How well do you work with other nurses, doctors and staff?

When you answer this question, emphasise your interpersonal skills, such as teamwork, patience
and active listening.

Example: “During my clinical training in the emergency response room, I learned how
important it is to communicate well with other nurses. For example, I make sure to consult with
a senior nurse or doctor whenever I administer a new treatment or medicine to patients. Often,
doctors know the medical history of their patients in detail, so I find it best to consult with them
rather than go by the demands of the patient.”

2. How would you handle a difficult patient?

If you receive this question, consider giving an example of a time when you encountered a
difficult patient and helped to improve the patient's outcome.

Example: “I spent a year in a geriatric care facility and had to work with Alzheimer's and
dementia patients. Some of them could be considered difficult patients because they would
actively try to put themselves in harm. It takes great patience to help such patients. Often they
just want to be treated like adults and have some autonomy, however, it is important to ensure
that they eat, sleep and take their medicines properly. As a nurse, I had to make them
comfortable with my presence before tending to them.”

3. How do you handle workplace stress?

To answer this question, describe the techniques you have developed for stress relief. You can
discuss hobbies, support groups, exercise regimens and other ways you maintain a healthy
lifestyle.

Example: “Work becomes hectic very often as a nurse. I wake up early to take my dog out on
walks. I try out new cooking recipes in my spare time while listening to podcasts. I make sure
that I take sufficient time out on weekends for recreational activities at home or with friends.
When work becomes intense during peak hours, I perform simple breathing exercises to calm
myself down.”

Related: Self Management Skills: Definition and Examples

4. How do you handle a situation where your replacement does not arrive on time?

When a replacement does not arrive on time, some solutions you can offer to this situation
include contacting your replacement while you stay for a few minutes beyond your shift or
finding someone else to cover the responsibilities before your coworker arrives.
Example: “I contact my replacement roughly an hour before my shift ends to ensure that they
will arrive on time. If they communicate that there will be a delay or absence, I help them find a
substitute to take their shift or inform the senior nurse or doctor when I cannot find a substitute.
In either case, I make sure to not leave my post until my replacement arrives.”

5. How would you handle a disagreement with a doctor?

When you answer this question, emphasise your interpersonal skills such as active listening,
teamwork and your ability to follow the chain of command when necessary. In your response,
mention that you first work directly with the doctor to resolve the discrepancy.

Example: “Doctors may handle a lot more patients than nurses. Sometimes it becomes difficult
for them to keep track of medical records and patient histories accurately. When there is a
discrepancy between a doctor's instructions and a patient's medical records, I discuss the issue
in detail with the doctor to get it resolved before we take any further action. When we cannot
resolve it, we take a mutual decision to escalate it to a supervisor.”

6. Describe how you manage a busy workload.

When you respond to this question, highlight your dedication to attending to your patients during
a variety of conditions. In your response, you can provide an example of a time that you
managed more tasks without compromising protocols or procedures.

Example: “Whenever there are too many tasks ahead of me in a shift, I sit with the other nurses
to split all our tasks into smaller components and handle them one at a time. Usually, we devise
a workflow where a single person handles similar tasks. This way, we increase speed and
efficiency by working in groups and delegating tasks effectively.”

Related: Nursing Roles and Responsibilities: A Complete Guide

7. Do you have any professional affiliations?

Your response to this question is an opportunity to emphasise that you seek opportunities to
advance your skills. This is a good time to highlight any areas on your resume that list extra
certifications you have gained through organisations, ways you are involved in the organisations
and certain areas of nursing you are passionate about.

Example: “I am a volunteer for the Indian Red Cross Society chapter in my city. I assist them in
blood donation drives and occasionally accompany other volunteers and program leads on
disaster relief and rural health missions.”

8. How would you handle a crisis such as an outbreak?

Your response to this question can demonstrate your knowledge of how to address specific
medical situations and skills like teamwork and adaptability. For a strong answer, discuss your
ability to collaborate, your in-depth knowledge of nursing procedures and your attention to
detail.

Example: "During monsoons, malaria and dengue outbreaks are common in my city and its
peripheral areas. In these periods, we see a lot of patients with the same range of symptoms. I
have participated in awareness drives with the assistance of the city health department, hospital
associations and several NGOs. I have realised from my personal experience that it is easier to
prevent such outbreaks than to handle them at their peaks."

9. How would you handle a patient who struggles with pain management?

Empathy is a vital skill for nurses to use when interacting with patients who may have pain.
Express that you take your patients' concerns seriously and provide an example that shows you
can help them through empathy and problem-solving.

Example: “I have worked as a nurse in a gynaecology ward. Since many new mothers
breastfeed their babies, we are advised to not put them on strong pain medication or
anaesthesia. However, the pain can become difficult for patients to handle. I usually stay by
their side during these times and help provide alternate pain relief measures like balms, oils,
massages and breathing and stretching exercises.”

10. How do you respond when people ask for your personal diagnosis outside a clinical
setting?

To answer this question, briefly discuss how important it is to seek medical advice in a clinical
setting from medical professionals who have access to information from tests.

Example: “I am often approached by friends and family about ailments and health issues that
they may be experiencing. Although I may provide them with a speculative diagnosis, I always
refer them to a doctor so that they can get it looked at professionally.”