Alaris® EtCO2 module
Topic 5: Responding to Alarms

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Low Respiratory Rate Alarms - Responding to Alarms Using the "APIE" Nursing Process1

Assess:

  • Respiratory distress or shortness of breath
  • Overmedicated and/or increased sedation
  • Were PCA doses recently increased2
  • Manually assess RR (count one full minute without stimulating patient)3
  • Wrong cannula selection (oral breathing versus nasal breathing)4
  • Snoring or possible obstruction (poor head/neck alignment)
  • Unauthorized use of PCA (PCA by proxy)
  • Cannula not connected correctly to patient or EtCO2 module

Plan:

  • Review PCA doses & physicians orders
  • Review RR and EtCO2 waveform
  • Review PCA/EtCO2 trend data for previous alarm/history

Intervention:

  • Always follow hospital protocols
  • Adjust PCA therapy as needed/ordered
  • Reposition/apply correct cannula
  • Consult RT/MD/other clinical resources
  • Re-educate family/patient on unauthorized PCA button use (PCA by proxy)
  • Improve airway obstruction/positioning

Evaluate:

Reevaluate patient

  • response (RR & EtCO2 waveform)
  • pain level
  • sedation level
  • unauthorized use of PCA
  • airway management (snoring, obstruction)
  • cannula placement

1Brunner & Suddarth’s Textbook of Medical Surgical Nursing 9th edition. Smltzer, S.C. & Bare, B.G. Ed. (2000). p. 29 Lippincott
2McCaffery, M., Pasero, C Pain Clinical Manual, Second Edition (1999) Mosby.
3Macintrye, P.E., Ready B.L. Acute Pain Management A Practical Guide Second Edition (2002). W.B. Saunders.
4Education PAK for Critical Care and Procedural Sedation CD-ROM Needham, MA Oridion Medical 2003.