Which assessment finding indicates that the client needs another pancuronium dose if a client on mechanical ventilation is receiving pancuronium (Pavulon) I.V. as needed?

Ventilator provides the patient with assisted ventilation. However, if the patient is conscious he starts to fight the ventilator. When the patient starts to fight the ventilator you need to increase the dose of pancuronium to help the respiratory muscles relax.

This allows the patient to be sedated and breathe along with the assisted attempts of the ventilator. The dose is usually administered every 20 to 60 minutes while keeping an eye on the patient for any signs of revival. However, the other movements, such as the movement of the legs and fingers aren’t reliable indicators of increasing need of pancuronium.

Fighting the ventilator-rationale: pancuronium, a nondepolarizing blocking agent, is used for muscle relaxation and paralysis. it assists mechanical ventilation by promoting endotracheal intubation and paralyzing the client so he breathes in synchrony with the ventilator. fighting the ventilator is a sign that the client needs another pancuronium dose. the nurse should administer a dose i.v. every 20 to 60 minutes. movement of the legs, fingers, or lips has no effect on the ventilator and therefore isnt used to determine the need for another dose.client needs category: physiological integrityclient needs subcategory: pharmacological and parenteral therapiescognitive level: applicationreference: springhouse nurses drug guide 2007. philadelphia: lippincott williams & wilkins, 2007, p. 975.