NU656 Unit 6 Ventilator Plan for Moderate ARDS Example

Course	NU656 AGACNP Critical Care Management
Unit	Unit 6
Paper type	Ventilator management plan
Length	About 1,060 words, 6 pages double-spaced
Format	APA 7 student paper
School	Purdue University Global
Program	MSN
Updated	September 2026

Free sample paper for NU656 Unit 6

Calculated From Her Height, Not the Scale: A Ventilator Management Plan for Moderate ARDS After Aspiration in a 44-Year-Old Woman

[Student Name]

Purdue University Global

NU656: AGACNP Critical Care Management

Unit 6 Ventilator Management Plan

[Instructor Name]

[Date]

The patient is composite; values, settings and times are bracketed.

What this part is doingThe weight calculation opens the plan because every volume that follows depends on it.

The Patient and the Diagnosis

Ms. [R.], [44], has epilepsy; she vomited and aspirated during a generalized seizure at home. She was intubated in the emergency department for a depressed level of consciousness and hypoxemia. Twenty hours later her chest radiograph shows bilateral opacities that are not explained by effusion, collapse or nodules, and a bedside echocardiogram shows normal left ventricular function, so heart failure does not account for the edema. On [70] percent oxygen with a PEEP of [10] cm H2O, her arterial PaO2 is [74] mmHg. The ratio of PaO2 to FiO2 is therefore about [106].

These findings meet the Berlin definition: onset within one week of a known insult, bilateral opacities, respiratory failure not fully explained by cardiac failure or fluid overload, and a PaO2 to FiO2 ratio between 100 and 200 on a PEEP of at least 5, which places her in the moderate category (ARDS Definition Task Force, 2012). The plan below is built for that category and says what would change it.

Step One: Predicted Body Weight

Lung size follows height and sex, not weight, so the tidal volume is calculated from predicted body weight. For women the formula is 45.5 plus 0.91 times the height in centimeters minus 152.4 (Acute Respiratory Distress Syndrome Network, 2000).

45.5 + 0.91 x (163 minus 152.4) = 45.5 + 0.91 x 10.6 = 45.5 + 9.65 = [55.1] kg.

If her actual weight of [88] kg were used, a target of 6 mL/kg would deliver [528] mL, a volume that would overstretch a lung already reduced in size by edema and collapse. Using the correct weight, 6 mL/kg is [330] mL.

What this part is doingThe plan shows what the wrong weight would have produced, which is the error the calculation exists to prevent.

The Settings, Each With Its Reason

1. Mode: volume assist control. Reason: a set tidal volume guarantees the protective volume while she is sedated. Recheck: each shift. Change if: she is awake and breathing comfortably, when a pressure support trial is considered.

2. Tidal volume: [330] mL, 6 mL/kg of predicted body weight. Reason: the ARDS Network trial found lower mortality with 6 mL/kg and a plateau pressure of 30 or less than with 12 mL/kg (Acute Respiratory Distress Syndrome Network, 2000), and the 2017 guideline recommends volumes of 4 to 8 mL/kg with plateau pressures below 30 cm H2O (Fan et al., 2017). Recheck: plateau and driving pressure within [one] hour. Change if: driving pressure above 15.

3. Respiratory rate: [24] per minute. Reason: keeps minute ventilation near [7.9] liters to control carbon dioxide at the lower volume. Recheck: arterial gas at [one] hour. Change if: pH below 7.30, rate increased up to 35.

4. PEEP: [10] cm H2O, with FiO2 adjusted using the lower PEEP/FiO2 table. Reason: keeps alveoli open at the end of expiration and allows the oxygen fraction to come down. Recheck: saturation and gas after each change. Change if: oxygen targets are not met.

5. Oxygen target: PaO2 55 to 80 mmHg or saturation 88 to 95 percent. Reason: the trial protocol's range, which avoids both hypoxemia and needless high oxygen. Recheck: continuously by oximetry.

6. Plateau pressure: target 30 cm H2O or below, measured with a half-second inspiratory hold. Recheck: every [four] hours and after any volume change.

7. Driving pressure: plateau minus PEEP, target 15 cm H2O or below. Reason: in a pooled analysis of nine trials, driving pressure was the ventilation variable most strongly associated with survival, and reductions in tidal volume or increases in PEEP helped only when they lowered driving pressure (Amato et al., 2015). Recheck: with every plateau measurement.

8. pH target: 7.30 to 7.45, with permissive hypercapnia accepted if pH stays above 7.25 and there is no raised intracranial pressure concern after the seizure.

The First Adjustment

One hour after the settings began, the plateau pressure measured [27] cm H2O. With a PEEP of [10], the driving pressure was [17]. The plateau was within the limit, but the driving pressure was not. The tidal volume was reduced to [275] mL, 5 mL/kg of predicted body weight, and the rate was raised to [30] to hold minute ventilation near [8.3] liters. The repeat plateau was [24], giving a driving pressure of [14]. A plateau under 30 is not the end of the check; the driving pressure is what tells us whether this lung is tolerating this volume.

Thirty minutes after the change, her gas read pH [7.31] with a PaCO2 of [52] mmHg, which meets the pH target. The rate will not be pushed higher unless the pH falls below 7.30, because very fast rates shorten expiration and risk trapping air.

What this part is doingThe adjustment is written as numbers before and after, so the reader can see why the volume came down.

Prone Positioning

If the PaO2 to FiO2 ratio remains below 150 on an FiO2 of at least 0.6 and a PEEP of at least 5 after [12 to 24] hours of stabilization, she will be turned prone for sessions of at least [16] hours. In the PROSEVA trial, prone positioning started early in severe ARDS and maintained for long sessions reduced 28-day mortality from 32.8 percent to 16.0 percent (Guérin et al., 2013), and the 2017 guideline recommends prone positioning for more than 12 hours a day in severe ARDS (Fan et al., 2017). The team will check the airway, lines and pressure areas before each turn. Recheck: ratio at [06:00] tomorrow.

Sedation, Fluids and the Gate to a Breathing Trial

Sedation will be kept as light as oxygenation allows, with a daily interruption once her ratio is above 150. Fluids will be conservative once she is off vasopressors, since extra lung water worsens oxygenation. She remains on her antiseizure medication, and the neurology team will review her levels.

She will be screened each morning for a spontaneous breathing trial. The gate is met when the FiO2 is 0.40 or less with a PEEP of 8 or less, she is making her own breathing effort, she needs no more than a low dose of a vasopressor, and she can follow commands after the sedation pause. Until then, the protective settings above remain in place, and every change is written on the flowsheet with the number that prompted it.

What this part is doingThe plan ends on a stated gate rather than an open promise to wean, so the next team knows exactly when to try.

References

Acute Respiratory Distress Syndrome Network. (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. New England Journal of Medicine, 342(18), 1301-1308. https://doi.org/10.1056/NEJM200005043421801

Amato, M. B. P., Meade, M. O., Slutsky, A. S., Brochard, L., Costa, E. L. V., Schoenfeld, D. A., Stewart, T. E., Briel, M., Talmor, D., Mercat, A., Richard, J.-C. M., Carvalho, C. R. R., & Brower, R. G. (2015). Driving pressure and survival in the acute respiratory distress syndrome. New England Journal of Medicine, 372(8), 747-755. https://doi.org/10.1056/NEJMsa1410639

ARDS Definition Task Force. (2012). Acute respiratory distress syndrome: The Berlin definition. JAMA, 307(23), 2526-2533. https://doi.org/10.1001/jama.2012.5669

Fan, E., Del Sorbo, L., Goligher, E. C., Hodgson, C. L., Munshi, L., Walkey, A. J., Adhikari, N. K. J., Amato, M. B. P., Branson, R., Brower, R. G., Ferguson, N. D., Gajic, O., Gattinoni, L., Hess, D., Mancebo, J., Meade, M. O., McAuley, D. F., Pesenti, A., Ranieri, V. M., . . . Brochard, L. J. (2017). An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline: Mechanical ventilation in adult patients with acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 195(9), 1253-1263. https://doi.org/10.1164/rccm.201703-0548ST

Guérin, C., Reignier, J., Richard, J.-C., Beuret, P., Gacouin, A., Boulain, T., Mercier, E., Badet, M., Mercat, A., Baudin, O., Clavel, M., Chatellier, D., Jaber, S., Rosselli, S., Mancebo, J., Sirodot, M., Hilbert, G., Bengler, C., Richecoeur, J., . . . Ayzac, L. (2013). Prone positioning in severe acute respiratory distress syndrome. New England Journal of Medicine, 368(23), 2159-2168. https://doi.org/10.1056/NEJMoa1214103

NU656 Unit 6 instructions, in plain terms

The Unit 6 assignment asks you to write the ventilator orders for a patient with acute respiratory distress syndrome and justify each one. Prompts usually require the diagnosis confirmed against the Berlin definition, a predicted body weight calculation, initial settings with a reason for each, monitoring targets, and the conditions for escalation or weaning. Three to five pages in APA 7 is common, and the expected sources are the ARDS Network trial, the 2017 ATS/ESICM/SCCM guideline and trials for adjuncts such as prone positioning. The plan should read as orders another clinician could follow. Showing the arithmetic for the weight and the volumes, and stating a recheck time for every setting, is usually part of what earns the top band.

Inside the NU656 Unit 6 example

The case paragraph confirms moderate ARDS against the Berlin criteria and rules out a cardiac cause with a bedside echo. The predicted body weight formula for women is worked line by line to 55.1 kg, followed by the 528 mL the actual weight would have produced. Eight numbered settings follow, from mode to pH target, each with its reason, recheck and trigger for change, citing the ARDS Network trial and the Fan guideline. The first adjustment is written as numbers before and after: a plateau of 27 and driving pressure of 17, then 275 mL at a rate of 30 and a driving pressure of 14, citing Amato. PROSEVA supports the prone criteria, and a breathing trial gate closes the plan.

Reading the NU656 Unit 6 grading rubric

Points for this plan usually fall into diagnosis, calculation, setting rationale, monitoring and escalation, and scholarly support. The diagnosis row needs each Berlin criterion checked against the case, including the exclusion of heart failure. Calculation points go to a correct predicted body weight shown with its arithmetic. Setting rationale is typically the largest row, rewarding a reason drawn from evidence for each setting rather than one sentence covering all of them. Monitoring earns full credit when every setting has a recheck time and a condition for change. Escalation should name the numbers that trigger prone positioning and those that open the weaning gate. Sources should be the trials and guideline behind each threshold.

NU656 Unit 6 help: mistakes that cost points

The most damaging error is setting tidal volume from actual weight, which in a heavy patient can nearly double the volume. Another is checking plateau pressure and stopping there, without calculating driving pressure. Plans often list settings without saying when they will be rechecked or what would change them, which leaves the next team guessing. Some raise the rate very high to fix carbon dioxide and trap air as a result. Students sometimes mention prone positioning without the ratio, oxygen fraction and PEEP that should trigger it, or propose it for mild disease. And a weaning plan that says only "wean as tolerated" earns little, since the gate should be written in numbers.

Get an NU656 Unit 6 example written to your instructions

Height, sex, the admission gas and the ventilator settings from the NU656 Unit 6 case, plus your rubric, are all it takes. The plan follows within 24-48h, free as a first request, setting each value beside its reason, a recheck time and the reading that would alter it. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.

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NU656 Unit 6 questions, answered

Why does the plan use predicted rather than actual body weight?

Lungs scale with height and sex rather than with body mass, so a heavier patient does not have larger lungs. Predicted body weight comes from a formula using height, and protective tidal volumes are set per kilogram of it. The sample shows the calculation for this composite woman and the size of the error that actual weight would have introduced into every later setting.

What is driving pressure, and why add it to the table?

Driving pressure is plateau pressure minus PEEP, a rough measure of the strain each breath places on the lung that remains open. In a pooled analysis by Amato and colleagues, it was more strongly associated with survival than tidal volume or plateau pressure alone. The sample records it after each change and uses it to justify lowering the tidal volume.

Are these settings meant for a real ventilated patient?

No. They belong to an invented patient, and each figure is a bracketed placeholder. Ventilator orders for real patients come from the treating team, the respiratory therapists and the unit's protocols. The sample shows how a plan ties each setting to its reason and its recheck, which is the reasoning coursework in this unit is typically graded on.

Where can I find a free NU656 Unit 6 sample paper?

The complete NU656 Unit 6 ventilator management plan is on this page, with the Berlin check, the predicted body weight arithmetic, eight settings with reasons, the first adjustment, prone criteria and five references. A plan for your own ARDS case can be drafted on request.

How is tidal volume calculated in the NU656 Unit 6 plan?

Predicted body weight for women is 45.5 plus 0.91 times height in centimeters minus 152.4. At 163 cm that is 55.1 kg, so 6 mL/kg gives 330 mL. When driving pressure read 17, the plan reduced the volume to 275 mL, or 5 mL/kg.