| Course | N420 Adult Health IV |
|---|---|
| Module | Module 2 |
| Paper type | Nursing care plan |
| Length | About 1,085 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Pre-licensure BSN |
| Updated | September 2026 |
Free sample paper for N420 Module 2
Awake, Intubated and Trying to Speak: A Care Plan for a Man on Mechanical Ventilation, With Prevention Built In
Student Name
Pre-licensure BSN Program, Aspen University
N420: Adult Health IV
Instructor Name
Month Day, Year
Awake, Intubated and Trying to Speak: A Care Plan for a Man on Mechanical Ventilation, With Prevention Built In
Mechanical ventilation keeps a patient alive while it exposes him to a new set of harms: pneumonia, delirium, weakness, pressure injury and the fear of being unable to speak. Mr. B., a composite 66-year-old retired electrician, was intubated for pneumonia with respiratory failure and is on his third ventilator day. He is now on low sedation, opens his eyes to his name and keeps mouthing words no one understands. This care plan sets out his assessment, ranks five nursing diagnoses and builds prevention into every part. Mr. B. is an illustrative composite.
Assessment
Mr. B. is on pressure-regulated volume control with 40% oxygen and a PEEP of 8, saturating 94%. His secretions are thick and tan but less than yesterday. He has a low-dose propofol infusion and scores 0 to -1 on the Richmond Agitation-Sedation Scale, alert or briefly drowsy. His delirium screen is negative today. He has been in bed for three days, his heels are red but blanch, and he has pulled at his tube twice, so soft wrist restraints were applied overnight. His wife says he hates not being able to talk.
Nursing Diagnoses in Priority Order
Five problems are ranked by how directly they threaten life or recovery. Impaired spontaneous ventilation comes first because every day on the ventilator adds risk. Risk for ventilator-associated events, including pneumonia, is second. Impaired verbal communication is third, because it drives his agitation and the self-removal risk. Risk for acute confusion is fourth, and risk for complications of immobility, including pressure injury and weakness, is fifth. Ranking them this way shows that liberation from the ventilator is the goal every other intervention serves.
Care Plan Table
Each ranked diagnosis appears below with its goal, interventions and the check that shows progress.
| Diagnosis | Goal | Key interventions | Evaluation |
|---|---|---|---|
| Impaired spontaneous ventilation | Passes a breathing trial and is extubated as soon as he is ready | Daily awakening trial paired with a breathing trial; lowest sedation that keeps him safe | Trial result documented daily |
| Risk for ventilator-associated events | No new pneumonia or ventilator-associated event | Head of bed 30 to 45 degrees; toothbrushing twice daily; subglottic suction if available; circuit changed only when soiled | No rise in oxygen or PEEP needs sustained two days |
| Impaired verbal communication | Communicates needs and pain reliably | Picture board, alphabet board, yes-no questions, writing pad; same questions each shift | Pain and needs understood on first or second attempt |
| Risk for acute confusion | Delirium screen stays negative | Sleep protection at night, glasses on, family visits, early mobility | Screen each shift |
| Risk for immobility complications | Skin intact; strength maintained | Heels offloaded; turns every two hours; sitting at edge of bed with physical therapy | No new pressure injury; mobility level rises |
Paired Awakening and Breathing Trials
In a randomized trial of 336 ventilated patients, those managed with a daily awakening trial followed by a breathing trial spent more days breathing without help over 28 days (14.7 against 11.6) and left intensive care sooner (median 9.1 against 12.9 days) than patients receiving usual sedation with a breathing trial. Self-extubation was more common with the protocol, 16 patients against six (Girard et al., 2008). For Mr. B., the nurse turns off propofol each morning, screens him for safety, and when he tolerates it, the respiratory therapist begins the breathing trial. Because he has already pulled at his tube, the nurse stays at the bedside during the awakening trial and explains each step.
Preventing Ventilator-Associated Events
The 2022 practice recommendations from infection prevention and critical care societies treat avoiding intubation, minimizing sedation, daily paired trials, early exercise and mobility, and elevating the head of the bed as essential practices, and they favor toothbrushing for oral care while advising against routine chlorhexidine mouthwash (Klompas et al., 2022). Ventilator circuits are changed only when visibly soiled or malfunctioning. For Mr. B., these practices are routine tasks already in the plan, which is the point: prevention works best when it is built into daily care rather than added as a separate checklist.
The ABCDEF Bundle
The same practices appear in the ABCDEF bundle: assess and manage pain, both awakening and breathing trials, choice of sedation, delirium monitoring, early mobility and family engagement. In a collaborative of 68 intensive care units and more than 15,000 adults, days on which patients received every eligible element were linked with less delirium, coma and restraint use, fewer patients still ventilated the next day, fewer readmissions to intensive care and lower early mortality (Pun et al., 2019). The study was observational, so better units may simply do more of everything, but it supports using the bundle as a daily framework. For Mr. B., the letter F matters most: his wife can help him use the communication board and orient him.
Communication for a Patient Who Cannot Speak
Mr. B.'s attempts to speak are a sign of recovery and a source of distress. In a study of 89 intubated, awake patients and 30 nurses, training nurses in communication skills and providing communication tools with speech-language pathology support improved the success of communication about pain (Happ et al., 2014). The plan asks every nurse to try yes-no questions first, then the alphabet or picture board, and to ask the same pain and comfort questions each shift so Mr. B. learns the routine. Being understood may also reduce his need for restraints.
Evaluation
By the end of the shift, Mr. B. should complete an awakening trial without distress, have his pain rated through the board, show a negative delirium screen and sit at the edge of the bed with therapy. The restraints will be reviewed every two hours and removed when he can use the board and follow commands. If he passes the breathing trial, the team will plan extubation with the respiratory therapist, and the plan will shift to post-extubation monitoring and swallowing assessment. Each result will be documented in the same place every shift, so trends, not single readings, guide the next day's plan. His wife will be asked at each visit whether he seems more like himself.
Conclusion
The care plan for Mr. B. treats liberation from the ventilator as the main goal and builds prevention into daily work: paired trials, head elevation, toothbrushing, delirium screening, mobility and family presence. Giving him a voice through simple tools is part of that plan, because a patient who can say what hurts is safer, calmer and closer to breathing on his own.
References
Girard, T. D., Kress, J. P., Fuchs, B. D., Thomason, J. W., Schweickert, W. D., Pun, B. T., Taichman, D. B., Dunn, J. G., Pohlman, A. S., Kinniry, P. A., Jackson, J. C., Canonico, A. E., Light, R. W., Shintani, A. K., Thompson, J. L., Gordon, S. M., Hall, J. B., Dittus, R. S., Bernard, G. R., & Ely, E. W. (2008). Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): A randomised controlled trial. The Lancet, 371(9607), 126-134. https://doi.org/10.1016/S0140-6736(08)60105-1
Happ, M. B., Garrett, K. L., Tate, J. A., DiVirgilio, D., Houze, M. P., Demirci, J. R., George, E., & Sereika, S. M. (2014). Effect of a multi-level intervention on nurse-patient communication in the intensive care unit: Results of the SPEACS trial. Heart & Lung, 43(2), 89-98. https://doi.org/10.1016/j.hrtlng.2013.11.010
Klompas, M., Branson, R., Cawcutt, K., Crist, M., Eichenwald, E. C., Greene, L. R., Lee, G., Maragakis, L. L., Powell, K., Priebe, G. P., Speck, K., Yokoe, D. S., & Berenholtz, S. M. (2022). Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 43(6), 687-713. https://doi.org/10.1017/ice.2022.88
Pun, B. T., Balas, M. C., Barnes-Daly, M. A., Thompson, J. L., Aldrich, J. M., Barr, J., Byrum, D., Carson, S. S., Devlin, J. W., Engel, H. J., Esbrook, C. L., Hargett, K. D., Harmon, L., Hielsberg, C., Jackson, J. C., Kelly, T. L., Kumar, V., Millner, L., Morse, A., ... Ely, E. W. (2019). Caring for critically ill patients with the ABCDEF bundle: Results of the ICU Liberation Collaborative in over 15,000 adults. Critical Care Medicine, 47(1), 3-14. https://doi.org/10.1097/CCM.0000000000003482
Reading the N420 Module 2 assignment instructions
The N420 course description in Aspen's catalog includes complex pulmonary problems, which is the ground this example stands on, since the module's own instructions are released only to enrolled students. A ventilator care plan normally asks for assessment data, prioritized nursing diagnoses, measurable goals, interventions with rationales and evaluation, and this module adds prevention of complications. Your instructor may supply a template or a case, or let you base the plan on a ventilated patient you cared for, stripped of anything that could identify him. Check the number of diagnoses expected, whether rationales need a citation each, and whether a specific bundle or guideline must be addressed. Some instructors also want patient and family teaching included. Some templates also ask you to name the bundle elements one by one.
How this N420 Module 2 example is built
About 1,060 words fall under ten headings, and a five-row care table sits near the start. The opening introduces the patient and the harms ventilation brings. The assessment section records ventilator settings, sedation score, delirium screen, skin and restraints. A section ranks the diagnoses and explains why liberation comes first. The care table follows. Paired awakening and breathing trials are explained with trial figures, including the rise in self-extubation. Prevention of ventilator-associated events, the ABCDEF bundle and communication for a patient who cannot speak each get their own section. Evaluation sets end-of-shift targets, and the conclusion ties prevention to daily care. Each section ends with what it means for this particular patient, not patients in general.
Reading the N420 Module 2 grading rubric
Care plan rubrics in pre-licensure courses usually look for prioritization, measurable goals, evidence-based interventions and evaluation. This plan earns prioritization marks by ranking diagnoses and explaining how the lower ones support ventilator liberation, which a margin note points out. Goals are measurable, such as a documented daily trial result. Interventions come from a randomized trial, a multisociety practice recommendation, a large collaborative and a communication study, each applied to this patient. The self-extubation finding is linked to his history, which shows judgment. Evaluation is specific and time-bound. The final marks go to a clear table and correct APA entries for four sources. Tying the communication tools to his restraints shows the diagnoses were thought through together.
Common N420 Module 2 mistakes, and how to avoid them
The most common care plan weakness is listing many diagnoses without explaining their order. Rank them and say why. Students also write vague interventions, such as maintain airway, instead of the specific practices the evidence supports: head elevation, toothbrushing, paired trials, early mobility. Another frequent mistake is recommending chlorhexidine mouthwash out of habit, although current guidance advises against routine use. Check the date of your sources. Some plans ignore communication, even though an intubated patient who cannot be understood becomes agitated and is more likely to be restrained. Finally, give evaluation criteria a time frame so the next nurse knows what to check. Check the restraint order every two hours and write down why it is still needed.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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N420 Module 2 questions, answered
What does N420 Module 2 usually ask for?
Aspen's N420 description includes complex pulmonary alterations, so a care plan for a patient on mechanical ventilation, including complication prevention, is a common assignment. Check your classroom for the template.
What is a ventilator-associated event?
A sustained worsening in oxygenation after a period of stability, shown by rising oxygen or PEEP needs. It includes pneumonia but also other complications such as fluid overload and atelectasis.
Is chlorhexidine still used for oral care in ventilated patients?
Current prevention recommendations favor toothbrushing and advise against routine chlorhexidine mouthwash for most adults. Follow your facility's policy and cite the current guidance.
Where can I find a free N420 Module 2 sample paper?
The whole ventilator care plan, five-row table and margin notes included, sits above in full for any reader. It follows the ARDS paper as the second of eight N420 samples.
What diagnoses fit an N420 Module 2 ventilator care plan?
Common choices are impaired spontaneous ventilation, risk for ventilator-associated events or infection, impaired verbal communication, risk for acute confusion and risk for immobility complications, ranked by threat to recovery.