A nurse instructor is lecturing nursing students on safety, quality and patient centered care. The students should recognize that which of the following recommendations promotes safe, quality, patient-centered care? Select all that apply.

A. Client develops ecchymosis at the venipuncture site. Minor bruising at venipuncture sites is a common and expected side effect of heparin therapy due to its anticoagulant effect. While the nurse should monitor for increased bruising, isolated ecchymosis at an IV site does not necessarily indicate excessive anticoagulation or require immediate provider notification.
B. PTT 70 seconds (control 25-40). Heparin therapy is adjusted based on the activated partial thromboplastin time (aPTT). The therapeutic range is typically 1.5 to 2.5 times the control value, which in this case would be approximately 60-100 seconds. A PTT of 70 seconds is within the therapeutic range, so it does not require urgent intervention.
C. Client develops hematuria. Hematuria is a sign of potential excessive anticoagulation or internal bleeding, which can be a serious complication of heparin therapy. This finding suggests that the client's coagulation status may need immediate reassessment, and the heparin infusion may require adjustment or reversal with protamine sulfate if necessary. The healthcare provider should be notified promptly.
D. Order for Coumadin 2.5 mg to begin today. It is common practice to start warfarin (Coumadin) while a client is on heparin therapy because warfarin takes several days to reach therapeutic levels. Heparin is typically continued until the INR reaches a therapeutic range. Therefore, this order does not require provider notification.

A. To facilitate weaning off the mechanical ventilator. While PEEP is an important component of mechanical ventilation, its primary function is not to facilitate weaning. Instead, it improves oxygenation by preventing alveolar collapse. Weaning involves gradually reducing ventilatory support, but PEEP is typically adjusted based on oxygenation needs rather than as a direct step in weaning.
B. To decrease trapped oxygen in the alveoli. PEEP does not decrease trapped oxygen; instead, it maintains alveolar patency and prevents atelectasis. In conditions like ARDS, alveoli tend to collapse due to fluid accumulation and inflammation, and PEEP helps counteract this collapse to improve gas exchange. Reducing "trapped" oxygen is not a function of PEEP.
C. To promote independent breathing efforts. PEEP itself does not promote spontaneous breathing; instead, it provides positive pressure at the end of exhalation to improve oxygenation. In fact, high levels of PEEP can suppress spontaneous breathing by increasing intrathoracic pressure, requiring careful adjustment to balance oxygenation and ventilatory effort.
D. To keep the airways and small lung spaces open. PEEP prevents alveolar collapse by maintaining positive pressure in the lungs at the end of expiration. This improves oxygenation and gas exchange, which is critical in ARDS, where alveoli are prone to collapse due to inflammation and fluid accumulation. Keeping alveoli open reduces shunting and improves oxygen delivery to tissues.