A nurse is preparing to discharge a client who is a status post-operative laryngectomy. The nurse should recognize which of the following discharge teaching is the highest priority?

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.

A. An adverse event. An adverse event is an unintended injury or complication resulting from medical care rather than the patient’s underlying condition. In this case, the surgical site infection (SSI) developed as a complication of surgery, requiring additional treatment. While adverse events may prolong recovery, they do not always indicate negligence or preventability.
B. A never event. Never events are serious, preventable medical errors that should not occur under proper care, such as surgery on the wrong site, retained surgical instruments, or administering the wrong medication. While SSIs are concerning, they are not classified as never events because they can occur even when proper precautions are taken.
C. A near miss. A near miss refers to an event that could have caused harm but was prevented before reaching the patient. Since the infection did occur and required intervention, it does not qualify as a near miss. A near miss example would be identifying and correcting a medication error before administration.
D. A sentinel event. Sentinel events involve unexpected occurrences that result in serious injury, permanent harm, or death, such as patient suicide, wrong-site surgery, or a fatal medication error. Although the infection required prolonged treatment, it did not lead to severe harm or death, making it an adverse event rather than a sentinel event.