Even though your patient can’t verbally express her needs, you’ll need to assess her pain level using a reliable scale. Keep in mind that a patient’s acknowledgment of pain means pain is present and must be treated. Two scales that help you evaluate your patient’s sedation level are the Richmond Agitation Sedation Scale and the Ramsay Sedation Scale.

Should you restrain an agitated ventilator patient to prevent extubation? Research shows self-extubation can occur despite physical restraints. It’s best to treat agitation and anxiety with medication and nonpharmacologic methods, such as communication, touch, presence of family members, music, guided imagery, and distraction.