After change-of-shift report on a ventilator weaning unit, which patient should the nurse assess first?

The patient who was successfully weaned and extubated 4 hours ago but has not had any urine output for the last 6 hours presents a significant concern. This lack of urine output may indicate acute kidney injury or dehydration, both of which require prompt assessment and intervention, especially following extubation. After a patient has been extubated, monitoring for complications is crucial, as respiratory difficulties or changes in hemodynamic status can arise suddenly.

The fact that this patient has been without urine output for an extended period signals a potential problem that could complicate their recovery post-extubation. Adequate kidney function is essential for maintaining fluid and electrolyte balance, and any compromise in renal function can exacerbate existing respiratory issues or complicate ventilation weaning.

In contrast, the patient who failed a spontaneous breathing trial may already be stabilized but requires ongoing monitoring, while the one with continuous PETCO2 monitoring is likely being managed closely. The patient on BiPAP with a ScvO2 of 69% may also need attention, but the lack of urine output post-extubation signals a more urgent situation that could affect multiple systems, making it the priority to assess first.