CARE OF VENTILATED PATIENT Ajish K Thankachan ADULT ICU KING KHALID MILITARY CITY HOSPITAL
MECHANICAL VENTILATION – It is a method to mechanically assist or replace spontaneous breathing .it is typically used after an invasive Intubation ,a procedure wherein an Endotracheal or tracheostomy tube is inserted into the airway .it is used in acute settings such as in the short period of time during serious illness. Purpose: Ventilators are used to provide mechanical ventilation for patients with respiratory failure who cannot breathe effectively on their own. they are also used to decrease myocardial gas consumption or intracranial pressure ,provide stability of the chest wall after trauma or surgery and when patients is sedated or pharmacologically paralyzed.
RESPONSIBLE PERSON: RESPIRATORY THERAPIES is generally the person who sets up the ventilators and changes ventilator settings based on physician’s order . NURSE is responsible for monitoring the alarms and the patients respiratory status. It is also responsible for notifying the respiratory therapist when mechanical problems occur with the ventilator and when there are new physician’s order requiring changes in the settings or the alarms parameters. PHYSICIAN is responsible for keeping track of the patient’s status on the current ventilator settings and changing them when necessary.
NURSING CARE OF VENTILATED PATIENTS MONITOR VITAL SIGNS CONTINOUSLY ENSURE THAT THE ENDOTRACHEAL TUBE PLASTER WAS FULLY SECURED . ENDO TRACHEAL TUBE PLASTER SHOULD NOT BE APPLIED TOO TIGHT OVER THE JUGULAR AREA . AVOID TIGHT ADHERENCE OF THE TUBE OF THE LIPS . ENDO TRACHEAL TUBINGS MUST BE CHANGE WITH IN 72 HOURS
3. ENSURE VENTILATOR SETTINGS ARE ADJUSTED ACCORDING TO DOCTORS ORDER, 4. SUCTION SECREATION AS NEEDED. 5. CARRIES OUT THE FOLLOWING HYGIENIC NECESSITIES : 6. ORAL CARE EVERY FOUR HOUR.
CHANGES POSITION 2-3 HOURLY. CHANGES DRESSING PRN IF VENTILATOR IS CONNECTED TO TRACHEOSTOMY . CHANGES ET TUBE PLASTER PRN. EVALUATES PATIENT’S PROGRESS DAILY.
RATIONALE PROVIDES INFO REGARDING AIR FLOW THROUGH THE TRACHEOBRONCHIAL TREE AND THE PRESENCE /ABSENCE OF FLUID MUCUS OBSTRUCTION . NOTE: FREQUENT CRACKLES OR RONCHI THAT DO NOT CLEAR WITH COUGHING /SUCTIONING MAY INDICATE DEVELOPING (ATELECTASIS ,PNEUMONIA ,ACUTE BRONCHOSPASM ,PULMONARY EDEMA . AUSCULTATE CHEST PERIODICALLY,NOTING PRESENCE /ABSENCE AND EQUALITY OF BREATH SOUNDS
ELEVATE HEAD OF BED ELEVATION OF PATIENT’S HEAD WHILE STILL ON VENTILATOR IS BOTH PHYSICALLY BENEFICIAL.
CHECK VENTILATOR ALARMS FOR PROPER FUNCTIONING VENTILATORS HAVE A SERIES OF VISUAL AND AUDIBLE ALARM.EXAMPLE :O2 low/high pressure . Turning off /failure to reset alarms places patient’s @ risk for un observe ventilator failure or resp. arrest
INFLATE TRACHEAL /E.T.CUFF PROPERLY CUFF MUST BE PROPERLY INFLATED TO ENSURE ADEQUATE VENTILATION
CHECK TUBINGS FOR OBSTRUCTION KINKS IN TUBINGS PREVENT ADEQUATE VOLUME DELIVERY AND INCREASE AIRWAY PRESSURE. WATER PREVENTS PROPER GAS DISTRIBUTION AND PREDISPOSES TO BACTERIAL GROWTH.
KEEP RESUSCITATION BAG @ BEDSIDE Provides /restore adequate ventilation when patient or equipment problems require patient removed from ventilator.
ASSIST PATIENT IN TAKING CONTROL OF BREATHING IF WEANING IS ATTEMPTED VENTILATORY SUPPORT IS INTERRUPTED DURING PROCEDURE /ACTIVITY Coaching patient to take slower ,deeper breath practice abdomen /pursed lip breathing assume position comfort and use relaxation techniques can be helpful in maximizing respiratory function. To promote comfort.
The patient with an artificial airway is not capable of effectively coughing, the mobilization of secretions from the trachea must be facilitated by aspiration. This is called as suctioning. OPEN SUCTION SYSTEM: Regularly using system in the intubated patients . CLOSED SUCTION SYSTEM: This is used to facilitate continuous mechanical ventilation and oxygenation during the suctioning. Closed suctioning is also indicated when PEEP level above 10cmH2O. (((Set vacuum regulator to appropriate negative pressure. For adult a pressure of 100-120 mmHg, 80-100mmhg for children & 60-80mmhg for infants)))
OBTAIN CHEST X-RAY AS ORDERED. TO CHECK THE TUBINGS IF PROPERLY IN PLACED .
Carefully explain all procedures to the patient, prior to their commencement ; Patient Comfort At all times, the nurse should attempt to: Orientate the patient to their environment and events; Provide a suitable means of communication for the patient. Involve the patient and their family in the planning and implementation of nursing care; Facilitate a proper day / night rhythm for the patient;
Communication Finding alternative means for the patient to communicate. The patient should be encouraged to try alternative methods such as mouthing words, writing, or pointing to letters, words, or pictures on a communication board. Communicating with these patients takes great patience and creativity, as well as dedication to helping them feel like their needs are being met.