Mechanical Ventilation

Mechanical Ventilation
Running head: ACCOUNTABILITY OF NURSING PROFESSIONALS: WEANING
Accountability of Nursing Professionals: Weaning from Mechanical Ventilation
Samantha Madrid
Grand Canyon University
Abstract
This paper will discuss the weaning of patients off of a mechanical ventilator. It will look at the
problems associated with prolonged intubation vs. premature extubation, and what healthcare
professionals can do to assess a patients readiness to begin the weaning process. A patient care
scenario will be given and an explanation of how nursing practice can evolve with the knowledge
from this study will be shown. The accountability of the nursing professional in regards to
mechanical ventilation will be visited as well.
Accountability of Nursing ... Show more content on Helpwriting.net ...
The nurse should assume responsibility and accountability for their patient's health. This requires the
nurse to research ways to assist a patient off ventilation, collaborate with physicians, and be aware
of the patient's condition and readiness to wean.
"For some investigators, 'weaning success' is defined as sustained spontaneous, unassisted breathing
with or without an artificial airway, and for others it is defined as sustained extubation" (Cook
2000). Whatever the nurse and physician see as the definition to weaning is far less important than
ensuring their patient is weaned at the correct time. Allowing a patient to remain intubated and on
mechanical ventilation when it is no longer needed, only puts the patient at risk for problems beyond
the reason for initial intubation.
Nurses should frequently monitor signs of a patient that is able to take spontaneous breaths.
Assessing levels of anxiety and diaphoresis along with frequent monitoring of vital signs can signal
to the nurse that the patient may no longer need the amount of assistance he is currently receiving.
The nurse may begin to wean the patient by decreasing the amount in mechanical support, in a slow
and gradual manner.
The study shows the decrease in mechanical support can be effected by increasing periods of
unassisted breathing, alternating unassisted breaths with mechanical breaths, and reduction of the
support delivered
... Get more on HelpWriting.net ...

Use Of Ecmo Versus Conventional Ventilation Patients With...
The Use of ECMO Versus Conventional Ventilation In Patients With Acute Respiratory Distress
Syndrome
Travis Day
Northwest Technical College
Extracorporeal Membrane Oxygenation is a medical modality that provides life support for patients
experiencing pulmonary failure, cardiac failure, or both. ECMO is able to maintain oxygenation and
perfusion to the body until the native lungs or heart function can be restored. According to Maj
(1990) "ECMO is a long term heart and lung bypass technique that has been successfully used since
1975." ECMO can be divided into two categories; Veno–venous ECMO (VV ECMO) which
supports the lungs by oxygenating the blood and returning the oxygenated blood to heart. This ...
Show more content on Helpwriting.net ...
It is important to recognize that ECMO is not a therapeutic intervention. ECMO provides cardiac or
respiratory support so that the patient is spared the harmful effects of mechanical ventilation such as
high airway pressure, high oxygenation, and perfusion impairment while reversible
pathophysiologic processes are allowed to resolve either by natural means or by medical or surgical
intervention.
One prospective randomized trial compared the effectiveness of ECLS with conventional
mechanical ventilation (CMV) in full–term newborns with severe respiratory insufficiency. This was
a randomized prospective study performed by O'Rourke (1989) which demonstrated a significant
difference in survival between neonates managed with ECLS (97%) and those managed by
conventional means (60%). Other studies have demonstrated a significant increase in survival
among pediatric respiratory failure patients managed with ECMO when compared to matched
patients managed with CMV.
The neonatal ARDS disease processes result in lung pathophysiology associated with pulmonary
hypertension and poor oxygenation. Conventional mechanical ventilation, surfactant administration,
and nitric oxide administrations are the first modalities used in order to increase the tissue perfusion
and respiratory insufficiency. When these interventions fail, ECMO will allow for lower ventilator
settings, preventing lung injury caused by the ventilator.
For optimal timing of

Lung Protective Strategies: A Case Study
Support by noninvasive ventilation may be effective in mild cases of ARDS. Thus, majority patients
require intubation and conventional ventilation. Mechanical ventilation is the key measure to
maintain respiratory function until recovery of lung damage. The current ventilatory strategy is
based on two concepts: lung protective strategy using a low tidal volume and open lung concept
using high grades of PEEP.
Open lung concept:
PEEP maintains alveoli in an open position and brings the dependent lung regions to favorable
position on compliance curve loop. Previously collapsed regions stay open and may increase slightly
in volume as they accept more gas. PEEP acts to keep the recruited lung open at end expiration.
Regional changes in compliance ... Show more content on Helpwriting.net ...
But in ARDS dependent (dorsal) lung region of the supine patient becomes favorable site of
ventilation. Prone positioning improve oxygenation in range 20% and decrease the degree of shunt
present in the lungs. This finding occur in 75% of patients. It is important to state that not all
patients respond equally well to prone positioning. But trials failed to demonstrate an improvement
in survival with this strategy and it is just an adjunctive measure. Contraindicated includes
pregnancy, head trauma or intracranial hypertension, pelvic or spinal fractures and shock.
(Voggenreiter et al; 1999)
Fluid management:
Hemodynamic Monitoring and Fluid management is considerable aspect in managing patient with
ARDS. Swan–Ganz catheter did not get better results than standard monitoring and is associated
with increased incidence of complications. Therefore, the routine use of pulmonary artery catheter is
not necessary. A fluid balance neutral or mildly negative is associated with better outcomes from
shorter duration of mechanical ventilation and ICU days, but no evidence supports reduction in
mortality rates. Restrictive fluid management is adopted widely among literatures.

Critical Study And Analysis Of Oral Care
The purpose of this document is a critical study and analysis of the oral care provided by nursing
staff as part of the Ventilator Care Bundle (VCB) and to assess whether the frequency of mouth care
performed is related to the prevention of Ventilator Associated Pneumonia (VAP) in patients
mechanically ventilated (Zilberberg et al. 2009).
The following document is a case study written by an intensive care nurse, who will explore the oral
care provided to a patient admitted in an Intensive Care Unit (ICU) and will assess the overall care
process. Additionally, the frequency, products used and techniques performed will be evaluated.
In order to evaluate if mouth care and its frequency are Gold Standard interventions to prevent VAP
... Show more content on Helpwriting.net ...
ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples
devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).
Oral care aims to supply an adequate hygiene level, which leads to reduce colonisation of dental
plaque and oropharynx and to reduce the aspiration of contaminated secretions into the lower airway
(Feider et al. 2010). Research has demonstrated that colonisation of the airway and aspiration of
colonised saliva are the two main pathogenic causes of VAP (Adib–Hajbaghery et al. 2011). Other
cause is the production of a biofilm along the endotracheal tube (ETT) which contains large
quantities of microbes that could be spread into the lungs by ventilator–induced breaths (Keyt et al.
2014; Palomar et al. 2010). Additionally, instilling saline into the ETT, suctioning secretions,
repositioning the ETT or coughing, could dislodge the biofilm into the airway and increase the risk
of VAP (Moore. 2003; Morehead and Pinto. 2002).
According to Hunter (2012, p.40) "VAP is a hospital acquired pneumonia that occurs 48 hours or
more after tracheal intubation or acute tracheostomisation". VAP is one of the most common
nosocomial infection responsible for one third of mortal respiratory infections in European ICUs
(Adib–Hajbaghery et al. 2011).
Despite of its high incidence, identifying VAP infection requires a

Reflection Upon A Critical Incident Essays
Reflection has its importance in clinical practice; we always seek to be successful and that can be
achieved by learning every day of our life through experiences we encounter. In that way we can
reconsider and rethink our previous knowledge and add new learning to our knowledge base so as to
inform our practice. Learning new skills does not stop upon qualifying; this should become second
nature to thinking professionals as they continue their professional development throughout their
careers (Jasper, 2006).
In keeping within current legislation on the protection and respect of an individuals' right of
anonymity, (Polit and Beck 2007), and to confidentiality, (Munhall 2007), any and all possible
identifiable characteristics of the ... Show more content on Helpwriting.net ...
One research summary listed on AHRQ website under patient safety is a device that has potential in
reducing the incidence of ventilator–associated pneumonia (VAP) (Collard & Saint, 2010).
Continuous aspiration of subglottic secretions (CASS) is an apparatus that has been shown to
decrease the incidence of VAP in certain patients. Included in this piece is a description of VAP, how
CASS can help improve patients at risk for VAP and a patient care situation regarding clients
receiving mechanical ventilation.
Ventilator–Associated Pneumonia
Pneumonia is the second most common hospital–acquired infection and is the leading cause of death
due to nosocomial infection in the United States (Augustyn, 2007). A patient who is intubated with
an endotracheal tube (ETT) is at increased risk of developing pneumonia. The bacteria colonizing
the oropharynx can move into the lower respiratory tract because the ETT provides a direct route
into the lower airway (Craven & Hjalmarson, 2010). This type of pneumonia is called ventilator–
associated pneumonia (VAP), it occurs in patients receiving mechanical ventilation for an extended
period of time. Ventilator associated pneumonia can be categorized as either early–onset or late–
onset. Early–onset VAP occurs between 48 to 96 hours and is usually caused by Haemophilus
influenza, an antibiotic sensitive community–acquired organisms (Collard & Saint, 2010). Late–
onset VAP is caused by

Acute Respiratory Distress Syndrome ( Ards )
According to the American Lung Association, "Acute respiratory distress syndrome (ARDS) is a
rapidly progressive disease occurring in critically ill patients." ARDS is an extreme manifestation of
a lung injury that can be associated with an acute medical problem. This occurs as a result of direct
or indirect trauma to the lungs. With nearly 200,000 cases in the United States each year, ARDS is
not extremely common ("Acute Respiratory Distress Syndrome"). Most people who acquire this
disease are critically ill patients within the hospital. The most common predisposing medical
problems of ARDS consist of: shock, trauma, pulmonary infections, sepsis, aspiration, and
cardiopulmonary bypass (Ignatavicious, 2013). ARDS is a severe syndrome and even with prompt
and aggressive medical treatment, almost fifty percent of those diagnosed do not survive. Those who
survive have a longer hospital stay along with recurring hospital admissions throughout their
lifetime ("Acute Respiratory Distress Syndrome"). Acute respiratory distress syndrome is a rapidly
progressive disease which requires thorough assessment, rapid diagnosis, and emergency treatment
measures in order to successfully respond to the disease process.
ARDS is acute respiratory failure with persistent hypoxemia, decreased pulmonary compliance,
dyspnea, noncardiac–associated pulmonary edema, and dense pulmonary infiltrates on the chest x–
ray. The main site of injury within the lung is the alveolar–capillary membrane

Benefits And Complications Of A Mechanical Ventilator
Throughout the 1940's in America the use of Mechanical Ventilation known as a "Vent Machine" has
been used to sustain life. There is evidence that suggests millions are put on a ventilator each year. A
Mechanical Ventilator is a method to mechanically assist or replace spontaneous breathing. Also, it
delivers a positive or negative pressure directly to the lungs. In addition, breathing may be assisted
by a respiratory therapist, registered nurse, physician, physician assistant, paramedic, or other
suitable person compressing a bag or set of bellows. Benefits of mechanical ventilation is to sustain
or improve ventilation, maintain tissue oxygenation, and decrease the patient work of breathing.
However, numerous complications may transpire ... Show more content on Helpwriting.net ...
(Anzueto) Mechanical ventilators deliver the force needed to distribute air to the lungs for patient
with ventilator failure. Mechanical ventilation redistributes blood flow from functioning respiratory
muscles to other vital organs. The lungs primary function is to add oxygen and to remove CO2 from
the blood passing through the lung's capillary bed. The lungs are comprised of a million alveoli
(bunches of grapes) clinging to each other and emptying into the bronchiolar tree by the tributary
network of airways eventually emptying into main bronchi and trachea. There are multiple modes of
mechanical ventilation support that provide air to the patient based on pressure, flow and volume.
Although lifesaving, mechanical ventilation can be associated with life threatening complications,
including air leaks and pneumonia. I. Effect of multimodality chest physiotherapy on the rate of
recovery and prevention of complications in patients with mechanical ventilation: a prospective
study in medical and surgical intensive care units.
Pattanshetty & Gaude (2011) identified mechanically ventilated patients have an increased risk of
complications leading to ventilation weaning more difficult resulting in excessive morbidity and
mortality. Chest physiotherapy plays an important role in management of ventilated patients.
However, these techniques have been studied on

The Causes Of Premature Neonates
Introduction
Premature neonates or preterm babies refer to the neonates that are born before 37 weeks of
gestation are over. Given that most of the body organs are not completely developed at this stage,
the neonates have a high risk of developing many complications at birth. A good example of these
organs is the lungs, which completely mature by week 36 of gestation. The surfactant production
does not begin until 20 weeks of gestation age; at this stage of gestation surfactant only present in
small amount and in immature form. The mature surfactant production begins approximately after
35 weeks of gestation age. Even though the lung has mature surfactant at this stage it is not
completely capable of respiratory function. Therefore, ... Show more content on Helpwriting.net ...
However, even if these methods have managed to reduce mortality in preterm infants, they are
associated with serious adverse effects that may be fatal or contribute to chronic conditions later in
life of the patient.
According to DiBlasi, even in animal models, the conventional methods cause inflammation of the
lungs and sometimes cause injure to the lungs.1 These techniques also cause redundancy in alveolar
growth and also affect the efficacy of surfactant produced in the animal lung.1 This is a good signal
that these techniques may have serious consequences in the neonate. One of the adverse effects of
invasive and mechanical ventilation is ventilator–induced lung injury.1 This complication is defined
by the presence of polytrauma (excessive tidal volume) and shear injury to the airways, a condition
known as atelectrauma.1 Insertion of the endotracheal tube into the lungs through the airways also
causes injury to the lungs and the airways, a condition known as endotrauma.1
Insertion of the endotracheal tube through the airways is also a painful procedure that may need the
neonate to be sedated first. According to DiBlasi, insertion of the tube may also cause acute airway
injury, emergencies, an infestation of the airway with bacteria,

The Routine Use Of Endotracheal Tube
It has been established that inability to successfully manage very difficult airway was been
responsible for as many as 30% of death totally attributable to anesthesia. (1)
The routine use of endotracheal tube is to secure the airway and prevent the aspiration of gastric
content in case of regurge or vomiting but there is a case series demonstrated that the routine use of
the endotracheal tube did not reduce maternal death due to aspiration(2)
Supraglottic airway devices have become a standard in airway management. These devices sit
outside trachea but provide a hands free means of achieving a gas tight airway(3). The i–gel is
supraglottic airway devices. The soft non inflatable cuff fits snugly on to the perilaryngeal frame
work, mirroring the shape of the epiglottis, aeryepiglottic folds, piriform fossae, perithyroid,
pericricoid, posterior cartilages and spaces. The seal created is sufficient for both spontaneously
breathing patients and for intermittent positive pressure ventilation. it provides a better seal for
positive pressure ventilation, separation of the respiratory from the alimentary tract.(4) The drain
tube prevents gastric insufflations, allows easy placement of gastric tube it has been shown that the
i–gel airway is better alternative device compared to PLMA for ease of insertion and maintenance of
anesthesia. (3,4) The i–gel works in harmony with the patient's anatomy so that compression and
displacement trauma are significantly reduced or

Chest X-Ray And Sputum Culture
It is vary minute to minute in the hospital, patients situation will be change in a blink of an eye.
Nowadays ventilated patients are easily infect pneumonia cause by serval bacteria, mortality rate for
ventilator–associated pneumonia (VAP) [1] lies between 20% and 60% [2][3], and can be even more
higher but it takes 3~5days for cultured and identify which type the bacteria is, by this time bacteria
keep growing and increase the difficulty of treatment so we are looking forward to change standard
operating procedure into instant detection without draw blood, chest X–ray and sputum culture. It is
usually unclear if the antibiotics are effective when culturing a specimen in the first 5 days, the most
critical period of patient survival. We try

Summary: Pumpless Extracorporeal Lung Assist
Pumpless Extracorporeal Lung Assist is a technology that was developed to treat patients with
ARDS. PECLA is an alternative to ECMO, and was developed for adults. It is different from ECMO
because it relies on the pressure created by the heart of the patient to move the blood through the
cannulas. The same membrane used in the filters of ECMO are used in PECLA. The device is small
and one patient use only. The PECLA can be hooked up to an oxygen flow of 1–12 L/minute, and
the ARDS patients were mechanically ventilated using lung protective strategies. As the
oxygenation levels improve, the patients can be weaned from the device by lowering the oxygen
flow.
Without the pump, PECLA avoids causing injuries to the blood vessels and allows

The Current Pressurized Oxygen Tension Based Indices Response
In this thesis, I have attempted to further explore the nature of the current utilised oxygen–tension–
based indices response, with a view to its use as a tool to assess the pulmonary oxygenation in
critically ill patients. Furthermore, this thesis developed a new index to assess pulmonary
oxygenation. This topic was explored with external pulmonary factors to quantify oxygenation
defect through a maze of mathematics, different diseases, and pathophysiology. There was one or
two ways that could lead us to the answer and many dead end routes. Ultimately, the research
produced an equation that was more robust than the PaO2/FiO2 ratio in terms of less variation. The
first chapter described two different types of oxygen indices and its use. The second chapter
described the medical simulator in general and the Nottingham Physiology Simulator (NPS) in
particular. In chapter three, we examined the variation of certain oxygen indices with changes in the
following external physiological factors (FIO2, Hb, RQ, and VO2) without changing the pulmonary
configuration status. This investigation was done with ARDS simulated patients using a validated
NPS model. The study demonstrates that the external physiological factors induced a remarkable
variation in comparing to oxygen indices, and the use of each index depends on the type of the
external physiological factors. However, we conclude that clinicians should be aware of using the
best index according to patient's status. Accordingly,

Ventilator Associated Pneumonia Essay
Ventilator–associated pneumonia is the leading cause of death out of all hospital–acquired
infections. Pneumonia that is acquired 48 hours or longer after at patient has been mechanically
ventilated is considered hospital acquired. Endotracheal tubes provide pathogenic microorganisms'
with a direct access to the lungs where they can easily set up shop and cause deathly consequences
for patients' in the acute care setting. For example, the mortality rate of patients who have
ventilator–associated pneumonia is 46% whereas unaffected intubated patients mortality rate is
32%. When ventilator–associated pneumonia (VAP) occurs in a patient(s), it often increases the
amount of days a patient is on the ventilator and increases their overall hospital stay (Safe Care).
The big problem with this is that VAP is costing hospitals ... Show more content on Helpwriting.net
...
This includes elevating the head of the bed at least 30 degrees, preventing aspiration, turning and
positioning, and most importantly, performing oral care. A major source of VAP is the aspiration of
microorganisms from the mouth, proving oral hygiene for mechanically ventilated patients is of top
priority. Although, methods and timing of oral care varies widely between facilities, for instance,
some hospitals may brush teeth with a tooth brush while others may use a sponge swab. A common
oral care protocol is usually brushing teeth every 8 hours and using an antimicrobial rinse
(chlorhexidine) every 2 hours (Ignatavicius & Workman, 2013). It should be noted that quality
education on the link between poor oral hygiene and ventilator–associated pneumonia should be
provided to licensed nurses as well as nurses' aides that would be responsible for providing oral
care. Understanding the importance of being vigilant at providing oral care may further reduce VAP
occurrences due to increased compliance and efficiency of oral care

The Primary Goals Of Airway Pressure Release Ventilation
1. What are the primary goals of Airway Pressure Release Ventilation (APRV)? Airway Pressure
Release Ventilation (APRV) is an unconventional pressure controlled mode of ventilation that use
inverse ratio strategy. Moreover, APRV based on the principle of open–lung approach, and it is a
lung protective strategy mode. Therefore, one of the primary goals of APRV is to decrease the
incident of Ventilator–induced lung injuries (VILI). Another purpose of APRV is that APRV aims to
recruit the lung as well as to improve oxygenation. To illustrate, APRV creates continuous sequences
of positive airway pressure that would significantly increase the mean airway pressure (Paw) which
would lead to Lung recruitment and improve oxygenation. Furthermore, APRV helps to decrease the
inflation/deflation process which contributes in avoiding alveolar derecruitment. In a similar way,
APRV applies pressure to sustain FRC for alveolar recruitment. Finally, APRV helps patient to
eliminate CO2 efficiently. On APRV, CO2 is washed during the release phase, and during
spontaneous breathing as patients on APRV are allowed to breathe spontaneously at any time at the
respiratory cycle on APRV. In Summary, The primary goals of Airway Pressure Release Ventilation
are to minimize Ventilator–induced lung injuries cases, help to recruit lungs, improve oxygenation,
avoid alveolar derecruitment, and eliminate CO2 efficiently. 2. Discuss the different methods of
removing CO2 with HFOV. High–frequency

Symptoms And Treatment Of Pediatric Intensive Care Unit
Introduction: As a student completing senior synthesis in the pediatric intensive care unit, I see
many patients, both chronic and acute, that require mechanical ventilation. I understand the many
risks involved with this life–saving procedure, but at the same time I often question why the patient
must remain on the ventilator for such extended periods of time. I based my PICOT question around
my observations of intubated patients. Nurses collaborate with respiratory therapists and physicians
to care for their patients, but have little to do with the respiratory management of intubated patients
besides being a patient advocate. I want to know if nurses could be more involved with the
management of mechanically ventilated patients to ... Show more content on Helpwriting.net ...
The apparent lack of research and evidence–based literature pertaining to mechanically ventilated
pediatric patients, and unique pediatric physiology, highlight the necessity for development of
protocols and guidelines specific to the population in order to reduce mechanical ventilation times.
You may ask why it is important to develop these pediatric protocols in an effort to reduce time of
mechanical ventilation. Since decreased time of mechanical ventilation has the potential to reduce
the incidence of harmful ventilator associated infections, and decreases the risk of acquiring such
infections, it is of utmost importance to the health and safety of these patients (Marelich, et al.,
2000; Randolph, et al., 2003). Furthermore, mechanical ventilation poses a great risk of tracheal
airway irritation and scarring (Randolph, et al., 2003). This can occur through the method of
endotracheal suctioning, duration of suctioning, frequency of suctioning pose, and length of time the
endotracheal tube is in place. All these factors can damage the patient's airway, compromise the
integrity of the endotracheal tube, and put the patient at risk for ventilator associated pneumonia
(Grap, 2009). There are several other aspects of care of the mechanically ventilated patient that
make reduced time of ventilation an important issue to consider. The management of mechanical
ventilation with sedation increases the need for skilled care in the ICU setting,

Infective Airway Diseases
Mechanical ventilation in Infective airway diseases
Introduction
Nearly 50% of patients with infective airway diseases are at an increased risk of developing Acute
Lung Injury or Acute Respiratory Distress Syndrome (ALI/ARDS). Endotracheal intubation may be
lifesaving in these situations, as they allow provision of adequate tissue oxygenation, reduce the
respiratory muscle effort and avert hemodynamic embarrassment. Over the last 20 years, many
clinical evidences have highlighted the harmful consequences of invasive mechanical ventilation
such as Ventilator associated pneumonia (VAP) and excessive mechanical stress leading to
perpetuation of lung injury.
Unavailability of robust clinical data fails to provide enough evidence–based data on ... Show more
content on Helpwriting.net ...
Does prone positioning affect 1) gas exchange or 2) outcome in sepsis related ALI, and 3) should
prone positioning be used for patients with ARDS requiring potentially injurious levels of FIO2 or
plateau pressure?
Recommendation:
In facilities with adequate experience, prone positioning should be considered in patients requiring
potentially injurious levels of FIO2 or plateau pressure who are not at high risk for adverse
positional changes.
6. Is there a defined fluid management strategy in sepsis–related ALI/ ARDS?
Recommendation:
Avoid administration of fluids in excess of those amounts needed to maintain appropriate vital organ
perfusion. Consider use of colloids in hypoproteinemic patients with ALI/ ARDS.
7. Are corticosteroids indicated in the 1) prevention, 2) early treatment (exudative phase), or 3) late
treatment (fibroproliferative phase) of sepsis induced

A. Root Cause Analysis. Healthcare Facilities Accredited
A. Root Cause Analysis
Healthcare facilities accredited by Joint Commission have an obligation to conduct a root cause
analysis (RCA) after a sentinel event Root cause analysis (RCA) is a process that is used to identify
origin of a problem in a system in order to develop corrective action plan. In healthcare sector, root
cause analysis, therefore, is conducted to determine the factors that contributed to a sentinel event.
Root Cause Analysis of the scenario
The subject patient: Mr. B
Age: 67–year
Day: Thursday
Timeline of events
3:30 p.m.: Mr. B. arrives at triage accompanied by his son. Assessment results – B/P 120/80, HR–88
(regular), T–98.6, R–32, weight 175 pounds, pain 10/10, Left leg appears shortened with edema in
the calf, ... Show more content on Helpwriting.net ...
Nurse J places an automatic blood pressure machine on the patient. Nurse J leaves his room and the
patient's son to remain in the room
4:35 p.m.: B/P 110/62, Oxygen saturation is 92%. Nurse J and the LPN on duty receives the
emergency transport patient, and they are also discharging two other patients. ED lobby is congested
with new patients.
4:40 p.m.: Oxygen saturation alarm goes off. Oxygen saturation is 85%. LPN enters patient's room
and resets the alarm and repeats the B/P reading. Nurse J is assessing the respiratory distress patient
and ordering respiratory treatments, Chest X–ray, and labs.
4:43 p.m.: Mr. B's son informs the nurse that the "monitor is alarming." Nurse J enters the room. B/P
is 58/30 and Oxygen saturation is 79%, respiration is 0, no palpable pulse.
A STAT CODE is called. Patient is connected to the cardiac monitor. Heart rhythm is ventricular
fibrillation. CPR is initiated by the RN. Patient is intubated and defibrillated. Reversal agents, IV
fluids, and vasopressors are administered.
5:13 p.m.: heart rhythm is normal sinus, B/P is 110/70, and pulse is palpable. Patient not breathing
on his own and is fully dependent on the ventilator. Pupils are fixed and dilated. No spontaneous
movements and not responding to noxious stimuli. Air transport is called. Patient is transferred to a

tertiary facility for advanced care.
Patient outcome
Day 7: Brain death is confirmed by EEG data. Patient dies after life–support is

The Effects Of Life Support Technology On Nursing Practice
The use of life support technology to achieve work of breathing in patients is referred to as
mechanical ventilation. The author chose the topic of positive pressure mechanical ventilation to
explore the indications of use, complications, and safety concerns in relation to nursing practice.
Topics to be explored will include weaning protocols to reduce complications and patient suffering
and ventilator–associated pneumonia due to prolonged intubation. Fundamental nursing
interventions will be reviewed regarding ventilation and preventing complications. Patients who
require advanced monitoring, treatment, and nursing care due to injury or disease are cared for in the
intensive care unit (ICU). Approximately 50% of these patients need mechanical ventilation
(Tingsvik, Johansson, Martensson, 2015). A ventilator is a machine that supports breathing if the
patient is unable to do so. Some patients need ventilators for a short period of time, while others
require prolonged ventilation, which increases the risk of complications. Indications for mechanical
ventilation arise when the patient cannot uphold spontaneous ventilation to sustain life, which
include apnea, acute respiratory failure, severe hypoxia, coma, neuromuscular disease, and
respiratory muscle fatigue. There are two types of mechanical ventilation. Negative pressure
ventilation is non–invasive and doesn't require an artificial airway (Lewis, et al, 2014). The negative
pressure decreases intrathoracic pressures to

The Effect Of Fast Track Care On Length Of Stay Patients...
Running Head: FAST TRACK CARE
Review of Literature
The Effect of Fast Track Care on Length of Stay in Patients Undergoing Cardiac Surgery
Alisa Ruffner, BSN
Fall 2014
University of Tennessee Health Science Center: College of Nursing
NSG 819: Evaluation of Practice
Introduction Cardiac surgery is among the most frequently performed surgical procedures in the
United States. According to the American Heart Association, over 575,000 open heart surgeries were
performed in 2005. Until relatively recently, sedation and prolonged ventilatory support through the
first twelve to eighteen hours post operatively have been standard. This allowed adequate time for
the patient's hemodynamic, respiratory and coagulation physiological ... Show more content on
Helpwriting.net ...
How does fast track care compare to conventional care after cardiac surgery?
Methods
An electronic review of literature was conducted through PubMed, Clinicalkey, and MEDLINE
OVID databases. Key words and phrases searched included 'fast track', 'cardiac surgery', 'length of
stay', 'intensive care unit', and 'protocols'. The evidence in the articles were evaluated and examined
in the attached table. The evidence was also categorized for quality using the Grade model rating
from A to D.
Findings
The most significant publication found involving fast track care was a Cochrane review entitled
"Fast–track cardiac care for adult cardiac surgical patients". This review examined 25 trials and
included over 4,000 patients. The trails included in this review were randomized control trials "that
compared the use of low–dose opioid based general anesthesia versus high–dose opioid based
general anesthesia, and early extubation using time–directed protocols versus usual care for
extubation" (Zhu, Lee, & Chee, 2012). This review examined several outcomes including mortality,
post–operative complications, time to extubation, ICU length of stay, hospital length of stay, and

inpatient costs. The authors concluded, based on these studies, that fast track care was safe for
patients undergoing low to moderate risk cardiac surgery. The
combination of low dose opioid anesthesia combined with a rapid extubation protocol post
operatively is shown to decrease the time on

A Study On Sedation Management
Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O '
Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to
improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led
to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since
this time have focused on the influence of sedation protocols, and outcomes. This paper will review
the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies.
Also, explanations including a preliminary conclusion will be discussed.
Research Synthesis
Does the compliance with a sedation protocol improve after nurses receive a sedation competency
over a three month period?
P–Nurses who have completed a sedation protocol competency
I–Sedation protocol competency
C–Baseline use of the sedation protocol before education
O–Consistent protocol utilization
T–Three months
A degree of evidence related to protocol usage and outcomes was collected to determine if a
researchable problem was obtainable and valuable. According to Davies (2011), research questions
should concentrate on "real–world problems" (p. 75). Patients in the intensive care unit who are
mechanically ventilated receive intravenous sedation on a regular basis. According to findings by
Wøien, Vaerøy, Aamodt, and Bjørk (2012), as much as "30–60% of intensive care patients

Acute Respiratory Failure Caused By Aspiration Pneumonia
Acute Respiratory Failure Caused by Aspiration Pneumonia
My patient is a 47–year–old female who was admitted into the University of Kentucky hospital on
September 9th, due to acute respiratory failure with hypoxemia. She was in respiratory distress and
had an altered mental status. Her chief complaint was shortness of breath.
Her medical history showed a history of strokes with left hemiparesis/aphasia, seizures,
hypertension, chronic systolic and diastolic dysfunction, mechanical aortic valve replacement,
depression with psychosis, nephropathy, and GERDS. She currently resides in a skilled nursing
facility. Initial assessment of my patient revealed she had an increased work of breathing using
accessory muscles she had a fever of 39 degrees Celsius. Vital signs included, respiratory rate 31,
blood pressure 130/85, breath sounds were diminished with crackles in the bronchioles. Chest
physical examined revealed increased fremitus and a dull percussion note.
After arriving at the emergency department at U.K. hospital, my patient reported to having choked
while eating breakfast on 9/7/16. She also mentioned that she frequently chokes while eating, so this
was not a surprise to her. She reported that she had another spell with pneumonia previously this
year as well as having difficulty breathing. She was placed on a bipap with 100% FIO2, with some
improvement of the hypoxia. Her sats were 86%. She was switch to a NRB mask at 100% FiO2.
After the change in oxygen

Building Design of the Engineering and Computing Builiding...
Introduction
As an aspiring Architectural Technologist I will be expected to possess a variety of skills which are
valuable for any Architectural Technologist position. I will be studying and evaluating a building
design of the Engineering and Computing Building, Coventry. I am to assess the structure,
identifying, why the building was designed in the way it was, the impact, challenges and purposes.
This will allow me to understand the integration of architectural and structural design.
1.1 Design philosophy and aesthetics
The Engineering and Computing Building (ECB) was designed by Arup Associates' and built by
main contractor Vinci. In designing this building Arup Associates' were trying to create a sustainable
postmodern building, which would become a flagship for the university and a landmark in the centre
of the city. Designed to meet the university's long–term needs in terms of improving the student
learning experience, using the building as a learning tool in itself.
The 15,000m² building is enclosed in a square, split into two 'L' shaped blocks. Linked together by a
glazed entrance at the corner and separated by a large gap on the opposite corner.
The 'L' block facing the south and west has been configured as the 'Nature' block. This four–storey
'Nature' wing features a green and blue roof planted with foliage, providing a variety of habitats to
encourage the local wildlife. Well known to attract insects that pipistrelle bats are known to prefer.
There is also

Obesity Is An Increasing Problem All Over The World And...
Obesity is an increasing problem all over the world and its prevalence differs from one area to
another. According to World health Organization (WHO) obesity is defined as body mass index
(BMI) of 30kg/m2 or more.1
It was reported that the proportion of obesity in surgical patients is greater than general population.2
This means that anesthesiologists are going to deal with increased number of obese patients whose
airway management is one of their own responsibilities. Endotracheal intubation is more difficult in
obese than in lean patients.3 Difficult tracheal intubation is defined by the American Society of
Anesthesiologists (ASA) as tracheal intubation requiring multiple attempts in the presence or
absence of tracheal pathology.4 1 Failure of tracheal intubation is one of the major causes of
morbidity and mortality during anesthesia.5,6
Consequently, the use of new tools that increase the success of tracheal intubation, particularly in
settings of potentially difficult intubation, can have a profound clinical impact.
The LMA CTrach® is a modified intubating laryngeal mask airway, which incorporates an inbuilt
integrated fibreoptic system and a detachable battery powered LCD colour monitor with a light
source that enables visualization of glottis during intubation.7
King vision is a new portable battery powered video laryngoscope that is composed of reusable
monitor and disposable blade which may be channeled or non–channeled. It is used successfully for
tracheal

A Short Note On The Air Leak Syndrome
Introduction
Air Leak Syndrome is a term used to describe a collection of similar pathologies related to air being
in pulmonary, pleural and interstitial spaces. The most common cause of air leak syndrome in
neonates is inadequate mechanical ventilation of their delicate lungs. The incidence of air leaks in
newborns is inversely related to the birth weight of the infants, especially in infants suffering from
respiratory distress syndrome and meconium aspiration (Walsh, 2015). Chest tube drainage and/or
needle aspiration are necessary in managing pneumopericardium with cardiac tamponade or tension
pneumothorax.
To prevent air leak syndrome, gentle ventilation with low pressure, low tidal volume, low
inspiratory time, high rate, and ... Show more content on Helpwriting.net ...
For pneumothorax, the incidence from 1990–2002 was 13% in babies weighing <1000 grams are at
high risk the first day or two after birth. Babies with pulmonary hypoplasia, meconium aspiration
syndrome, and respiratory distress syndrome are also at higher risk. Use of NIV/CPAP also
increases the risk. An article in the Pediatrics journal cited three cases where children of various
ages developed various air leaks from the use of high–flow nasal cannula (HHNC) therapy. The
author cited the urgent need to conduct more studies on HHNC and that it should not be used for
providing positive distending pressure. Set flows should not exceed the patient's minute ventilation
(Hegde, 2013).
Prevention
Sadly, it should be understood that most of pulmonary air leaks are iatrogenic. Healthcare workers
should not be overly aggressive when doing CPR and using the bag mask. Infants' lungs are fragile
and cannot handle being over–ventilated. When using mechanical ventilation, use low pressures low
tidal volumes and high respiratory rates. Risk of pneumothorax and pulmonary interstitial
emphysema can be reduced by using surfactant.
Pathophysiology
Air leaks are a result of overdistention of the lungs and can cause uneven alveolar ventilation and air
trapping. Increased pressures can rupture alveoli or other tissues, allowing air to escape into the
interstitial spaces. This air can then travel through perivascular adventitia, causing pulmonary
interstitial emphysema. If the air

A Study On Sedation Management Essay
Literature Review
Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O '
Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to
improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led
to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since
this time have focused on the influence of sedation protocols, and outcomes. This paper will review
the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies.
Also, explanations including a preliminary conclusion will be discussed.
Research Synthesis
Does the compliance with a sedation protocol improve after nurses receive a sedation competency
over a three month period?
P–Nurses who have completed a sedation protocol competency
I–Sedation protocol competency
C–Baseline use of the sedation protocol before education
O–Consistent protocol utilization
T–Three months
A degree of evidence related to protocol usage and outcomes was collected to determine if a
researchable problem was obtainable and valuable. According to Davies (2011), research questions
should concentrate on "real–world problems" (p. 75). Patients in the intensive care unit who are
mechanically ventilated receive intravenous sedation on a regular basis. According to findings by
Wøien, Vaerøy, Aamodt, and Bjørk (2012), as much as "30–60% of intensive

The, Bundle And Role Of Critical Care Nurses
Running head: The "ABCDE" Bundle The "ABCDE" Bundle and Role of Critical Care Nurses' Sue
Lawniczak College of Lake County Nursing 133 October 5, 2016 THE "ABCDE" BUNDLE 1 The
"ABCDE" Bundle and Role of Critical Care Nurses' Introduction Critical care in the United States is
currently accelerating at a rapid pace and is predicted to continue the growing trend as more people
age. With high costs and diminishing availability of nursing care, the medical field is at a crucial
juncture with managing the health of those who are in critical care. Individuals who enter Intensive
Care Units (ICU) are at higher risk for developing further complications the longer they are under
critical care such as developing Intensive Care Unit delirium and weakness to ventilator–associated
pneumonia. The role of critical care nurses' in the ICU is not only essential but it is pertinent in the
success of a patients' ability to recover and leave the ICU department. "A "bundle," according to the
Institute for Healthcare Improvement, is a set of evidence–based practices–generally 3–5–that, when
performed collectively and reliably, improve patients' outcomes. The Awakening and Breathing
Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle
incorporates the best available evidence related to delirium, immobility, sedation/analgesia, and
ventilator management in the ICU and tailors the

The Neurally Adjusted Ventilatory Assist (NAVA)
The medical field is very fast–paced and new technological discoveries are constantly being made.
When one thinks of new medical findings, cancer cures and surgery are common thoughts.
However, a very interesting and slightly controversial discovery has been made in the neonatal
world. The Neurally Adjusted Ventilatory Assist (NAVA) is "a form of partial ventilator assistance in
which the machine delivers assistance in proportion to the electrical activity of the diaphragm
(EAdi), as assessed by means of transesophageal electromyography" (Gianmaria Cammarota et al.,
2011). It is meant to lower inspiratory pressure and respiratory muscle load in preterm infants
(Gianmaria Cammarota et al., 2011). In other words, it helps the patient– whether they be an infant
or an adult– breathe when their lungs aren't able to aid in that process. M. Ferrer and P. Pelosi,
authors of "European Respiratory Monograph 55: New Developments in Mechanical Ventilation"
say that the signal from the EAdi is used to regulate NAVA, which then causes the airways to
receive pressure. "With NAVA, both timing and the magnitude ventilator delivered assistance are
controlled by the EAdi" (M. Ferrer & P. Pelosi., 2012, p 116). My research proves that NAVA can
work better than pressure support ventilation (PSV) and can be used not only for neonates, but
patients in the ICU that are affected by lung–related injury or illness that causes them to have
difficulty breathing on their own; though there are

Symptoms Of Acute Respiratory Distress Syndrome
There are many diseases all around the world that affect our loved ones. One in particular that is
common among many hospitals is Acute Respiratory Distress Syndrome, also known as ARDS.
Originally it was called Adult Respiratory Distress Syndrome but realized that was not accurate
because it not only affects adults but children also. ARDS is defined as "the acute onset of
respiratory failure, bilateral infiltrates on chest radiograph, hypoxemia as defined by a PaO2/FiO2
ratio ≤200 mmHg, and no evidence of left atrial hypertension or a pulmonary capillary pressure
(Fanelli et al., 2013) It can also include cyanosis, tachypnea, dyspnea, reduced respiratory
compliance and an arterial blood gas showing respiratory alkalosis with evidence of hypoxemia. Out
of the many pulmonary disorders out there, ARDS is one of the most difficult diseases to manage
and has a high mortality rate that comes with it. For this condition to occur, many things have to
take place in the body. First the pulmonary capillaries and alveoli epithelial tissues become
inflamed. This results in absorbency of these layers of tissues which then leads to plasma, which is
abundant in protein, to escape out of the capillaries and into the alveolar space. After the trauma to
the alveolar lining occurs, this allows fluid into the alveoli, which then results in pulmonary edema.
During this whole process damage to two different types of cells is being done. Type I and II of the
alveolar epithelial cells. Type II

Weaning The Unweanable.aspx Ventilation Is A Modern...
Marrone, S. EdD, RN–BC, CTN–A, Eason, J. BS, RRT–NPS, McLeod, C. MSN, RN, Marriott, C.
BSN, RN, Alleyne, J. MHA, RN, Walker, D. RN, Bish, C. RN,. Weaning the 'Unweanable ' (2012,
March 1). Retrieved July 26, 2015. http://respiratory–care–sleep–
medicine.advanceweb.com/Features/Articles/Weaning–the–Unweanable.aspx
Biphasic cuirass ventilation is a method of external ventilation that is considered to be a modern
improvement of the iron lung. With this type of negative pressure ventilation it is possible for the
patient to acquire a large amount of tidal volume as well as a high respiratory rate. Most of the more
common methods of ventilation are determined by the elastic recoil of the chest which, in return,
restricts the respiratory rate. Complications, such as infections, that are usually associated with the
invasive method of ventilation can be avoided when using this non–invasive ventilation technique.
Instead of participating with one or the other, biphasic cuirass ventilation has the capability to utilize
both phases of respiration, the expiratory and inspiratory phases.
Sometimes when a patient is on the more common form of mechanical ventilation for an extended
time or if the patient has undergone respiratory failure, their respiratory muscles have a tendency to
become weak. With the use of this biphasic cuirass ventilation method they can have the opportunity
to build and strengthen those muscles which, in return, can allow them to be weaned from the
ventilator

Idiopathic Interstitial Pulmonary Firosis ( Ipf ) Essay
Idiopathic interstitial pulmonary firosis (IPF) is considered the most common form of interstitial
lung disease (ILD). Its course is a progressive of and its cause is unknown. Idiopathic interstitial
pulmonary firosis a‫ٶ‬ect the gas exchange as it results in chronic inflmmation and progressive firosis
of lung parenchyma. Нe signs and symptoms of this disease consist of progressive dyspnea,
hypoxia, clubbing and crepitations at the lung bases [1]. IPF is a fatal lung disease; the natural
history is variable and unpredictable: Most patients with IPF demonstrate a gradual worsening of
lung function over years; a minority of patients remains stable or declines rapidly. Some patients
may experience episodes of acute respiratory worsening despite previous stability. НH
ATS/ERS/JRS/ALAT 2011 Revised Diagnostic Criteria Нe diagnosis of IPF is based on the absence
of a known cause of lung firosis computed tomography (CT) fidings and, in cases with CT
abnormalities that are not classical for IPF, the use of pathological criteria [2]. An 2‫ٹ‬FLDO
ATS/ERS/JRS/ALAT Statement IPF is defied as a specifi form of chronic, progressive firosing
interstitial pneumonia of unknown cause, occurring primarily in older adults, limited to the lungs,
and associated with the histopathologic and/or radiologic pattern of unspecifid interstitial
pneumonia (UIP) [3]. НH Diagnosis of IPF Requires 1. Exclusion of other known causes of
interstitial lung disease (ILD) Нe presence of a unspecifid interstitial

Causes And Consequences Of Sepsis
Sepsis, also referred to as blood poisoning is a potentially life threatening complication that results
from an infection. These infections, typically caused by bacteria cause chemicals to be released in to
the bloodstream in order to fight the infection. As a result, this triggers an inflammatory response
throughout the body, which in turn may cause a cascade of changes, which may damage organ
systems, causing them to fail. The infection present in the blood in this case becomes systemic,
spreading through the body (Abraham, Matthay Dinarello, et al, 2000). Sepsis may start with any
given type of infection from small or minor infections such as a urinary tract infection and abscessed
tooth to more serious ones such as meningitis. Septic shock on the other hand is the most severe
form of sepsis, and has been associated with high mortality rates. Uncontrolled sepsis results in
septic shock, which is largely the result of progressive compromise of various organ systems and the
eventual development of multiple organ failure. When sepsis progresses to septic shock, there is a
drastic drop of blood pressure, which may cause death. With regards to septic shock, the onset of
treatment determines chances of outcome. Whereas early intervention may reduce mortality rates,
late septic shock reduces the chances of survival.
2. Etiology
One of the most common causes of sepsis is bacterial infection. However, it may also arise from
other conditions that may

A Family 's Tough Choice : Life Or Death
A Family's Tough Choice: Life or Death When a tragedy strikes, the family is already pushed to
make difficult decisions about their injured loved one. Possible decisions may include, donating
viable organs, donating the body to science, and in the worst case scenario, funeral details. But what
if the tragedy involves a pregnant brain dead mother? The family should have the choice of keeping
the mother on life support until the baby is developed enough for a cesarean section can be
performed, or to take the mother off of life support to end the suffering. Leaving the choice to the
family would make the situation possibly less painful. If the hospital takes the mother off life
support against the family's wishes, that choice by the hospital would be considered very unethical.
When a patient 's body is no longer able to support bodily functions, life support is used until the
body can function properly on its own again. Most commonly when an individual 's heart, brain, or
lungs stop working properly is when they will be placed on life support. When patients need to be
placed on life support, most are placed on mechanical ventilators. A ventilator is a machine that
helps a person breath. This machine, which is also known as a respirator, pushes air into the lungs
which helps the flow of oxygen reach the whole body. A ventilator is most commonly used
temporarily for cases such as pneumonia, but can also be used longer in cases of lung failure. To
insert the

Effect Of Innovation Within The Healthcare Industry
The effect of innovations within the healthcare industry leads to many scientific and technical
changes in healthcare delivery. To cope with these changes, there necessitate to prepare and train
healthcare workers to improve employees ' knowledge and the quality of care. Limited clinical
experience with new mode of mechanical ventilation, such as Airway Pressure Released Ventilation
mode, make its implementation difficult in real critical world. Adequate staff training time, offsite
support services, and backup from ventilator manufacturers are essential to improve employees '
knowledge and skills. My research topic seeks to investigate the effectiveness of scenario–based
learning in training healthcare practitioners in the use of APRV. Airway Pressure Released
Ventilation (APRV) was first introduced by Dr. Christine Stock and Dr. John Downs, in the late
1980s. The APRV application was originally used as a rescue therapy to manage ARDS patients who
have difficulty in oxygenation.{40} The Drager Evita was the first ventilator provide APRV. Other
ICU ventilator manufacturers incorporated APRV mode with different terminology. Such as, the
Maquet Servoi refers to APRV as Bi–vent; the Puritan Bennett 840 uses the term Bi–level; the
Cardinal AVEA uses Bi–phasic; and Hamilton G5 refers to APRV as DouPAP.{13} Airway Pressure
Released Ventilation is a form of nonconventional mode of ventilation that based on open–lung
principle.{13} It is a time triggered, pressure limited, and

Patient Reflection
During the ICU rotation, there was an opportunity to interview an intubated patient, with whom I
was assigned to for 2 consecutive clinical days. As per the patients and reports given by the nurse,
the patient came to the emergency department complaining of right abdominal pain. Furthermore,
the patient's lungs were unable to compensate making it difficult to breathe due to the patient being
morbidly obese. In addition to this, the patient had a past medical history of Coronary Artery
Disease, Diabetes Mellitus and Hypertension and a left atrium enlargement. Therefore, the patient
was admitted intubated on 10/22/2017 and taken to the ICU, as a result of a perforated viscus ulcer.
Interview
Did you hear anything? /can you describe what you heard? When asked questions, the patient
expressed not hearing various things during the intubation procedure. Specifically, the patient
remembered being told about the intubation and numerous muffled voices before the procedure.
After the procedure, the patient noted hearing familiar voices of the family especially the patient's
mom, asking how the patient was feeling. Further, the patient also heard conversations between
nurses.
Did you see anything? /can you describe what you saw? The patient saw numerous hazy faces
before the procedure. However, the patient for a large time block does not recall any details during
the procedure. After, being intubated the patient recalls slightly seeing his mother yet, due to the
sedation, the

Intensive Care Unit Analysis
Introduction 166
Endotracheal tube, mechanical ventilator, central venous catheter, invasive pressure monitors, ECG
cable, oxygen saturation monitor, Foley catheter, drain tubes, chest tubes, percutaneous pacemaker,
and peripheral intravenous line. These are just an example of cables and tubes that can be attached
to a single patient who is treated in an intensive care unit (ICU) and most of them trigger an alarm if
a patient moves like a normal human being. Needless to say, it is evident for nurses that these
patients suffer from these wires and tubes, unfamiliar environment surrounded by the constant
multiple mechanical noises, and interruption of rest caused by nursing cares, treatments, diagnostic
tests, and procedures although all of them are meant to be life–saving.
To support these patients in their ICU stay, we nurses take care all aspect of their needs by
maintaining patient–centered care and evidence–based practice aligned with both Canadian Nurses'
Association and College of Nurses of Ontario (Canadian Nurses Association, 2010, ... Show more
content on Helpwriting.net ...
Then limitations were applied as the first author is a nurse, full–text, peer reviewed, from the year of
2000 inclusive, and written in English to yield 15 articles. Resulted countries include Australia,
Belgium, Canada, Denmark, Israel, Malaysia, Sweden, United Kingdom, and the United States of
America. And published year ranged from 2000 to 2016. All of the studies focused on patients, with
one of them included healthcare workers, and the other one included the significant others as an
additional subject. 11 out of 15 studies explored the patients' experience with mechanical ventilation
(MV), 2 out of 15 studies focused on ICU delirium, and remaining two studies focused on the
general patient population in the ICU without specification of medical

Risk Pneumonia And Mischance Ventilation ( Ippv ) Is The...
considered a relative contra– indication due to risk of aspiration pneumonia and mischance
ventilation. According to international guidelines the conventional invasive mechanical ventilation
(IPPV) is the best option for patients with impaired conscious state. 5 As IPPV is associated with
many complications and difficulty in weaning in COPD patients . In this study NPPV in the form of
BiPAP was given to COPD patients with type –2 respiratory failure and GCS between 10–15 and
efficacy of BiPAP was monitored. The outcome of BiPAP in patients with normal GCS was
compared to patients with low level of consciousness. 6 OBJECTIVE: To determine the
effectiveness of BiPAP in COPD patients with Hypercap¬nic respiratory failure in relation to ...
Show more content on Helpwriting.net ...
Also we adjusted the pressures during inspiration and expiration to maintain the saturation within
required limits. If we increased the EPAP ,then the IPAP was also increased. EPAP can be increased
up to 8 cm of H2O. BiPAP ventilation may be discontinued at time with clinical evidence of
deteriorating conscious level or hemodynamic instability. Data Collection Demographic and
baseline clinical data was collected from patients before being put on BiPAP. The information was
obtained about age, gender, pH, GCS, PO2, PCO2, RR, Bicarbonate etc. The information about
arterial blood gases was again taken from patients two hour after receiving ventilation with BiPAP
The data was recorded in a structured Performa and then entered into SPSS 16. Arterial blood gases
were compared before and after BiPAP ventilation in both Groups with reference to their Glasgow
Coma Scale (GCS) . Mean and SD were calculated for quantitative vari¬ables. Paired `t'test and
Chi–Square test were applied for comparison of relevant parameters. Results A total of 90 patients
were included in this study. The mean (SD) age of study cohort was 63.7 (8.30) years with an age
range of 40–80 years. The present study cohort has a male preponderance. On admission, out of total
90 patients,24 patients were in hypercapnic encephalopathy with GCS in between 10–14. 66
patient were having GCS of

Respiratory Essay
Case Study for Respiratory Disorders #2
Scenario
A.W., a 52–year–old woman disabled from severe emphysema, was walking at a mall when she
suddenly grabbed her right side and gasped, Oh, something just popped. A.W. whispered to her
walking companion, I can't get any air. Her companion yelled for someone to call 911 and helped
her to the nearest bench. By the time the rescue unit arrived, A.W. was stuporous and in severe
respiratory distress. She was intubated, an IV of lactated Ringer's (LR) to KVO (keep vein open)
was started, and she was transported to the nearest emergency department (ED).
On arrival at the ED, the physician auscultates mufﬂed heart tones, no breath sounds on the right,
and faint sounds on the left. A.W. is ... Show more content on Helpwriting.net ...
You also note that on the cardiac monitor A.W. is having numerous irregular beats.
6) Which one of these lab test results most concerns you? Explain.
BUN elevation can be caused by impaired renal secretion that could cause shock.
7) What is causing the irregular beats on the cardiac monitor?
She could possibly be going into shock because of elevated BUN levels.
As the physician begins the process to insert the chest tube the mechanical ventilator suddenly fails.
8) What should you do?
I would tell the doctor to stop if he didn't start and grab a manual ventilator and try to find a
replacement mechanical ventilator.
A.W.'s chest tube is inserted successfully and she is stabilized. She is admitted to the ICU and will
be in the hospital on bed rest for a minimum of several days as she recovers.
9) What is the number one complication you want to guard against for A.W.? Explain.
Pneumonia, because she isn't mobile.
10) What can you do to prevent this complication?
Have AW use an incentive speromiter to help with deep breathing.
Three days after admission A.W. is diagnosed with a pulmonary embolism.
11) List six assessment ﬁndings you should monitor closely for with this condition.
I would carefully monitor vital signs, cardiac dysrhythmias, pulse oximetry, ABG's and lung sounds.
12) Why did A.W. develop a

The Intensive Care Unit ( Icu )
Let's Take a Walk The intensive care unit (ICU) is the area of the hospital where patients are the
most critically ill. Life– saving treatment is the focus of care for these patients. However, little is
thought on how the illness or injury affects the patient in the long run. There have been recent
studies on potential changes in patient care to include ambulation of patients' while they are still on
a ventilator. Early ambulation while in the ICU will be a change from current methods of care, and
the change no doubt will be a rough road. The path we will follow includes a review of the
microsystem and the 5 P's, IOM aims, EBP models, and steps to implement the project locally. Let's
take a walk and see how a mobility Quality Improvement (QI) project will provide long term
improvement to critically ill patients. Phenomenon of Interest With a plan to work in the critical care
area, as a Clinical Nurse Specialist (CNS), articles with an ICU focus become high on the priority
list for review. With ten years of experience as a basis, the writer's opinion is that care of the
severely ill has not changed in the area of mobility while in the ICU over that time. Patients in the
ICU are traditionally on bed rest until just a day or two prior to discharge from the unit. In review of
local policy, the ICU at Walter Reed National Military Medical Center (WRNMMC), currently does
not have a mobilization project. The Medical ICU average patient stay at WRNMMC, based off the
writer's last

Providing Anesthesia For Lung Transplantation
Providing anesthesia for lung transplantation (LT) is considered by many to be a major feat in
cardiothoracic anesthesia. Some say it involves the most complex manipulation of cardiothoracic
physiology, especially when cardiopulmonary bypass (CPB) is not used. There are many indications
for end–stage pulmonary disease, from obstructive lung disease to pulmonary vascular disease.
Traditionally, ventilation strategies for this population included tidal volumes of 8–12ml/kg to
prevent atelectasis and zero PEEP to prevent a shunt of blood flow (Slinger, 2012). This strategy
proved to cause harm during the periorperative period. Research now indicates that a reduction in
tidal volume with added PEEP not only decreases atelectasis, but it also reduces pulmonary
inflammatory response (Coppola, Froio, Chuimello 2014). These patients already have a
decreased respiratory reserve, therefore inducing an inflammatory mediated response with
ventilation settings can be detrimental and should be avoided at all costs by the nurse anesthetist. It
is imperative for the nurse anesthetist understand the necessity of lung protective ventilation
strategies in LT.
Patient Assessment
Lung transplantation surgery is often unpredictable and emergent. Therefore, the preoperative
workup of transplant recipients must be thoroughly performed in advance with appropriate updating
of clinical data and investigations whilst on the waiting list. If the patient has been on the waiting
list for an extended

Mechanical Ventilation

Recommended

Recommended

More Related Content

More from Heidi Owens

More from Heidi Owens (20)

Recently uploaded

Recently uploaded (20)

Mechanical Ventilation