The document discusses mechanical ventilation, including definitions, types, indications, settings, complications, and nursing management. Mechanical ventilation is a method of positive or negative pressure breathing assistance used when patients cannot maintain adequate oxygen or carbon dioxide levels on their own. The major types are negative pressure ventilation and positive pressure ventilation. Settings control factors like respiratory rate, tidal volume, oxygen concentration, and PEEP. Complications can include hypotension, pneumonia, and increased intracranial pressure. Nurses monitor patients, ventilator settings and alarms, and prevent complications like infection through interventions such as oral care.
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
The presentation deals with the principles of mechanical ventilation, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
The presentation deals with the principles of mechanical ventilation, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
Caring patient on Mechanical Ventilator Shanta Peter
Mechanical ventilators are used now in general wards , not only in ICU -to save patient's life. We need to care patient and ventilator while working with it ..
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
3. Introduction About Mechanical
Ventilation
Mechanical ventilation 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 ICU for a short period of time during a serious
illness. It may be used at home or in a nursing or
rehabilitation institution if patients have chronic
illnesses that require long-term ventilation
assistance.
4. DEFINITION
Mechanical ventilation is a positive or negative pressure
artificial breathing device that can maintain ventilation
and oxygen delivery for prolonged periods. (It is
indicated when the patient is unable to maintain safe
levels of oxygen or CO2 by spontaneous breathing even
with the assistance of other oxygen delivery devices
5. Indications
Lung or airway disorders or trauma e.g.
Pneumonia, ARDS, rib fractures, asthma,
pulmonary edema, pneumothorax.
Circulatory disorders e.g. MI, cardiogenic shock,
heart failure,
Acute exacerbation of COPD
Neuromuscular disorders and trauma e.g. GBS,
Myasthenia gravis, head injury.
Airway obstruction e.g. facial trauma, aspiration,
head / neck / chest burns, oral cavity burns.
7. Types or Forms Of Mechanical
Ventilation
The two major types of Mechanical Ventilation are
Negative pressure and positive Pressure
ventilation
The main form of mechanical ventilation is
positive pressure ventilation, which works by
increasing the pressure in the patient's airway
and thus forcing air into the lungs. Less common
today are negative pressure ventilators (for
example, the "iron lung") that create a negative
pressure environment around the patient's
chest, thus sucking air into the lungs.
8. Types or Forms Of Mechanical Ventilation
Negative Pressure
Ventilator
Positive Pressure
Ventilator
9. Settings of Mechanical
Ventilation
• Mechanical Ventilator Settings
regulates the rate, depth and
other characteristics of ventilation.
Settings are based on the
patient’s status (ABGs, Body
weight, level of consciousness
and muscle strength)
16. Intubation Procedure
Check and Assemble Equipment:
Oxygen flowmeter and O2 tubing
Suction apparatus and tubing
Suction catheter or yankauer
Ambu bag and mask
Laryngoscope with assorted blades
3 sizes of ET tubes
Stylet
Stethoscope
Tape
Syringe
Magill forceps
Towels for positioning
18. Intubation Procedure
Preoxygenate with 100% oxygen to
provide apneic or distressed patient
with reserve while attempting to
intubate.
Do not allow more than 30 seconds to
any intubation attempt.
If intubation is unsuccessful, ventilate
with 100% oxygen for 3-5 minutes
before a reattempt.
21. Intubation Procedure
After displacing the epiglottis
insert the ETT.
The depth of the tube for a male
patient on average is 21-23 cm at teeth
The depth of the tube on average for a
female patient is 19-21 at teeth.
22. Intubation Procedure
Confirm tube position:
By auscultation of the chest
Bilateral chest rise
Tube location at teeth
CO2 detector – (esophageal
detection device)
24. Complication
• Hypotension
• Pneumothorax
• Decreased Cardiac Output
• Nosocomial Pneumonia
• Increased Intracranial Pressure (ICP)
• Alarms turned off or nonfunctional
• Sinusitis and nasal injury
• Mucosal lesions
• Aspiration, GI bleeding, Inappropriate ventilation (respiratory
acidosis or alkalosis, Thick secretions, Patient discomfort due to
pulling or jarring of ETT or tracheostomy, High PaO2, Low
PaO2, Anxiety and fear, Dysrhythmias or vagal reactions during
or after suctioning, Incorrect PEEP setting, Inability to tolerate
ventilator mode.
25. Mechanical Ventilation:
Complications
• Neurological complications
– Positive pressure ventilation → increased intrathoracic
pressure
– interferes with venous drainage; increased ICP
• GI
– Stess ulcers and GI bleeds; Rx with H2 receptor blockers
– Gastric and bowel dilation
26. Mechanical Ventilation:
Complications
• Musculoskeltal
• Muscle atrophy d/t immobilization
– Mobilize
– ROM
• Psychologic
• Stress
• Communication very important
• Sedate, explain, family visits, pain management
• Facilitate expression of needs
32. Ventilator Settings
Terminology
•A/C: Assist-Control
•IMV: Intermittent Mandatory Ventilation
•SIMV: Synchronized Intermittent
Mandatory Ventilation
•Bi-level/Biphasic: Non-inversed
Pressure Ventilation with Pressure
Support (consists of 2 levels of pressure)
33. Ventilator Settings
Terminology (con’t)
•PRVC: Pressure Regulated Volume
Control
•PEEP: Positive End Expiratory Pressure
•CPAP: Continuous Positive Airway
Pressure
•PSV: Pressure Support Ventilation
•NIPPV: Non-Invasive Positive Pressure
Ventilation
34. VOLUME vs. PRESSURE
VENTILATION
Volume ventilation: Volume is
constant and pressure will vary with
patient’s lung compliance.
Pressure ventilation: Pressure is
constant and volume will vary with
patient’s lung compliance.
35. POSITIVE END
EXPIRATORY PRESSURE
(PEEP):
• This is NOT a specific mode, but is rather an
adjunct to any of the vent modes.
• PEEP is the amount of pressure remaining in
the lung at the END of the expiratory phase.
• Utilized to keep otherwise collapsing lung
units open while hopefully also improving
oxygenation.
36. Continuous Positive Airway
Pressure (CPAP):
• This is a mode and simply means that a pre-
set pressure is present in the circuit and
lungs throughout both the inspiratory and
expiratory phases of the breath.
• CPAP serves to keep alveoli from collapsing,
resulting in better oxygenation and .
• The CPAP mode is very commonly used as a
mode to evaluate the patients readiness for
extubation.
37. Nursing Management
How to keep the Ventilator ready to receive the
case ?
Check the Air and oxygen
connections
Connect the Ventilator
tubes to ventilator
38. How to keep the Ventilator ready to
receive the case ?
• Connect the chest lung to
the ventilator tubing's
Make sure that you correctly
connected the tubing's and check
for any looseness
39. How to keep the Ventilator
ready to receive the case ?
Connect the servo guard
(From the patient)
Connect the filter
(To the Patient)
40. How to keep the Ventilator
ready to receive the case ?
• Check the tubing’s for any
leakage
» Change the Bacteria filter
41. Nursing Interventions
• Observe for tube misplacement-
• Observe for tube obstruction; suction;
ensure adequate humidification.
• Explain purpose/mode/and all treatments;
encourage patient to relax and breath with
the ventilator; teach importance of deep
breathing; provide alternate method of
communication.
42. Nursing Interventions
• Observe for tube misplacement-
• Observe for tube obstruction; suction;
ensure adequate humidification.
• Explain purpose/mode/and all treatments;
encourage patient to relax and breath with
the ventilator; teach importance of deep
breathing; provide alternate method of
communication.
43. Nursing Interventions
• Assess for GI problems. Preventative
measures include relieving anxiety,
antacids. therapy.
• Maintain muscle strength.
• Provide nutrition as ordered.
44. Nursing Diagnosis
1. Ineffective airway related to presence of artificial
airway, accumulation of secretions and immobility.
- change patient’s position 2 hourly.
- Asses for pain
- Monitor chest x-rays
- Maintain ventilator settings as ordered
- Maintain ventilator settings as ordered.
- Observe for tube obstruction; suction; ensure
adequate humidification.
45. Nursing Diagnosis
2. Impaired gas exchange related to insufficient oxygen
levels.
- Monitor ABG’s.
- Assess LOC,and irritability.
- Observe skin colour .
- Administer oxygen as ordered
- Observe for tube obstruction; suction ; ensure
adequate humidification.
46. Nursing Diagnosis
• 3. Decreased cardiac output related to impeded
venous return by PPV as manifested by decreased
BP, decreased urine output, increased heart rate
- monitor vital signs and level of consciousness
- observe and monitor for clinical manifestations of
decreased cardiac output
- monitor hemodynamic.
47. Nursing Diagnosis
4. Imbalanced nutrition less than body requirement
related to NPO status
- Provide nutrition as ordered,
- Observe for muscle wasting
- Observe for nausea, vomiting, abdominal
distension, and stool characteristics
- Insert nasogastric tubes if needed
48. Nursing Diagnosis
5.Impaired verbal communication related to intubation
and artificial airway
- evaluate patient’s ability to communicate by other
means
- ensure that call bell is placed within easy reach of
patient at all times
- make eye contact with patient at all times
49. Nursing Diagnosis
7. Risk for infection related to intubation.
- evaluate risk factors that causes patient to infection
- provide oral hygiene.
- monitor sputum for changes in characteristics,
- monitor tracheostomy site for infection
- maintain good hand washing technique.
- maintain sterile techniques for all dressing changes
and suctioning
-Administer antibiotics as ordered
50. Nursing Diagnosis
8. Risk for injury .
- obtain ABG values
- monitor patient for signs and symptoms for
decreased cardiac output such as hypotension,
tachycardia, arrhythmia
- drain fluid from the ventilator tubing
- maintain sterile technique, good oral care, and
careful positioning and observe for signs and
symptoms for pulmonary infections
52. Nursing Interventions
8- Maintain safety:-
9- Provide psychological support
10- Facilitate communication
11- Provide psychological support &
information to family
12- Responding to ventilator alarms
/Troublshooting ventilator alarms
13- Prevent nosocomial infection
14- Documentation
52