1. The document discusses mechanical ventilation and the nurse's role in caring for patients on ventilators. It defines mechanical ventilation, its purpose, and common modes of ventilation.
2. It outlines the nurse's responsibilities in assessing patients on ventilators, including monitoring for complications and troubleshooting alarms. Common complications include decreased cardiac output, barotrauma, and nosocomial pneumonia.
3. The document also covers indications for intubation, preparing a patient for intubation, and preventing complications such as sinusitis, tracheoesophageal fistula, and laryngeal stenosis.
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 ..
Hemodynamic monitoring- Hemodynamic monitoring refers to the measurement of pressure, flow and oxygenation within the cardiovascular system. Hemodynamic monitoring is amandatory process in all the critical care units to assess the patients progress. This presentation is aimed to create an insight on Hemodynamic monitoring.
The insertion of a cannula or a tube into a hollow organ such as intestines or trachea, to maintain an opening or passageway is known as intubation.
The insertion of a long breathing tube or artificial airway (endotracheal tube - ETT) into the trachea (windpipe) via the mouth is called endotracheal intubation
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 ..
Hemodynamic monitoring- Hemodynamic monitoring refers to the measurement of pressure, flow and oxygenation within the cardiovascular system. Hemodynamic monitoring is amandatory process in all the critical care units to assess the patients progress. This presentation is aimed to create an insight on Hemodynamic monitoring.
The insertion of a cannula or a tube into a hollow organ such as intestines or trachea, to maintain an opening or passageway is known as intubation.
The insertion of a long breathing tube or artificial airway (endotracheal tube - ETT) into the trachea (windpipe) via the mouth is called endotracheal intubation
An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used in airway management.
A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
ENDOTRACHEAL TUBE INTUBATION II Parts II Details II Clinical DiscussionSwatilekha Das
What is endotracheal intubation?
Endotracheal intubation is a procedure by which a tube is inserted through the mouth down into the trachea (the large airway from the mouth to the lungs). Before surgery, this is often done under deep sedation. In emergency situations, the patient is often unconscious at the time of this procedure.
For detailed information plz watch the slides till end.......
And plz like, share and comment and follow......
An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used in airway management.
A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
ENDOTRACHEAL TUBE INTUBATION II Parts II Details II Clinical DiscussionSwatilekha Das
What is endotracheal intubation?
Endotracheal intubation is a procedure by which a tube is inserted through the mouth down into the trachea (the large airway from the mouth to the lungs). Before surgery, this is often done under deep sedation. In emergency situations, the patient is often unconscious at the time of this procedure.
For detailed information plz watch the slides till end.......
And plz like, share and comment and follow......
Mechanical ventilation ppt including airway, ventilator, tubings and connections, nursing management, trouble shooting common problems and issues, suctioning etc.
indication foe intubation ,routes of intubation , the role of nurse in intubation ,indication of mechanical ventilation ,ventilators ,ventalotory modes and its advantages and disadvantages , complication of mechanical ventilation , nursing Management for patients on ventilator ,suction technique and weaning process
The must to know facts about ventilator. Indeed a detailed information can be gathered from the presentation. This presentation includes definition, history, terminology, need of ventilation,indication, types, complications, etc.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Defination:Mechanical ventilation is the use of a mechanical device (machine) to inflate and deflate the lungs. Purpose: Mechanical ventilation provides the force needed to deliver air to the lungs in a patient whose own ventilatory abilities are diminished or lost.
3. The nurse must be able to do the following 1. Identify the indications for mechanical ventilation. 2. List the steps in preparing a patient for intubation. 3. Determine the FIO2, tidal volume, rate and mode of ventilation on a given ventilator. 4. Describe the various modes of ventilation and their implications. 5. Describe at least two complications associated with patient’s response to mechanical ventilation and their signs and symptoms.
4. 6. Describe the causes and nursing measures taken when trouble-shooting ventilator alarms. 7. Describe preventative measures aimed at preventing selected other complications related to endotracheal intubation. 8. Give rationale for selected nursing interventions in the plan of care for the ventilated patient. 9. Complete the care of the ventilated patient checklist. 10. Complete the suctioning checklist. (A) To review indications for and basic modes of mechanical ventilation, possible complications that can occur, and nursing observations and procedures to detect and/or prevent such complications. (B) To provide a systematic nursing assessment procedure to ensure early detection of complications associated with mechanical ventilation.
5. Indication for Intubation Acute respiratory failure evidenced by the lungs inability to maintain arterial oxygenation or eliminate carbon dioxide leading to tissue hypoxia in spite of low-flow or high-flow oxygen delivery devices. (Impaired gas exchange, airway obstruction or ventilation-perfusion abnormalities). 2. In a patient with previously normal ABGs, the ABG results will be as follows: PaO2 > 50 mm Hg pH < 7.25 PaO2 < 50 mm Hg on 60% FIO2 : restlessness, dyspnea, confusion, anxiety, tachypnea, tachycardia, and diaphoresis PaCO2 > 50 mm Hg : hypertension, irritability, somnolence (late), cyanosis (late), and LOC (late)
6. 3. Neuromuscular or neurogenic loss of respiratory regulation. (Impaired ventilation) 4. Usual reasons for intubation: Airway maintenance, Secretion control, Oxygenation and Ventilation. Types of intubation: Orotracheal, Nasotracheal, Tracheostomy
7. Preparing for Intubation 1. Recognize the need for intubation. 2. Notify physician and respiratory therapist. Ensure consent obtained if not emergency. 3. Gather all necessary equipment: a. Suction canister with regulator and connecting tubing b. Sterile 14 Fr.(Adult) suction catheter or closed in-line suction catheter c. Sterile gloves d. Normal saline e. Yankuer suction-tip catheter and nasogastric tube
8. f. Intubation equipment: Manual resuscitator bag (MRB), Laryngoscope and blade, Wire guide, (Stylet), Water soluble lubricant, Xylocaine spray g. Endotracheal attachment device (E-tad) or tape h. Get order for initial ventilator settings i. Sedation as required j. Soft wrist restraints as required k. Call for chest x-ray to confirm position of endotracheal tube l. Provide emotional support as needed/ ensure family notified of change in condition
9. Intubation Types of Ventilators Ventilator Settings Modes of Mechanical Ventilation
10. 1. Associated with patient’s response to mechanical ventilation: A. Decreased Cardiac Output Cause - venous return to the right atrium impeded by the dramatically increased intrathoracic pressures during inspiration from positive pressure ventilation. Also reduced sympatho-adrenal stimulation leading to a decrease in peripheral vascular resistance and reduced blood pressure. 2. Symptoms – increased heart rate, decreased blood pressure and perfusion to vital organs, decreased CVP, and cool clammy skin. 3. Treatment – aimed at increasing preload (e.g. fluid administration) and decreasing the airway pressures exerted during mechanicalventilation by decreasing inspiratory flow rates and TV, or using other methods to decrease airway pressures (e.g. different modes of ventilation).
11. B. Barotraumas 1. Cause – damage to pulmonary system due to alveolar rupture from excessive airway pressures and/or over distention of alveoli. 2. Symptoms – may result in pneumothorax, pneumomediastinum, pneumoperitoneum, or subcutaneous emphysema. 3. Treatment - aimed at reducing TV, cautious use of PEEP, and avoidance of high airway pressures resulting in development of auto-PEEP in high risk patients (patients with obstructive lung diseases (asthma, bronchospasm), unevenly distributed lung diseases (lobar pneumonia), or hyper inflated lungs (emphysema).
12. C. Nosocomial Pneumonia Cause – invasive device in critically ill patients becomes colonized with pathological bacteria within 24 hours in almost all patients. 20-60% of these, develop nosocomial pneumonia. 2. Treatment – aimed at prevention by the following: a.Avoid cross-contamination by frequent handwashing
13. b.Decrease risk of aspiration (cuff occlusion of trachea, positioning, use of small-bore NG tubes) c.Suction only when clinically indicated, using sterile technique d.Maintain closed system setup on ventilator circuitry and avoid pooling of condensation in the tubing e.Ensure adequate nutrition d.Avoid neutralization of gastric contents with antacids and H2 blockers
14. D. Positive Water Balance 1. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) – due to vagal stretch receptors in right atrium sensing a decrease in venous return and see it as hypovolemia, leading to a release of ADH from the posterior pituitary gland and retention of sodium and water. Treatment is aimed at decreasing fluid intake. 2. Decrease of normal insensible water loss due to closed ventilator circuit preventing water loss from lungs. This fluid overload evidenced by decreased urine specific gravity, dilutionalhyponatremia, increased heart rate and BP.
15. E. Decreased Renal Perfusion – can be treated with low dose dopamine therapy. F. Increased Intracranial Pressure (ICP) – reduce PEEP G. Hepatic congestion – reduce PEEP H. Worsening of intracardiac shunts –reduce PEEP
16. 2. Associated with ventilator malfunction: A. Alarms turned off or nonfunctional – may lead to apnea and respiratory arrest Troubleshooting Ventilator Alarms Low exhaled volume: Cuff leak, Tubing disconnect, Patient disconnected Evaluate cuff; reinflateprn; if ruptured, tube will need to be replaced. Evaluate connections; tighten or replace as needed; check ETT placement, Reconnect to ventilator High pressure: Secretions in airway, Patient biting tubing, Tube kinked, Cuff herniation, Increased airway resistance/decreased lung compliance (caused by bronchospasm, right mainstem bronchus intubation, pneumothorax, pneumonia), Patient coughing and/or fighting the ventilator; anxiety; fear; pain.
17. Suction patient, Insert bite block, Reposition patient’s head/neck; check all tubing lengths, Deflate and reinflate cuff, Auscultate breath sounds, Evaluate compliance and tube position; stabilize tube, Explain all procedures to patient in calm, reassuring manner, Sedate/medicate as necessary Low oxygen pressure: Oxygen malfunction Disconnect patient from ventilator; manually bag with ambu; call R.T
18. 3. Other complications related to endotracheal intubation. A. Sinusitis and nasal injury – obstruction of paranasal sinus drainage; pressure necrosis of nares 1.Prevention: avoid nasal intubations; cushion nares from tube and tape/ties. 2. Treatment: remove all tubes from nasal passages; administer antibiotics.
19. B. Tracheoesophageal fistula – pressure necrosis of posterior tracheal wall resulting from overinflated cuff and rigid nasogastric tube 1. Prevention: inflate cuff with minimal amount of air necessary; monitor cuff pressures q. 8 h. 2. Treatment: position cuff of tube distal to fistula; place gastrostomy tube for enteral feedings; place esophageal tube for secretion clearance proximal to fistula. C. Mucosal lesions – pressure at tube and mucosal interface 1. Prevention: Inflate cuff with minimal amount of air necessary; monitor cuff pressure q. 8 h.; use appropriate size tube. 2. Treatment: may resolve spontaneously; perform surgical interventions.
20. D. Laryngeal or tracheal stenosis– injury to area from end of tube or cuff, resulting in scar tissue formation and narrowing of airway 1. Prevention: inflate cuff with minimal amount of air necessary; monitor cuff pressure q. 8.h.; suction area above cuff frequently. 2. Treatment: perform tracheostomy; place laryngeal stent; perform surgical repair.
21. E. Cricoidabcess– mucosal injury with bacterial invasion 1. Prevention: inflate cuff with minimal amount of air necessary; monitor cuff pressure q. 8 h.; suction area above cuff frequently. 2. Treatment: perform incision and drainage of area; administer antibiotics. 4. Other common potential problems related to mechanical ventilation: 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.
22. PLAN OF CARE FOR THE VENTILATED PATIENT Patient Goals: Patient will have effective breathing pattern. Patient will have adequate gas exchange. Patient’s nutritional status will be maintained to meet body needs. Patient will not develop a pulmonary infection. Patient will not develop problems related to immobility. Patient and/or family will indicate understanding of the purpose for mechanical ventilation.