It’s not an easy task to determine whether or not early tracheostomy or weaning mechanical ventilation is performed. As the healthcare team works in collaboration with each other, the patient’s best interest is carefully evaluated to ensure the best overall outcome for the particular patient. Having a knowledge base of what currents trends are regarding quality of life status post tracheostomy placement versus potential complications, must be part of the decision process by all parties involved. One the other hand, weaning a patient from mechanical ventilation, must be done in a safe and timely fashion, as other complications are seen from prolonged life support measures.
Much has been debated over the past few years regarding performing early tracheostomy versus mechanical ventilation and how other disciplines play a role in helping to make this sometimes difficult decision. I have set out to explore both aspects, in an attempt to answer the questions before me. Accessing databases of research to prove one over the other has proven harder than I had anticipated. Still the need to know more about this topic has kept my attention focused on fact finding. Proving an analysis and evaluation of the information gathered will help me draw a conclusion to the matter.
As we are well aware, being a patient at a hospital can prove beneficial or problematic. As it is with the most critical of patients, they require a closer level of surveillance and monitoring than those on other med-surg associated units. As the care of an ICU patient can escalate quickly, it’s critical to assess the needs of your patient in a timely manner. Looking at a ventilated patient who requires many different modalities, assessing the need for such ther...
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...ese patients Parker et al (2007). In this care model plan, priorities can be set to advance the health and wellness of these patients as well as bring differing solution options to these somewhat complex case scenarios. As patients are trached and weaned from mechanical ventilation, there is always a risk for developing an infection. Although, infection rates are low compared to those in patients with an endotracheal tube still in place, trach patients are not free of an infectious state themselves (Miller, 2008). Trach care in addition to ET tube care, and strict hand hygiene care, all play a key role in preventing the spread of various infections (Miller, 2008). So how can we better care for and support these patients? One goal that the healthcare providers can work towards is decreasing the number of ventilator days a patient spends on supportive life measures.
VAP develops in a patient after 48 hours or more of endotracheal intubation. According to a study by Relio et al. (as citied in Fields, L.B., 2008, Journal of Neuroscience Nursing, 40(5), 291-8) VAP adds an additional cost of $29,000-$40,000 per patient and increases the morality rate by 40-80%. Mechanically ventilated patients are at an increased risk in developing VAP due to factors such as circumvention of body’s own natural defense mechanisms in the upper respiratory tract (the filtering and protective properties of nasal mucosa and cilia), dry open mouth, and aspiration of oral secretions, altered consciousness, immobility, and possible immunosuppression. Furthermore, the accumulation of plaque in the oral cavity creates a biofilm that allows the patient’s mouth to become colonized with bacteria.
Additionally, the clinical staff has shown very low level of confidence in the RR documentation on observation chart. Lack of time, laziness, lack of training and knowledge and unawareness of the importance of the respiratory assessment are main reasons to neglect this important aspect of nursing as stated in this study (Philip, Richardson, & Cohen,
Introduction BiPAP is a form of noninvasive mechanical ventilation used in patients with acute respiratory failure. Many of these patients go on noninvasive ventilation due to COPD exacerbations that are infectious, with congestive heart failure, and ventilator parameters based on their clinical assessment and changes in arterial blood gases. Two different studies were conducted on COPD patients, using a BiPAP machine to improve exacerbations and their activities of daily living. There are many positive outcomes for using these noninvasive ventilators, however when used incorrectly, negative outcomes or no changes at all are always possible. Positive Use for COPD Exacerbations
Ventilator Associated Pneumonia (VAP) is a very common hospital acquired infection, especially in pediatric intensive care units, ranking as the second most common (Foglia, Meier, & Elward, 2007). It is defined as pneumonia that develops 48 hours or more after mechanical ventilation begins. A VAP is diagnosed when new or increase infiltrate shows on chest radiograph and two or more of the following, a fever of >38.3C, leukocytosis of >12x10 9 /mL, and purulent tracheobronchial secretions (Koenig & Truwit, 2006). VAP occurs when the lower respiratory tract that is sterile is introduced microorganisms are introduced to the lower respiratory tract and parenchyma of the lung by aspiration of secretions, migration of aerodigestive tract, or by contaminated equipment or medications (Amanullah & Posner, 2013). VAP occurs in approximately 22.7% of patients who are receiving mechanical ventilation in PICUs (Tablan, Anderson, Besser, Bridges, & Hajjeh, 2004). The outcomes of VAP are not beneficial for the patient or healthcare organization. VAP adds to increase healthcare cost per episode of between $30,000 and $40,000 (Foglia et al., 2007) (Craven & Hjalmarson, 2010). This infection is also associated with increase length of stay, morbidity and high crude mortality rates of 20-50% (Foglia et al., 2007)(Craven & Hjalmarson, 2010). Currently, the PICU has implemented all of the parts of the VARI bundle except the daily discussion of readiness to extubate. The VARI bundle currently includes, head of the bed greater then or equal to 30 degrees, use oral antiseptic (chlorhexidine) each morning, mouth care every 2 hours, etc. In the PICU at children’s, the rates for VAP have decreased since the implementation of safety ro...
Hunter, Annadurai and Rothwell defines ventialtor-associated pneumonia as nosocomial pneumonia occurring in patients receiving more than 48 hours of mechanical ventilation via tracheal or trascheotomy tube. It is commonly classified as either early onset (occurring within 96 hours of start of mechanical ventilation) or late onset (>96 hours after start of mechanical ventilation. A ventilator is a machine that is used to help a patient breathe by giving oxygen through an endotracheal tube, which is a tube placed in a patient’s mouth or nose, or through a tracheostomy, which is a surgical opening created trough the trachea in front of the neck. Infection may occur if bacteria or virus enters the tube into the lungs or airways by manual manipulation of the ventilator tubing.
Featherstone, P., Prytherch, D., Schmidt, P., Smith, G. (2010). ViEWS: towards a national early warning score for detecting adult inpatient deterioration. Resuscitation, 81(8), 932-937.
According to the Registered Nurse (RN) Scope of Practice Position Statement, “the RN is responsible for providing safe, compassionate, and comprehensive nursing care to patients and their families with complex healthcare needs” (Texas Board of Nursing, 2011). Nurses often care for five to six patients at one time; therefore, in order to provide the best quality care, patients are often connected to monitoring devices such as, physiological monitors, venti...
Goodfellow, L. T. (2011). 2015 and Beyond: Usable and Unbiased Data. Respiratory Care, 56(12), 1977-1978. doi: 10.4187/respcare.01619
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
Journal of Critical Care, 503.) The leading causes of most errors among stress and interruption are other factors such as: wrong dosage, dose omissi...
In an IPU, a dedicated team made up of both clinical and nonclinical personnel proves the full care cycle for the patient’s condition (Lee & Porter, 2013). The first priority of understanding the patients will be to meet the needs regardless of the situation so they will find pleasure and security of allowing the Caring Angel Hospital to continue providing services for themselves and family members. When the patients are taken care of, it will definitely reflect well on the organization’s business reputation. Therefore, the medical attention and the responsibilities that are provided to the patients should not lack the quality, value, or image of what each individual patient needs for their
The Cumulative Index to Nursing and Allied Health Literature (CINAHL) was used to find peer-reviewed articles, using query terms such as: aspiration pneumonia, ventilator, and prevention. In addition, the TWUniversal search engine was utilized to find peer-reviewed articles, with the key words: aspiration pneumonia, ventilator, and enteral.
Anesthesiologists have many responsibilities. 3They measure the patient’s temperature, pulse, heart rate, and breathing rate while under the sedative. They have...
Nursing Diagnosis I for Patient R.M. is ineffective airway clearance related to retained secretions. This is evidenced by a weak unproductive cough and by both objective and subjective data. Objective data includes diagnosis of pneumonia, functional decline, and dyspnea. Subjective data include the patient’s complaints of feeling short of breath, even with assistance with basic ADLs. This is a crucial nursing diagnosis as pneumonia is a serious condition that is the eighth leading cause of death in the United States and the number one cause of death from infectious diseases (Lemon, & Burke, 2011). It is vital to keep the airway clear of the mucus that may be produced from the inflammatory response of pneumonia. This care plan is increasingly important because of R.M.'s state of functional decline; he is unable to perform ADL and to elicit a strong cough by himself due to his slouched posture. Respiratory infections and in this case, pneumonia, will further impair the airway (Lemon, & Burke, 2011). Because of the combination of pneumonia and R.M's other diagnoses of lifelong asthma, it is imperative that the nursing care plan of ineffective airway clearance be carried out. The first goal of this care plan was to have the patient breathe deeply and cough to remove secretions. It is important that the nurse help the patient deep breathe in an upright position; this is the best position for chest expansion, which promotes expansion and ventilation of all lung fields (Sparks and Taylor, 2011). It is also important the nurse teach the patient an easily performed cough technique and help mobilize the patient with ADL's. This helps the patient learn to cough and clear their airways without fatigue (Sparks a...
While taking care of my patient on the cardiothoracic intensive care unit, I assisted another nurse who was helping her seventy-one year old patient ambulate to promote circulation and decrease the patient’s chance of developing pneumonia. It also helps the patient to build strength and confidence after such a major surgery like this patient underwent. This patient had come in with non-ischemic cardiomyopathy and had a history of cocaine and alcohol abuse, atrial fibrillation, mitral regurgitation, and hypertension. She had a left ventricular assistive device placed, and ten days after the device had been placed, she was diagnosed with H1N1, had a tracheostomy performed, and was placed on the ventilator. Since she had to wear a mask when outside of her room and had a tracheostomy, it was really difficult to understand the patient’s needs, and this was very concerning to me.