ROLE OF NURSE IN CARE OF MECHANICALLY VENTILATED PATIENT

HAND HYGIENE

Wash hands before direct contact. 40% of infections are transmitted by the hands of hospital staff

Use sterlium or alcohol based hand rub in between procedure

RECORDING OF VITAL SIGNS

Record vital signs (Assess for hypotension, tachycardia, tachypnoea)

Observe respiratory pattern and auscultate lung sounds

Observe for breathing pattern in relation to ventilatory  cycle

Assess for changes in mental status and LOC

Continuous pulse oximetry

Observe ABG for abrupt changes or deterioration as required

ENDOTRACHEAL TUBE CARE

Introduce an oropharyngeal airway

Maintain inflation of the cuff at 15 to 20 mmHg

Institute Endotracheal suctioning as appropriate

Administer humidified oxygen before suctioning to loosen secretions

Change Endotracheal tapes every 24 hours

Inspect the skin and oral mucosa

Stop feeding during 30 to 60 minutes before suctioning and chest physiotherapy

Observe the type, color and amount of secretion,notify the changes

Avoid drawing of arterial blood sample immediately after suctioning

Watch for side effects: hypoxemia, bradycardia, and hypotension

ORAL HYGIENE

Provide careful oral hygiene

Apply lubricant to lips to prevent drying, cracking and excoriation

Rotate the ET tube from one corner of mouth to the other side at least every 24 hours

ARTERIAL BLOOD GAS ANALYSIS

ABG reflects oxygenation adequacy of gas exchange in the lungs and acid base status

Avoid taking sample immediately after suctioning, nebulisations and baging

While drawing blood prevent entry of air in syringe

Send immediately ABG sample to laboratory

MAINTAIN NUTRITIONAL NEED

Basal energy expenditure calculation (Harris Benedict Equation)

Men: 66.477 + (13.75 multiply W) + (5 multiply H) – (6.76 multiply A) Kcal/Day

Female: 65.51 + (9.56 multiply W) + (1.58 multiply H) – (4.68 multiply A) Kcal/Day

(W = weight of Pt., H = Height of Pt., A = Age of Pt.)

High protein, high fat and low carbohydrates diet can be beneficial

Add mineral supplements to the diet expecially magnesium and phosphorus. These are essential for energy production and respiratory muscle function

POSITIONING

Turn and reposition the patient every 2nd hourly

Positioning prevents complications such as pneumonia and atelectasis

PERSONAL HYGIENE

Frequent oral hygiene must be done

Eye care to be given every 4th hourly to prevent corneal ulcers and dryness of conjunctiva

Provide skin care

Provide catheter care using sterile technique

ALLAYING ANXIETY AND FEAR

Explain all the procedures to the patient and relatives to win their confidence

Talk and clear the doubts of patient and attainders. Never ignore their feelings.

Use therapeutic touch

Encourage the family members to visit the patient as per hospital policy

CARE OF VENTILATOR CIRCUIT

Keep the water level in humidifier in normal limit

Humidification during mechanical ventilation required to prevent hypothermia, inspissations of airway secretions, destructions of airway epithelium and atelectasis

A heated humidifier should be set to deliver an inspired gas temperature of 33 -/+ 2 Degree Celcius

The temperature of inspired gas should not exceed 37 degree celcius at the airway threshold

Sterile water should be used only

Condensation from the patient circuit should be considered infectious waste and should never be drained back in to the humidification reservoir

Change the circuit when it is visibly soiled or mechanically malfunctioning

Bacterial filters should not be used for more than 48 hours

Use universal precautions when involved in circuit changes

CARE OF VENTILATOR ALARMS

Never Shut Alarms Off – Alarm system must be activated and function at all time. It is acceptable to silence alarms for a preset delay while suctioning and during oxygen flush before suctioning

If equipment failure is suspected and unable to determine the cause of alarm, manually ventilate the patient with resuscitation bag until the problem is corrected

VENTILATOR CARE BUNDLE

According to IHI ‘bundle’ is a group of evidence – based care components for a given disease that, when executed together, may result in better outcomes than if implemented individually.

It includes:

DVT Prophylaxis (unfractioned heparin, elastic stockings, pneumatic compression, elevation of affected extremity, gentle foot and leg exercise, fluid administration)

GI prophylaxis (H2 blocker/proton pump inhibitor)

Head of bed elevated to 30 to 45

Daily sedation vacation/daily spontaneous breathing trial

Skin safety (manage pressure, adequate nutrition, wound assessment and wound care)

Fall prophylaxis

ROLE OF NURSE IN CARE OF MECHANICALLY VENTILATED PATIENT

ROLE OF NURSE IN CARE OF MECHANICALLY VENTILATED PATIENT PDF 

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