6. Mechanical Ventilation.docx - Mechanically Ventilated...

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Mechanically Ventilated Clients RESPIRATORY CLINICAL EXAMPLES: The Mechanically Ventilated Patient PRIOR TO CLASS REVIEW : Lewis Chapter 26 – previous foundational information regarding: a. Normal respiratory system functioning – A & P of respiratory system b. Respiratory assessment parameters – his tory and physical exam c. Respiratory diagnostic studies (blood, sputum, radiology, endoscopic) Also review: Hypoxemia, hypercapnia, ventilation-perfusion mismatching (shunting, dead space – Fig. 68-4) READINGS : Lewis, et al., (8 th ed.) a. Pages 528-535 (tracheostomy) b. Pages 1698-1713 (artificial airways, mechanical ventilation) OBJECTIVES : 1. Discuss nursing responsibilities in caring for pt who is receiving noninvasive or invasive methods of mechanical ventilation. 2. Discuss complications associated with ventilator support options and describe appropriate nursing interventions. I. Artificial Airways A. Endotracheal intubation – a tube placed into the trachea past the larynx 1. Indications Upper airway obstruction (tumor) Apnea High risk of aspiration Ineffective airway clearance ( thick, lots of secretions ) Respiratory distress 2. Oral intubation ( PREFERRED )- through mouth and into trachea; stops above chorine (bronchi split) Risks ( chipped/broken teeth; can bite on tube causing obstruction, would use and oral airway to push tongue down ) 3. Nasal intubation ( 1 st evaluate septum; Placed blindly, no scope to see; HIGH RISK of infection ) Tubes can kink.. issue Contraindications ( any type of facial or head trauma/fractures/injury/surgery ) 4. Tracheostomy (used if long term ventilation is needed. Less dead space than oral or nasal ventilation. Great to wean from ventilator) 5. NEED CONSENT FOR INTUBATION!!! 1. Explain procedure to patient and/or family. 2. Need a bag/valve mask with 100% O2 source for preoxygenation before intubation. B. Endotracheal intubation procedure 1. Obtain consent 2. Equipment: Bag-valve mask, suction, oxygen source, and IV access available 3. Endotracheal tube placement procedure Remove dentures Pre-medicate Preoxygenate for minimum of 3 minutes with 100% oxygen before and between attempts Limit each attempt to 30 seconds “Sniffing position” ( Contraindicated with head/neck injuries ) Inflate cuff ( inflate to 20-25 cm mmHG ) Normal arterial tracheal perfusion is estimated at 30 mmHg – cuff must be less Confirm placement End tidal CO2 Auscultate lungs Observe for symmetric chest wall movement CXR to confirm ( should be 3-5cm above chorina on xray ) Attach to oxygen source ( may be humidified )
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Secure ETT according to facility policy ( NOTE MARK AT LIP- DOCUMENT !) ABG ( within 25-30 minute to confirm correct ventilator settings ) Continuous oxygen saturation monitoring while on ventilator C. Rapid Sequence Intubation (RSI) 1. Concurrent administration of a paralytic and a sedative during emergency intubation.
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