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VENTILATORY ASSISTANCE (MECHANICAL) Many patients on ventilators are now being transferred from the intensive care unit (ICU) to medical-surgical units with problems including (1) neuromuscular deficits, such as quadriplegia with phrenic nerve injury or high C-spine injuries, Guillain-Barré syndrome, and amyotrophic lateral sclerosis (ALS); (2) COPD with respiratory muscle atrophy and malnutrition (inability to wean); and (3) restrictive conditions of chest or lungs, such as kyphoscoliosis and interstitial fibrosis. The expectation is that the majority of patients will be weaned before discharge. That is the focus of this plan of care. However, some patients are either unsuccessful at weaning or are not candidates for weaning. For those patients, portions of this plan of care would need to be modified for the discharge care setting, that is, an extended care facility or home. Types of Ventilators Volume-cycled ventilators are the primary choice for long-term ventilation of patients whose permanent changes in lung compliance and resistance require increased pressure to provide adequate ventilation (e.g., COPD). Pressure-cycled ventilators are desirable for patients with relatively normal lung compliance who cannot initiate or sustain respiration because of muscular/phrenic nerve involvement (e.g., quadriplegics). CARE SETTING Patients on ventilators may be cared for in any setting; however, weaning is usually attempted/accomplished in the acute, subacute, or rehabilitation setting. RELATED CONCERNS Cardiac surgery: postoperative care Chronic obstructive pulmonary disease (COPD) and asthma Hemothorax/pneumothorax Spinal cord injury (acute rehabilitative phase) Total nutritional support: parenteral/enteral feeding Psychosocial aspects of care Patient Assessment Database Gathered data depend on the underlying pathophysiology and/or reason for ventilatory support. Refer to the appropriate plan of care. Discharge plan DRG projected mean length of inpatient stay: 9.5 days (or more) considerations: If ventilator-dependent, may require changes in physical layout of home, acquisition of equipment/supplies, provision of a backup power source, instruction of SO/caregivers, provision for continuation of plan of care, assistance with transportation, and coordination of resources/support systems Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES Pulmonary function studies: Determine the ability of the lungs to exchange oxygen and carbon dioxide, and include but are not limited to the following: Vital capacity (VC): Is reduced in restrictive chest or lung conditions; normal or increased in COPD; normal to decreased in neuromuscular diseases (Guillain-Barré syndrome); and decreased in conditions limiting thoracic movement (kyphoscoliosis). Forced vital capacity (FVC):
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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