call RT to check cuff pressureApneaover sedationchange in patient conditionself extubation/decannulationmanually ventilate patient with ambu bag with flowmeter at 15 L/mincall respiratory therapist STAT to assist with assessment and correction of respiratory statusinitiate call to physician as indicated, consider ventilator setting changes or reversal of sedative narcotic for patients with over sedationinitiate BLS, Code Blue Response, and/or Anesthesia Code as indicatedHighRespiratoryRatePain, anxietyMedicate as indicatedWater in tubingDrain tubingChange in clinical conditionCall RT, call physician as indicatedLow Tidalchange in patient’s breathing assess patient03/25/1917
VolumeeffortsCall RT, call physician as indicatedpatient is disconnected, loose connection or leak in circuitstighten connections, search tubing for source of air leakETT/trach cuff leak (patient vocalizing)Call RT to check cuff pressureVentilator InopExhalation Valve LeakLow BatteryVentilator Malfunctionmanually ventilate patient with ambu bag with flowmeter at 15 L/minLeave ventilator on – do not shut offCall RTHeat AlarmChange in temperature of heating coils located in ventilator tubingSilence alarm on heater and notify RT to troubleshootLow Exhaled Minute Volumedisconnection or loose connectiontighten connections, search tubing for source of air leakchange in patient’s conditionassess patientCall RT, call physician as indicatedRESPIRATORY PARAMETERS AND PATIENT ASSESSMENTRespiratory Therapists measure lung mechanics and parameters daily to assist in developing a weaning plan, if applicable, for a ventilator patient. As stated earlier, Weaning Protocols are listed on Respiratory Care Home Page via the I*Net.Some Key Points:Monitoring during Mechanical Ventilation is a collaborative effort between nursing and respiratory therapy. The following are signs of diaphragmatic failure and increased work of breathing and requires return to a higher level of ventilatory support;oRR>35 for 30 minutes sustained,oSpO2(pulse ox) < 92% for 30 minutes sustained,oHemodynamic instability or increased dysrhythmias,oChange in mental statusoUse of accessory muscles of breathing, and/or oPersistent patient complaints of air hunger or difficulty breathing despite intervention and coaching.03/25/1918
The Tidal Volume and Minute Volume are observed minimally every 4 hours while the patient is mechanically ventilated. The respiratory therapist is responsible for recording these values along with ventilator checks. It is also the responsibility of the nurse to be familiar with these parameters. (See Table below)Careful evaluation of sedation medication is necessary. Pressure support ventilation requires an intact respiratory effort. If assessment reveals a Tidal Volume and Minute
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- Winter '16
- Nursing, ventilator alarms