Case Study: Replacing Nebulizers

The prevention of VAP through standardized care can reduce mortality rates, reduce mechanical ventilation days, and decrease costs and improve patient outcome.

This assignment will discuss the nurse's role in devising of a care plan for a patient, including the rationale upon which this care plan has been based, evaluating that the goals intended are met or amended. The patient's identity will be protected using a pseudonym of Kora in keeping with the standards of maintaining confidentiality set by Nursing and Midwifery (NMC, 2015). The patient has Chronic Obstructive Pulmonary Disease (COPD) which is a long-term health condition which is slowly progressive, cause’s obstruction to airway that cannot be reversed, alterations in breathing with exacerbation often suggesting worsening of the disease (Currie, 2007). Kora is 63 years has three young grandchildren permanently in her care, Kora being in

To encourage physicians, ICU nurses, and respiratory therapist to use the ventilator associated pneumonia bundle in all ventilated patients in an intensive care unit.

This study focuses on methods to confirm proper tube placement. Through a cross sectional study, the research concluded that over seventy eight percent of critical care health workers use multiple methods to confirm tube placement. Some of the more common methods include looking at the gastric aspirate’s pH, observing the patient for signs or respiratory distress, and capnography. Auscultation of the air bolus was not included in the study because it was deemed “unreliable”. However, a small separate study was done and about eighty eight percent of critical care health workers claimed they also used an air bolus auscultation as a method of confirming placement. So, what is the reasoning for health care workers to continue doing this if it is unreliable? It has been hypothesized that this method requires the least amount of supplies and the nurses can do it quickly and easily. This research study along with many others concludes that air bolus auscultation is not an accurate method because the sounds nurses are used to hearing that “confirm” proper tube placement in the gastrointestinal tract are the same as sounds heard in the lungs and other areas of the

The team will navigate patients through the program, resources and pulmonary rehabilitation. The registered nurse will meet with the patient prior to discharge to evaluate and refer them to the appropriate services along with the social worker, which may find alternative way to pay for patients medication and other support services that may be offered. The nurse practitioner and the respiratory therapist will see the patient within 48 of hours upon admission into program. The nurse practitioner and respiratory therapist will evaluate the needs at home and enroll the patient in pulmonary rehabilitation, which will be part of the care offered to all patients. Resources for the patient will consist of a 24-hour hotline for patients who may need to seek medical advice prior to going to the emergency room. Patient will be supplied with emergency medications for home use if symptoms begin to appear. A nurse practitioner will be available to advice the patient in intervention with the emergency medications is indicated and advice if treatment may need to be continued in the emergency room. With the protocols in place for medications, the patient will be seen within 12 hours if use of the emergency medications were taken in the home. The nurse practitioner will update the electronic medical chart of the patient to document

Participants reaffirmed that the guidance of the nursing team at the moment of discharge were specific to the care in relation to the drug therapy or to invasive devices, such as probes and tracheostomies, without a focus on the guidance about the general care related to the chronic health conditions and the importance of following-up the child after the hospital discharge. One can say that the factors associated with the readmission of children are related to the age group of infants, with respiratory problems associated with chronic conditions, besides the lack of effectiveness in the post-discharge follow-up. Accordingly, it is relevant to reflect about the role of the nursing team in the planning of interventions capable of providing the adaptation of children and their families over the period of admission, at the moment of discharge and in the post-discharge. The combination of guidance of verbal and written strategies can help us to understand the trajectory of illness and adaptation, thereby avoiding

Respiratory therapy refers to both a subject area within clinical medicine and to a distinct health care profession. During the 20th century, there were many health care fundamental transformations. Here are 10 possible predictions of what may occur in the future of respiratory care: (1) Less focus on raising PaO2 as a primary goal in managing patients with acute hypoxemic respiratory failure. (2) More attention to

Karen Meunier, is the education consult for New Orleans’s Childrens Hospital Ventilator Assisted Care Program (VACP). Mrs. Meunier educated the audience on the history of ventilators. Next, Mrs. Meunier stated the criteria for the children who are enrolled in the Ventilator Assisted Care Program. Overall, these children either have a neuromuscular, brain and/or spinal cord injury, and/or birth related diagnosis. The children in the program live at home in Louisiana, under the age of 26, Medicaid eligible, and require daily mechanical support of respiratory efforts. Lastly, Mrs. Meunier informs the audience about each member in the VACP staff. The VACP staff includes an education consultant, respiratory therapist trainer, two case managers,

Through the convenience sampling, 90 clients were recruited as research participants were in the waiting room of the respiratory clinic. 60 subjects agreed to attend a support group for socialization with each other. 30 of 60 clients were assigned to participate in the presentation and therapeutic exercises by the instructor. The instructor group divided into halves: 15 clients received instructions with family caregiver and the other clients without a caregiver. The second 30 clients received written materials and allowed to access the website for video presentation and exercises. Half of website group assigned to the family caregiver and the other half without a caregiver. The last 30 subjects were assigned as a control group, and half of these clients received usual care with family caregiver and other 15 clients without a family caregiver. The data was collected by the pulmonary functional status survey, 30 items, five points, Likert-type scale.

J., Cormier, S., & Meyer, T. (2012). Reduction in the Incidence of Ventilator Associated Pneumonia: A Multidisciplinary Approach. Respiratory Care, 57(5). 688-696. DOI: 10.4187/respcare.01392

Out of the 53 subjects, twenty six patients were recruited to the hospital at home care and twenty seven were hospitalized. The two groups were similar in demographic, clinical, and pulmonary function characteristics, however pneumonia as a cause of acute decompensation was most frequent in the hospitalized group versus the hospital at home group. In the hospital at home group 18 subjects or 69.2% responded well and eight required hospitalization. These eight subjects were all older and suffered from ALS which is an advance form of NMD and also had a history of more hospitalization during the last three years. Three out of those eight subjects required intubation due to mucus encumbrance and severe hypoxemia and eventually needed a tracheotomy. Three other subjects required full time ventilatory dependence and a 24 hour surveillance in respiratory ICU.

Two issues were to be addressed, length of stay (especially mechanically ventilated patients) and the failure of the medical staff to respond to nursing calls. This length of stay has improved. The medical staff response has improved but, remains an issue. Currently the program covers 7A - 7P. The over night cover is by a physician on call from home who may be called in. The I house coverage is provided by the hospitalist program. Some of these individuals are not proficient in airways or lines. The airway support is by a respiratory therapist or a nurse anesthetist ( a mid-level provider) when available. The coverage is haphazard, inconsistent, and at times unsafe. The goal of the proposed plan is to augment the 7P -7A at home physician with an in-house Midlevels who can reliably intubate, gain central access, and support the patient until assistance can

During the 1930s there was extensive use of this technology in caring for victims of the polio epidemic. These iron lungs were cumbersome, and provided little access to provide patient care. Recent advancements however, have made negative pressure ventilation a viable option in non-invasive mechanical ventilation. The “modern” iron lung consists of a flexible cuirass, or shell, which is designed to fit over the anterior of the chest. On inspiration, a negative pressure helps to pull the rib cage up and forward, increasing the space in the thoracic cavity, facilitating better air flow and ventilation. Expiration is achieved by passive recoil. These latest devices offer many of the same ventilatory modes as positive pressure vents do, as well as, high frequency chest wall oscillation and cough assistance. The HFCWO assists patient in mobilizing secretions much the same way the vest works in chest physiotherapy. The cuirass can also provide peep by providing a continuous negative distending pressure baseline. This negative extrathoracic pressure provides a new functional reserve capacity (FRC) from which the patient can breathe from. Biphasic cuirass ventilation can also provide a positive pressure to assist in assist in exhalation. This positive phase decreases the potential for large end expiratory lung volumes which may facilitate gas trapping or barotrauma to compromised lung

The findings show that the length of stay in emergency department decreased when children were treated with the spacer instead of a nebulizer (MD-33 minutes; -95% CL -43 to -24 minutes). The total time for nebulizer group required 103 minutes while that to spacer group required 33 minutes. Similarly, For the spacer group it was also found that the pulse rate and risk of tremor were lower with a mean difference for pulse rate -5% baseline (95% CL-8% to -2%). While the hospital admission rates did not show any significant differences. This Cochrane review has assessed that nebulizer is not superior to spacer as the result did not have any significant dissimilarities. Beside the point that the spacer was advantageous for reducing the stay in the emergency department. The third article findings are based on a comparison of clinical outcomes in both children and adults suffering from acute asthma in emergency department or community. The studies were assessed from all over the world. Out of 112 abstracts which were originally identified from Cochrane airway group database, 44 of them were appraised with a possible inclusion. The results of the review showed no any significant differences in the primary outcomes

A study was conducted to assess the effect of manual hyperinflation and suctioning in mechanically ventilated patients to prevent the risk of ventilator associated pneumonia admitted in intensive care unit of selected hospital, Belgaum, Karnataka – A randomised control trial.