There have been several studies attempting to clearly identify the risk factors for the extubational difficulty. First of all, Demling et al. prospectively investigated the use of standard criteria for extubation in 700 patients in ICU, but could not find any good predictors for extubation failure (Demling et al., 1988). Leak test is still the controversial routine choice of many practitioners used to predict the potential occurrence for airway edema evaluating whether the airway caliber is sufficient for ventilation (Chung et al., 2006; Ding et al., 2006; Kriner, Shafazand & Colice, 2005). In one study, the evaluation of the leak test in 72 spontaneously breathing ICU patients indicated that the presence of a cuff leak may associated with
Patient outcome consisted of performing 10 deep breaths per hour. We have reviewed details that were difficult for the patient to remember, such as breathing out before placing the lips on the mouthpiece, and holding breath for 3 to 5 seconds at the top of each inhalation. With empathy, I provided understanding that being hospitalized is never easy due to sensory overload, pain and lack of privacy. Additionally, we have discussed the basic pathophysiology of lung inflammation and what it can do to a person. So overall, the outcome included enhanced disease knowledge with effective use of incentive spirometer.
Throughout my clinical rotation, the only concern for this patient was pain management and discomfort from the chest tube site. The patient was given Ketorolac for a pain of 4/10 using the numeric pain sale. The patient was also at risk for pneumonia and pressure ulcers from immobility and not coughing/deep breathing. Nursing interventions were getting the patient up to the chair and using the incentive spirometer ten-times per hour. Another concern was SOB and fatigue with activities.
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
In the memoir Night, the author, Elie Wiesel, uses vividly descriptive diction to establish the theme that one should never let go of their goals. After Elie and his family were forced to leave their home, they were loaded into a box car. Elie recalls that, “After two days of traveling [on the train], [ they] began to be tortured by thirst.” (Wiesel 21). Elie Wiesel’s choice of the word torture, instantly brings to mind a picture of people going through unbearable suffering. His vivid descriptions easily bring to mind instant images of what the text is depicting. Through Elie’s ride in the box car, he never let go of his goal of survival. His vivid description of the box car show you what Elie had to withstand while never letting go of his
Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,
An unplanned extubation (UE) in the Neonatal Intensive Care Unit (NICU) is an unforeseen occurrence observed due to various factors. One of these is due to the lack of a procedural standardization among healthcare providers. This is notably evident when staff is handling the infant during daily assessments and when care is rendered. The reason this issue was selected was because of the potential serious complications or death that a can occur to a patient due to the lack of procedural standardization, preventing UE is the issue that will be addressed.
The primary nursing diagnosis for this patient is impaired gas exchange, related to abnormal ventilation and perfusion ratio, as evidenced by restlessness, irritability, anxiety, decreased level of consciousness, abnormal arterial blood gases, and abnormal skin color (Gulanick & Myers, 2014, p. 82). A.C. has an endotracheal tube (ETT), and there is a note for the next day to have surgery to put in a tracheostomy. She is currently a smoker, her C02 is 74.6mEq/L which is high, her pH is low at 7.19, and the bicarbonate is 28.6mEq/L which is high. Her oxygen saturation is maintaining at 90%. Her PA02 is 56mm Hg and FI02 is 0.60. The patient is very anxious and restless in the bed, despite sedation and pain medication, and her skin is pale in color and she is diaphoretic.
From investigation in health practices, ventilator associated pneumonia caught my attention. “Ventilator Associated Pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units. Most episodes of VAP are thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. Aspiration of gastric secretions may also contribute, though likely a lesser degree. Tracheal intubation interrupts the body’s anatomic and physiologic defenses against aspiration, making mechanical ventilation a major risk for Ventilator Associated Pneumonia. Semi-recumbent positioning of mechanically ventilated patients may help reduce the incidence of gastroesophageal reflux and lead to a decreased incidence of VAP. The one randomized trial to date of semi- recumbent positioning shows it to be an effective method of reducing VAP. Immobility in critically ill patients leads to atelectasis and decreased clearance of bronchopulmonary secretions. The accumulation of contaminated oropharyngeal secretions above the endotracheal tube cuff may contribute to the risk of aspiration. Removing these
On arrival to UKMC the patient received a Glasgow Coma Score of 3, which is an indication that intubation is needed. Bipap therapy was attempted but failed, due to respiratory failure. This was confirmed by arterial blood gases. After being assessed by the team at UKMC, the patient was intubated for respiratory failure, as well as shock of an unclear etiology. Rapid sequence intubation drugs, Etomidate and Succinylcholine where administered prior to intubation. A 7.5 endotracheal tube was used
In this study, patients that had been ventilated in the intensive care unit from April to November of 2010 were included. There were few ways that the person could be excluded, these were if the patient had cardiac arrhythmias or severe obesity. All of the patients were monitored vary closely, such as with an electrocardiogram, invasive and non-invasive arterial pressure, and percutaneous
One of the many benefits is monitoring the effectiveness of CPR that is favored among paramedics, continuous monitoring in Emergency Rooms and ICU during ambulatory transport for confirmation of accurate placement of ETT (endotracheal tube). It offers a rapid alarm for ventilator disconnection which is identified by a flat line on the capnogram. It also provides an early warning signs of shock, displaying a decreased numeric value in ETCO2. This has implications with any patient that is at risk for shock, especially trauma and cardiac patients. Patients who are suffering from hyperthermia when their metabolism is suppressed and their internal temperature is on critical overdrive--increasing their ETCO2 levels significantly. ETCO2 is also used among asthmatic patients and those with anxiety disorders by teaching them how to effectively control their breathing. Furthermore, it has been verified that in postoperative patients especially “high risk”-those with obstructive sleep apnea and those receiving high doses of opioids for pain management are more of an increased risk of adverse respiratory events and through proper patient monitoring through use of ETCO2 can prevents such undesired events. “Capnography can serve as a rapid assessment and triage tool for critically injured patients and victims of chemical exposure. It provides the ABCs in less than 15 seconds.”-Krauss, Heightman, JEMS,
I met this incredible woman late in my life. She happened to come into my life once my mom married her son. She always had something interesting to say about her life. When this paper was discussed in class I knew who exactly I was going to write about. Here is the story of Teresa Torres:
There is a considerable controversy regarding the use of OBL in patients with respiratory failure and those on mechanical ventilation because of the potential high morbidity and mortality associated with its use in those patients (20, 21). While the role of OLB has become well established in the diagnosis of interstitial lung disease (18), its utility and safety are more controversial in critically ill patients. Proponents of OLB argue that solid diagnosis of underlying aetiology can be helpful in determination of the best course of treatment (22). Moreover, the risk of biopsy is fairly low if adequate precautions are taken (23). In contrast, opponents of OLB believe that defining the underlying mechanism of injury is largely academic and it will not add new to the treatment of those patients because of the lack of specific therapies for underlying aetiologies of ARDS and respiratory
Background and Rationale: Currently, postoperative pulmonary complications “account for about 25% of deaths occurring within 6 days of surgery,” (Yoder, M 2015). Post-operative pulmonary complications (PPCs) are of major concern due to the increased length of hospital stays and high rates of occurrence and death as a result. Those at greater risk of developing a pulmonary complication include preexisting lung disease, medical comorbidities, poor nutritional status, overall poor health, and in those who smoke. (Yoder, M, 2015.) The type of surgery the patient is having also affects the risk. Complications include, but are not limited to, pneumonia, bronchospasm, respiratory failure and prolonged mechanical ventilation. The development of such complications negatively affects the expected outcomes for patients. “The basic mechanism of PPCs is a lack of lung inflation that occurs because of a change in breathing to a shallow, monotonous breathing pattern without periodic sighs, prolonged recumbent positioning and temporary diaphragmatic dysfunction. Mucociliary clearance along with the decreased cough effectiveness, increases risks associated with retained pulmonary secretions, “ (Overend, T., Anderson, C., Lucy, S., Bhatia, C., Jonsson, B., & Timmermans, C., 2001). Currently,
Dimich-Ward, Helen, PhD; Michelle Lee Wymer, BSc; and Moira Chan-Yeung, MB. “Respiratory Health Survey of Respiratory Therapists” CHEST; Oct2004, Vol. 126 Issue 4, p1048-1053,