Extubational Difficulty

Even though the consequence of saline instillation on a ventilator patient in the acute care setting is pneumonia or the patient may become hemodynamically unstable, this practice remain contentious, the practice of this procedure will also decrease the oxygenation. (Ayhan, et al., 2015),

The studies done on the subject of NSI for suctioning of ventilated patients have not provided a valid and solid conclusion. Nonetheless, most studies agree that NSI is not a recommended procedure when suctioning the ventilated patient. Factors that affect the decision include that the use of NSI provokes a higher incidence of VAP, hypoxemia, bronchospasm, cardiac and respiratory arrest, increased intracranial pressure, and no increase in the retrieval of mucus from the patient’s airway. Hence, the use of NSI should not be part of routine care when taking care of a ventilated

Use of daily spontaneous breathing trials to assess the patient’s ability to sustain ventilation, oxygenation, and breathing.

ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).

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

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

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.

The patient may have a hard time breathing because she is in pain after having surgery. Since they patient doesn’t want to breath due to the pain it can cause atelectasis and later sepsis if not treated in time. It would be important to teach the patient about splinting and to use an incentive spirometry in order to help her be able to breath. Another risk factor for the patient not being able to oxygenate would be hypovolemia since there is less blood volume which can also lead to less oxygen being able to travel in the blood or able to perfuse throughout the body.

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

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.

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.

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,

One of the most common causes of an airway obstruction in unconscious patient's is their tongue. This problem can be overcome by the use of an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA). These airway adjuncts are inserted into the patient's mouth or nostril, and are designed to hold the tongue in a position that prevents it from occluding the airway. Another skill authorized for BLS providers is the use of a bag-valve-mask (BVM). This tool allows EMS personnel to deliver positive pressure ventilations to a patient who is not breathing sufficiently on their own. However, this skill is commonly performed improperly. When using a BVM, an EMS provider must make certain that his patient's airway is patent, and that his head is positioned properly. Furthermore, it is critical that an EMS provider ensures that the mask is maintaining a complete seal around his patient's nose and mouth. Otherwise, pressure needed to force air into the lungs escapes through the unsealed portion of the mask, reducing the effectiveness of the ventilation. Another, more advanced skill used by EMS providers is the performance of an endotracheal

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