Mechanical Ventilation

Critically ill patients that require mechanical ventilation are at risk of developing secondary infections that may increase length of stay and possibly even morbidity. This fragile patient population requires special attention and meticulous adherence to established nursing standards of care. These standards of care are founded on evidenced based practices. It is important that nurses receive education about why these standards are in place and what consequences can result due to not following the established care protocols.

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).

Any of these issues have the potential to extend the patients length of stay in the hospital. The restraints have the potential to make the patient more agitated, thus increasing his risk of injury. Understanding the nursing-sensitive indicators can greatly contribute to a better outcome for all patients.

Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O ' Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since this time have focused on the influence of sedation protocols, and outcomes. This paper will review the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies. Also, explanations including a preliminary conclusion will be discussed.

Terminal weaning is when mechanical ventilation is discontinued for a patient expected to die without its support (Knight & Espinosa, 2010). One of the most common methods of discontinuation is through slowly reducing the fraction of inspired oxygen (Knight & Espinosa, 2010). Terminal extubation is the removal of the endotracheal tube, and this can be done “during or after a terminal weaning process” (Knight & Espinosa, 2010, p. 527). Removal of life-supporting interventions is the cause of most deaths in critical care units (Knight & Espinosa, 2010). Knight and Espinosa (2010) discussed palliative sedation and terminal weaning in the same chapter because the two topics go together.

The discharge criteria in the policy states the patient will be fully awake, vital signs stable, no nausea or vomiting, and the patient is able to void. All practitioners that provide moderate sedation must complete a training module prior to providing moderate sedation, this includes personnel assisting with the procedure. The first process failure was not meeting the required monitoring of the patient as mandated by the moderate sedation policy. In the absence of ECG or respiratory monitoring the sedation administered produced apnea then asystole without ED personnel being aware of acute changes in the patient’s condition. There is no explanation for why the patient was not on continuous ECG monitoring. Equipment was found to be in good working order.

The moderate sedation policy will be revised to require one on one nursing staff to monitor patient from admission until discharge criteria is met. Patient vital sign parameters will be included along with frequency of monitoring. All staff who assist or perform moderate sedation will complete required training as described in the policy. Annual recertification will be completed by all practitioners and registered nurses through continued education, observation, and implementation.

Keywords: intensive care, patient scenario, clinical practicum, pathophysiology, disease processes, interventions, diagnoses, assessments, health prevention, promotion, health outcomes

Admissions in general acute hospitals for patients over the age of 65 is 38% with 60% of those patients ending up on a medical surgical unit (Boltz, 2013). The number of restrained patients within this age range varies from 13-27% for medical surgical or non behavioral restraints, this number can significantly decrease based on alternative interventions attempted prior to restraint application with the number of restrained days varying from 3 to 123 out of every 1000 days (Enns et al., 2014). Reasons for non behavioral restraints are when a patient is; pulling at lines/tubes, removal of equipment/dressing, inability to respond to direct requests/follow instructions, intubation, or falls/risk of injury/keeping patients safe. A typical hospital

UE is a serious event that presents as a patient safety and quality improvement concern in the critically ill infant in the NICU. An UE is the premature removal of the endotracheal tube per the patient or staff (accidentally or deliberately) while a patient is receiving invasive mechanical assistance. This occurrence can have significant risk consequences and is considered a potentially life threatening event due to the loss of airway control and mechanical support. Sometimes it is possible for the infant to develop hypercarbia, hypoxia, airway trauma, ventilator-associated pneumonia, intraventricular hemorrhage, and

Ventilator-associated pneumonia (VAP) remains a big drawback within the hospital setting, with terribly high morbidity, mortality, and cost. Some people tend to perform an evidence-based review of the literature that specializes in clinically relevant pharmacological and non-pharmacological interventions to prevent VAP. Thanks to the importance of this condition the implementation of preventive measures is predominant within the care of mechanically ventilated patients. There is proof that these measures decrease the incidence of VAP and improve outcomes within the intensive care unit. A multidisciplinary approach, continuing

Does the compliance with a sedation protocol improve after nurses receive a sedation competency over a three month period? The available data supported the hypothesis that nursing education and competency can lead to consistent best practices and positive outcomes for patients. The answers to this research question can help develop interventions that support best practices for patients who are mechanically ventilated and receiving intravenous sedation.

The clinical problem with this case scenario bring up one of many common concerns. Many hospitals today plan discharge for patients as soon as they are admitted. There are many concerns that come from this fast assumption of discharge. Planning for discharge before the patient is fully assessed by the nurse also involves fast discharge teaching, which leaves the patient and caregivers anxious and uneducated about their future. This is where the problems come into play with the nurses, patients, and caregivers. When it comes to this scenario, caregivers are scared or hesitant to have to care for loved ones on such short notice and after a brief hospital stay. This normally

Before participating in simulation, we were required to complete several learning activities in order to prepare for the topics covered during the simulation experience. We were assigned two articles to read that would enhance our knowledge and understanding while providing the necessary academic background for our simulation scenarios. The first article discussed the topic of withdrawing ventilator support in end-of-life patients dependent upon mechanical ventilation. Kim (2012) provides a historical background of the issue of withdrawing ventilator support and discusses what it means to be ventilator dependent and have failed weaning trials. She presents the physiological and psychological factors that

There are several types of mechanical ventilators and ventilator mode settings. All of them have distinctive features that can aid patients towards recovery and therapy. Professionals in the medical field would agree that medical interventions such as intubation and mechanical ventilation can critically save and support patients who are suffering from severe acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). A type of ventilation called the high frequency percussive ventilation (HFPV) is being advocated as a vital therapy to patients with ARDS as well as an effective method in treating smoke inhalation injury in burn patients. Compared to the conventional mode of ventilation, HFPV can greatly improve oxygenation and ventilation. Furthermore, HFPV is now being widely used especially when conventional modes of ventilation cannot achieve oxygenation and ventilation goals (Kunugiyama and Schulman, 2012).