Essay on Mechanically Ventilated Patients, An Annotated Bibliography

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.

The early intravenous fluid administration for resuscitation of the critically ill hypovolemic patient is the corner stone of shock therapy (Kruemer & Ensor 2012). The Surviving Sepsis recommends early optimization in the first six hours, followed with fluid challenges in the case of persistent hypo

1) Summary of Article: A review of literature shows the length of time a catheter remains in the body is directly associated with CAUTI.

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,

The presence of fluid in the alveolar space could potentially cause the lung capacity to be effected as well.

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

541). Interventions should be rendered continuously, promptly and appropriately as it can cause life-threatening complications (Holt 2009, p. 26). Apparently, the patient is stable, but continuous assessment and management should be done to avoid recurrences of untoward signs andsymptoms and prevent potential complications. Firstly, continuous assessment and vital signs should be done and these include blood pressure, cardiac rate, respiration, venous distention and skin turgor to assess possible occurrence of fluid overload as a result of rapid administration of large fluid that is often needed to treat the patient with DKA (Smeltzer & Bare 2004 p. 1185). Aside from this, documentation of fluid intake and output should be monitored and documented to assess for circulatory overload and renal function (Holt 2009, p. 61). Significantly, it is integral in the provision of continuous care that nurses reassess the factors that may have contribute or led to DKA, and educate the patient and his family about strategies to prevent its recurrences (Smeltzer & Bare 2004 p. 1186; Lemone, Burke & Bauldoff 2011, p. 551).

Hadjiliadis, D. (2012, January 2). Septic Shock. New York Times. Retrieved November 23, 2013, from http://www.nytimes.com/health/guides/dise

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),

Furthermore, prompt infusion of antimicrobial agents ought to be priority and this may require extra vascular access ports (Dellinger, et al., 2008). Early goal-directed resuscitation has confirmed to improved survival for emergency department patients presenting with septic shock in a randomized, controlled, single-center study. Resuscitation lessen 28-day death rate (Dellinger, et al., 2008). In a reviewed conducted by Dellinger, et al., (2012) advocated administering one litre of crystalloid or 300-500ml of colloid more than 30 minutes, to accomplish a central venous pressure (CVP) of 8 mm Hg to 12 mm Hg. Volumes ought to be increased if there are huge indications of hypoperfusion (Dellinger, 2014).

As previously mentioned, the left ventricle is no longer as compliant and therefore cannot fill with blood without encountering resistance. The use of diuretics decreases overall volume, which as a result decreases overall pressure. This lost pressure may be needed in order for blood to pump with added pressure against the resistance into the ventricle. Once pressure is lost the patient is said to have hypotension and is at risk for blood not being able to perfuse to vital tissues (Burchum et al., 2016, pg.

Pulmonary capillary blood flow is lowest in the apices where alveolar pressure is greater than capillary pressure. So ventilation is greater than perfusion. Blood flow is greatest at the bases of the lungs where the pressure in the vessels is greater than alveolar pressure so perfusion is greater than ventilation. Blood flow and alveolar ventilation are never perfectly matched. Perfusion (Q) is usually greater than ventilation (V). A normal V/Q ratio is 0.8. If the V/Q ratio is low this means there is not enough ventilation to oxygenate the blood. If the V/Q ratio is high this means blood flow is less than ventilation so ventilation is being wasted.

Utilizing the five points mentioned would transition the information from the systematic review into practice. The review would identify as an evidence summary in the model, producing a more manageable quantity of information. It can then be translated as it is combined with clinical expertise and tailored to the clinical setting. The setting that would benefit the most from this change would be those in the critical care setting, as septic patients are in a critical state and are monitored closely. Having strong supporting evidence will make a substantial argument to change practices. Utilizing the data, combined with clinical expertise and experience, supports the changes needed to provide the most up to date, evidence based care. Clinical expertise regarding sepsis benefits the healthcare team in acknowledging other clinical data that could be used to determine fluid volume status, straying away from depending on central venous pressure. The goal would be to transition from using central venous pressure as a reliable indicator of fluid volume status to utilizing noninvasive cardiac output monitoring, when possible, and other clinical indicators. Another change would involve discrediting the validity of central venous pressure as a volume status indicator to clinicians. Mark, Monnet, and Teboul (2007) noted that 90% of intensivists use central venous pressure

This is especially important on those patients admitted with low mortality risk DRGs. This is accomplished by identifying and preventing, potentially avoidable complications and adverse events. For example, patients admitted for syncope and collapse secondary to dehydration will more than likely be placed on IV Fluids. One goal would be to hydrate the patient and reevaluate them throughout their hospitalization for improvement. However, if the patient’s intake and output is not monitored closely, the patient can become volume overloaded and develop symptoms similar to those seen with Right Sided Heart Failure. Once that happens, the patient will require additional medications and additional hospital days because of provider error of not placing an order for the Nurses to monitor his/her volume status.

amount of pressure exerted on arterial walls in the patient’s heart. Blood pressure is measured in