Neurally Adjusted Ventilation Assist: A Case Study

* Practicum Goal: * Prevent further complications in respiratory distress by educating the nurse on the use of CPAP and BiPAP to support the patient population with acute respiratory distress and other chronic respiratory illness.

One being venoarterial (VA) ECMO which can provide support for an individual with a failing heart. This procedure can give full support of the heart and lungs. Another form of support is the venovenous (VV) ECMO which can offer up to 80% of cardiac output gas exchange without having cardiovascular support. For a physician to perform ECMO, they will place tubes called cannulae into the patient to facilitate the removal and return of blood back in the body. What dictates how to place the tubes is dependent on the patient’s weight and the type of ECMO being administered. Once the tubes are in place and machine is turned on then the patient's blood begins to move out of the body through the drainage cannula. The blood coming from the body into the pump is carrying very little oxygen. It is then filtrated through the pump known as an “artificial lung”, where O2 is added and CO2 is removed. George Makdisi state, “While outside the body, hemoglobin becomes fully saturated with oxygen and CO2 is removed” (par. 7). Thereafter, the blood returned to the patient after it has been warmed. The ECMO medical professional monitoring the patient will set the proper parameters of flow and then start to wean them off as the patient’s injured heart or lung is well enough to take over the work. There is sizeable team present during ECMO therapy. The surgeon handles insertion of the cannulas at the start and the removal of them once the treatment has completed. Throughout ECMO, the patient is taken care of by doctors, nurses, respiratory therapists, and other specialists. Usually there are several nurses and respiratory therapists that are specially trained to handle ECMO patients and there will always be one at the bedside to frequently monitor vitals, perform care, and assess the

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).

In the first step of the Tanner (2006) model nurses use their personal knowledge and experience to notice whether the patient requires attentions based on their expectations and looking at environment of the patient. Therefore, for an experience nurse it is easier for them responding to the similar situation if she or he revisit because the knowledge is already there through experience. In the case of Mr Devi, assessment will perform using systematic assessment based on the ABCDE approach (Airway, Breathing, circulation, Disability and Exposure). The ABCDE approach is an evidence-based practice widely accepted and used by all the members of a multidisciplinary team (MDT) to assess an acutely ill patient (Harrison and Daly 2011). First, life-threatening

A degree of evidence related to protocol usage and outcomes was collected to determine if a researchable problem was obtainable and valuable. According to Davies (2011), research questions should concentrate on "real-world problems" (p. 75). Patients in the intensive care unit who are mechanically ventilated receive intravenous sedation on a regular basis. According to findings by Wøien, Vaerøy, Aamodt, and Bjørk (2012), as much as "30-60% of intensive

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 role of the recovery nurse covers many aspects. Nurses within the recovery setting provide short-term critical care to patient’s post-anaesthesia. The recovery area is designed to aid the nurses in the support, monitoring and assessment of post-anaesthetic patients (Dougherty and Lister, 2011). Nurses will aid the reversal of the anaesthetic effect, so the patient is able to maintain their own airway (AAGBI 2002). Once the patient is clinically recovered, they will be transferred to the discharge lounge. It is the recovery nurse’s responsibility to ensure the patient is well

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),

In recent years respiratory therapy has gained a vast amount of recognition. According to "The Bureau of Labor Statistics", the employment of respiratory therapists is projected to grow nineteen percent over the next seven years. Along with increasing advancements in technology and medical research, there is also an ever increasing demand for respiratory therapists worldwide. Breathing is something that every individual must do, however, there are sometimes altercations in doing so, and this is where respiratory therapy comes into effect. In order to learn more about this topic, I enrolled into a Writing and Research course at my college. Upon taking this course, I had the pleasure of shadowing a couple of respiratory therapists at

Shallow breathing and pain altered this patient’s comfort. Therefore, one of the nursing diagnoses can be stated as “Breathing Pattern, Ineffective r/t pain and anxiety, as evidenced by respiratory depth changes" (Ackley & Ladwig p. 175). We briefly discussed the specifics of incentive spirometry use before initiating the intervention. After return demonstration, the patient was ready to use his incentive spirometer.

A Glasgow Coma Score of 8 or less also is an indication that the patient will need to be intubated soon. Once the tube is placed the ventilation may be useful in controlling the intracranial pressure as an intervention. Hyperventilation is a method used to reduce the carbon dioxide concentration in the vessels causing vasoconstriction which lessens the amount of blood circulating in the brain resulting in a decreased ICP (Zink and McQuillan, 2005). According to Zink and McQuillan, this intervention should only be utilized 24 hours after the initial injury because cerebral blood flow is often reduced at this point and constricting the vessels more may cause ischemia to occur. While using this technique it is important to monitor oxygenation to the brain tissue to assure no irreparable damage is

The skilled CRNA is not only proficient in the operating room, but also comfortable dealing directly with patients and their family members. Once in the operating room this is where their wealth of knowledge, experience, and critical thinking really comes into play. Taking into account the patient’s history and current medical issues, the CRNA lays out a plan of care for the patient and makes decisions regarding the type, dose, and rate of medications needed to induce a safe anesthetic effect for the patient during the procedure. While the procedure is underway it is the duty of the CRNA to keep the patient stable and successfully handle any bumps in the road that might occur. This is the role of the nurse anesthetist that I have been most impressed with. The time that I spent in the OR following a CRNA I witnessed him handle difficult situation after difficult situation. As the patient’s respiratory status started to decline, I watched as he manipulated the ventilator; switching between modes and changing settings until a safe respiratory rate and saturation level was achieved. Later the patient went into an adventitious heart rhythm that began to affect their

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,

Upon arriving at the scene, the advanced care paramedic would begin the primary survey. All dangers would be assessed, including environmental dangers, animals, agitated bystanders and any other alarming cues. Once all dangers have been assessed the ACPs begin investigating the patient’s responsiveness using the acronym AVPU (QLD.gov.au, 2016). An assessment of their alertness, verbal response, response to painful stimuli or unconsciousness is completed. Once assessed, the patient’s airway is then checked to be clear of any obstructions to ensure proper respiration can occur, at this point, the triple airway manoeuvre would be adjusted to only the opening of the mouth and the jaw thrust (QLD.gov.au, 2015). If the patient complains of neck and back tenderness, neurological deficit, evidence of intoxication or a distracting injury (QLD.gov.au, 2016. 2) spinal immobilisation is required to ensure no further damage to the spinal cord occurs or an aid to keep the patient as calm as possible if a distracting injury (Hodegetts et al., 2011). The patient's breathing should then be assessed now that the spine in immobilised to ensure the depth, rate and rhythm of the breaths are adequate. If needed an oropharyngeal airway may need to be inserted into the mouth to keep the tongue from blocking the airway if it is tolerated (Higginson et al,. 2013). Lastly, in the primary survey, the

According to the text, Breathe Right Strips were invented by Bruce Johnson, a chronic nasal congestion sufferer. Mr. Johnson Brought his creation to CNS Inc. CNS took the product and primarily marketed it to sports teams, nasal sufferers and night-time snorers. The product really became prominent when Jerry Rice of the San Francisco 49ers wore the product in the Super Bowl. According to cns.com, Breathe Right Strips is also available in vapor strips, clear and tan strips, and nasal strips for kids. Some of the other products include nasal spray, throat spray, fiberchoice and a portable vaporizer. Armed with these few, but strong products in 1995 CNS, decided to go global.