Protocolized Weaning: A Case Study

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).

Although when it happens, there can be a devastating impact on patients as well as to the multidisciplinary theatre team involved. Consequently, the DAS has produced a consensus set of guidelines for managing failed intubations in adult and paediatric patients, but there are as yet no such nationally-agreed guidelines in obstetrics, therefore each obstetric unit should have their own flowchart with regards to management of failed intubation (Brien and Conlon, 2013). Furthermore, in light of the latest DAS guidelines, several aspects of clinical anaesthetic practise have changed over recent years (Frerk at al, 2015). Amongst the changes are the use of new drugs such as rocuronium and suggamadex and using electronic video-laryngoscopes (Frerk et al, 2015). Further work had also looked at extending the period of apnoea without causing desaturation by optimising the preoxygenation process and adequate patient positioning (Frerk et al, 2015). As a result, updated guidelines for difficult intubations in adult patients were published in 2015; these guidelines provide a flowchart to be used when endotracheal intubation proves difficult or impossible and focus on the central importance of oxygenation while reducing the amount of airway interventions in order to minimize trauma to the delicate airway (Frerk et al, 2015). The main message of the revised guidelines is

The authors begin their initiation of the research article by stating their reason attention is needed to study the rate of accidental decannulation (AD). Due to the increment in the number of patients receiving protracted mechanical ventilation through artificial airway, much attention is needed to focus on how to reduce the morbidity and mortality rate of accidental decannulation. Not much recognition is given to the complications of AD compared to accidental extubation following translaryngeal intubation (White et al., 2012). According to the authors, the research was triggered by two sentinel events, hence a research for the identification of the causes of AD in LTACH and implementation of strategies to curb the situation.

This essay provides a written account of the holistic assessment used when admitting a patient onto a respiratory ward. A brief outline is also included of the processes involved together with the resources used for collating information. Using the Roper, Logan and Tierney activities of daily living (ADL’s), eating and drinking, has been identified as one goal of nursing care. A short reflection has also been included based on experiences gained on a first clinical placement on the ward. For the benefit of this essay the selected patient will be referred to as Mrs P in order to maintain confidentiality.

The American Journal of Critical Care (AJCC) is a scientific journal that is provided by the AACN on a bimonthly rotation. The journal’s main focus is evidence-based practice. Its subscribers are able to read about the latest advancements in clinical research relating to treatment of critically ill patients. It regularly includes features highlighting

The literature supported a positive impact on patient outcomes when sedation awakening trials (SAT) and spontaneous breathing trials (SBT) were coordinated (Klompas et al., 2015, Woien & Bjork, 2012, & Woien, Vaeroy, Aamodt, & Bjork, 2012). The literature also supported the compliance of the coordination was more predictable when the nursing division was provided with protocol education (Klompas et al., 2015, Woien & Bjork, 2012, & Woien, Vaeroy, Aamodt, & Bjork, 2012). The summation of findings indicates that when education was integrated with the research methods, the outcomes related to nursing compliance were consistent and led to the completion of best practices. Nursing education was a controlled variable in research that found a positive correlation with SAT and SBT and outcomes for patients. Additionally, research without this controlled variable found inconsistencies with the performance of SAT/SBT and related outcomes. As a result, the particular relationship between

The title clearly represents the main topic and population of the study – the changes that occur in medical care when a person is placed on a Do-Not-Resuscitate order and pediatric oncology patients. The abstract capably depicts the problem that is being addressed, the results from the study, and the implications of the study. The methods for gathering data are also included in the abstract. The abstract may benefit from including the limitations of this research study, specifically that this study focused on one hospital; therefore, the results may not be able to be generalized to other populations. Overall, the abstract is written well.

1.16. Explain the standard set of nursing observations that are completed on an individual who is in respiratory distress? Blood pressure, L&S manual or machine, SPo2 used on finger, ear or nose, Respirations for full minute, HR manual or through machine, neurovascular observation and capillary refill, pain scale, alert scale (Chrisp & Taylor, 2011)

The practitioner ensured that the patient was dry and was covered to maintain dignity and privacy. The anaesthetist accompanied the practitioner to the PACU to observe and establish that the patient was physiologically stable during transfer. On arrival to PACU the scrub staff and anaesthetist took part in the PACU handover. It is imperative that a formal handover of the patient care is given with all relevant details about anaesthesia and surgery verbally communicated, in order to aid the continuity of care and minimise the risk of omissions (Hamlington, 2012). One study (Kluger and Bullock, 2002) observed that 14% of adverse recovery events was contributed by inadequate handover procedure. The patient was observed on a one-to one basis by the recovery ODP whilst observations and monitoring was recorded. Recordings of respiratory rate, heart rate, NIBP and pulse oximetry were made at 5 minute intervals as laid out in AAGBI’s guideline for postoperative recovery (Association of Anaesthetists of Great Britain and Ireland, 2013). Sedation and mobility recordings were also needed due to the intrathecal anaesthesia, as well as temperature, pain intensity, blood loss,

The American Journal of Critical Care is a bi-monthly, peer-reviewed journal focused on improving the care of critically ill patients and their families. The authors provide resources in the form of research studies, case reports, reports on new techniques, clinical/basic science reviews, guest editorials and clinical studies. The editors strongly encourage works focused on collaborative practice and research targeted at health professionals caring for critical care populations.

Malkoc, Karadibak and Yildim. (2007) carried out a study to determine the effect of physiotherapy on ventilator dependency and the length of stay in an intensive care unit. Clear outcome measures were used on 510 patients which determined the effectiveness of the treatment, involving chest physiotherapy with some mobilisation. The researchers concluded that there was a significant difference in the control and intervention groups with the length of stay in the intervention group being significantly lower (P < 0.05).

Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress Syndrome (Amato et al.,). The topic of the article is the use of protective lung strategies and the effects they have on mortality rate for patients with Acute Respiratory Distress Syndrome (ARDS). The problem the authors, and practitioners around the world, face is that traditional methods for mechanical ventilation damage already diseased lungs which increases the mortality rate of patients with ARDS. The purpose of this study is to define what lung protective strategies are comprised of and to determine if using these strategies will reduce pulmonary complications which will ultimately decrease mortality rates. The questions the authors focused on were:

All of the samples were convenience samples of patients who survived a stay in the intensive care unit, questioned anywhere from 8 weeks up to one year later post discharge. All studies used questionnaires, interviews, and reviews of the patient’s charts for interventions. The results of the studies were not the same for all patients.

There is various aspect of care available for the children who enter hospital and they are placed at each care according to their diagnosis and individual needs. One study identifies Intensive Care Unit (ICU) as, “health care settings where a wide range of lifesaving methods of