Risk Pneumonia And Mischance Ventilation ( Ippv ) Is The Best Option For Patients With Impaired Conscious State

Critically ill patients who are intubated on mechanical ventilation for more than 24 hours of are at an increased risk of 6 to 21 times of developing ventilator associated pneumonia (VAP). Patients intubated for lesser than 24 hours are at 3 times the risk of acquiring VAP.15

* 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.

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).

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,

In the study there were twelve patients that volunteered for the experiment. Out of the twelve; eight of the patients decided not to have the BIPAP on before surgery. The remaining four did allow the BIPAP. In the volunteers to the study that did not do the BIPAP only survived for two months to ten years. While the four, that did the study after two to eight years did not show any bronchiolitis obliterans. Bronchiolitis obliterans is chronic rejection following a lung transplant.

BiPAP is a form of noninvasive mechanical ventilation used on patients that have acute respiratory failure. Many of these patients go on noninvasive ventilation due to COPD exacerbations that are infectious, with congestive heart failure, and ventilator parameters based on their clinical assessment and changes in arterial blood gases. Two different studies were conducted on COPD patients, using a BiPAP machine to improve exacerbations and their activities of daily living. There are many positive outcomes for using these noninvasive ventilators however when used incorrectly, negative outcomes or not changes at all are always possible.

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

Another follow up ABG at 0100 shows a small improvement on the Ph to 7.18, the Pco2 became more acidotic moved to 53, the Po2 improved to 77 which shows he is oxygenating better but still hypoxic, his Hco3 acidosis is improving at a change to 19.8, and sating 91% now. The Pt is now breathing at a rate has come down to 10 BPM on his own above and beyond the vent. After consulting with the physician we changed the Vt to 600 and the pressure support to 20 and Cpap to 15. The Pt continued on these settings till 0415. The physician then made the change to Bi-level with the settings of a rate of 14 pressure support of 25, and an H/L pressure of 35/15. The Pt at this time is pulling a Vt of 745 and a spontaneous rate of 17 and still at 100% Fio2 and sating 92%. This is the point when the Pt makes the turn. The Bi-level or APRV was the proper setting for this Pt. He continued to improve over the next several days with his peek pressure climbing to 40. The Pt continues these settings and slowly improves and eventually weaned from the ventilator till the Pt no longer needs support.

For the collection of data, developed and verified NI surveillance was used. The NI surveillance was useful for measuring both the incidence and risk factors of VAP according to Katherason et al (2009). Demographical data, past medical history, medications, nutritional status, laboratory results, diagnosis, history of illness, etc were all included in the surveillance. The Acute Physiology and Chronic Health Evaluation III score measured the severity of the illness. The APCHE is comprised of the acute physiological score that entails the major physiological systems and the chronic health evaluation that incorporates the influence of co-morbid conditions on the patient’s current health (O'Keefe-McCarthy, Santiago, & Lau, 2008).

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

Rationale: Correct Answer is 1 - Arterial blood gases measure the pH, oxygen and carbon dioxide in arteries and gives us important information regarding the patient’s gas exchange and acid-base status (McCance & Huether, 2015, p. 1243). Measuring intake and output is an important process throughout the patient’s entire hospital stay. Prior weaning attempts do not have any importance to a current weaning

All over the world, chronic obstructive pulmonary disease (COPD) is a very significant and prevalent cause of morbidity and mortality, and it is increasing with time (Hurd, 2000; Pauwels, 2000; Petty, 2000). Due to the factor of COPD being an underdiagnosed and undertreated disease, the epidemiology (Pauwels, Rabe, 2004) is about 60 to 85 % with mild or moderate COPD remaining undiagnosed (Miravitlles et al., 2009; Hvidsten et al., 2010).

The first assessment I performed for my patient, C.P., was during a day shift on February 23, 2016. Upon receiving her into my care at approximately 0730hrs, I noticed that she was extremely difficult to rouse awake as she was drowsy and could not seem to keep her eyes open. On top of this, she was exhibiting unusually slow respirations while laying supine on her bed, with many blankets around her. For the purpose of this paper, I will be focusing on my respiratory assessment. During this event, performing a thorough respiratory assessment was challenging because C.P. was unable to fully participate due to her current cognitive state.

TBI is the leading cause due to high incidence, complexity and the presence of challenging clinical management situations such as intracranial hypertension, thoracic trauma and intra-abdominal hypertension. The most common manifestation of a TBI is acute RDS with a high mortality rate. Respiratory failure paired with high PEEP setting and low tidal volumes make patients with increased intracranial hypertension harder to manage. It is hard to maintain these patient’s PaCO2 within a normal range causing protective ventilation strategies to be more difficult. The protective ventilations strategies recommend the mechanical ventilation include maintaining plateau pressures lower than 30cm H2O independently of ARDS severity. However, in patients with a TBI are at greater risk for pulmonary injury, which depends on the trauma severity, even in patients with a TBI and no RDS. In both patient types, TBI with and without RDS, the protective mechanical ventilation strategies are aimed at protecting the lungs and the lung function. Because of the variety of disease causes, there is speculation as to whether ARDS should be described as a single entity, or whether for each special situation it could all be described as a specific class of ARDS, with different management of the ventilation. The aim of this study

However, there were no peep values at bedside. We know per our standard of care if there was an emergency and we had to bag our patient and did not apply the same peep we would compromise our end-expiratory pressure which would lead to the collapsing of their alveolars.