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Mechanical Ventilation Management

Mechanical Ventilation maintain the patient’s arterial blood gas, which is achieved through keeping the PaO2, pH, and PaCO2 as close to normal limits as possible. This is indicated for patients who cannot maintain adequate ventilation and/or unable to protect one’s own airway.

Preparation
● Ensure patient on a ventilator is carefully monitored and that the alarms are always on.
● Monitor the system at regular intervals to detect problems early.
● Anticipate problems and anticipate your response to the problems.
● Remember that machines fail and have a manual system in place, i.e., oxygen tank and Ambu bag.
Mechanical Ventilation Management
Special Considerations
• The psychosocial needs of the patient must be addressed.
• The nutritional needs of the patient who is on an MV are of utmost importance.
• Cardiac output may be decreased, which will affect end-organ perfusion.
• Patients on MV are at high risk for the development of pneumothorax.
• Repositioning of patient at least every 2 hours facilitates removal of pulmonary secretions and prevention of atelectasis.
• Age of patient.
• Coexistence of different pathologies.

Relevant Nursing Diagnoses
● Impaired spontaneous ventilation
● Ineffective breathing pattern

Expected Outcomes
● Improved patient oxygenation status
● Able to maintain airway reflexes
● Absence of adventitious breath sounds
● Normal respiratory rate
● Negative inspiratory flow of greater than–20 cm
● Vital capacity greater than 10 mL/kg
● PaO2 greater than 60 on FiO2 of less than 50%
● Patient achieves target tidal volumes, promoting optimal lung expansion

Implementation
● Wash hands.
Reduces the transmission of microorganisms.
● Explain the rationale for therapy to patient and family.
Establishes rapport, reduces anxiety, and promotes autonomy.
● Develop communication plan if time and condition permit.
Enables patient to communicate needs.
● Address physical and psychological comfort measures.
Reduces discomfort, and improves patient outcomes.
● Administer pain and anxiety medication as prescribed.
Reduces discomfort and anxiety related to therapy.
● Adjust alarm setting.
Provides early detection of potential problems. Mechanical alarms are useful but patient assessment is vital.
● Provide client opportunity for position changes and mouth and endotracheal tube care frequently.
Promotes mobilization of secretions, and prevents oral cavity erosion.
● Preoxygenate by providing 100% oxygen and suction when indicated.
Promotes removal of pulmonary secretions and improved pulmonary function.
● Continuously evaluate ventilator settings, arterial blood gases
(ABGs), goals for therapy, and patient response.
Improvement or deterioration in patient condition often requires changes in ventilator setting.
● Monitor patient’s ventilator pressure readings and breath sounds for presence and quality.
Barotrauma and pneumothorax associated with MV often present in an abrupt rise in peak inspiratory pressure or decreased breath sounds.
● Perform oral care and avoid triggers for gag reflex, such as deep oropharyngeal suctioning. Contaminated oral secretions are often associated with nosocomial pneumonia.
Gagging causes discomfort and increases intrathoracic and intracranial pressure.
● Elevate head of bed at least 30 degrees.
Reduces the risk for aspiration and promotes lung expansion.
● Change ventilator tubing according to hospital policy to prevent colonization of microorganisms.
Warm, moist nature of ventilator equipment is a medium for bacterial growth, which makes patient prone to nosocomial infections.
● Make appropriate ventilator changes such as increasing or decreasing rate and/or tidal volume and monitor for patient’s ability to be weaned from ventilator.
Changes in ventilator setting facilitate spontaneous ventilation and self sustained ventilation.
● Make referrals to dietitian to provide optimal nutrition.
Provides holistic care to meet the individual needs of the patient.
● Wash hands.
Reduces the transmission of microorganisms.

Evaluation and Follow up activities
● Assess the initial reason for MV, and evaluate goals for therapy
● Anticipate duration of MV
● Know successful criteria for achievement of goals
● Detect patient problems early
● Evaluate arterial blood gas analysis
● Patient’s tolerance to treatment
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