Mr J has significant risk factors putting him in danger of contracting Ventilator acquired pneumonia (VAP). see appendix 6.
The clinical picture of Mr J is suggestive of respiratory failure. Respiratory failure happens when the body starts to lose its capacity to ventilate and oxygenate the blood like it should (Aitken, Elliott & Chaboyer 2012).
While mechanically ventilatored, laying Mr J supine or even a back rest of 15-30 degrees puts him at greater risk of developing VAP than he would in the semirecumbent 45 degrees position (Alexiou et al, 2009). For prone position see appendix 3.
However, in the hemodynamically compromised patient, sitting the patient up to 45 degrees can cause drops in mean arterial pressure and central venous oxygen saturation so in the early stages of ICU admission patients may need to be placed at 20-30 degrees to overcome this (Gocze et al,2013). Mr J seems hemodynamically stable.
For Mr J who has unilateral lung disease, which is seen when one side of his lungs becomes significantly impaired, positioning for adequate VQ becomes very important.
Mr J has quite significant right side opacities, and positioning him right side up will encourage more blood flow to the good lung and improve VQ mismatch, and also help by decreasing resistance and increasing the compliance and air entrainment into the right lung (Coppadoro, Bittner, & Berra 2012). Regular suctioning must happen to avoid contamination of the healthy lung because as lung recruitment occurs, secretions can become more copious due to previous unventilated parts of the lung starting to drain (SY 2010).
Two key factors affecting airflow are compliance and resistance. Resistance affects air moving in and out of the lungs and...
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...hoscopy which found thick browny secretions is used not only as a diagnostic tool, but also to clear his right lung. Mr J had cultures sent and was given broad spectrum antibiotics while awaiting results.
Mr J is sedated for comfort while intubated but it is proven that reducing sedation and extubating a patient as soon as appropriate will help avoid VAP (DeBakey 2010). The ETT can hinder natural mechanisms that normally protect the airways including muccocillary flow, hair, saliva, sneeze, and cough reflex, and this may lead to the result of bacteria moving into the lung and lower lobes easily (DeBakey 2010). Mr J had a MAAS score of 1 on admission (Responsive only to noxious stimuli) with one factor being heavy sedation, but later on his MAAS score improved to 3 (Calm and cooperative) which can enable the extubation assessment process (DeBakey 2010).
The contraction of the inspiratory muscles increases the volume of the thoracic cavity causing the pressure within the alveoli to decrease and air to flow into the alveoli. During resting inspiration, the diaphragm, the external intercostals and the parasternal intercostals contract to stimulate inspiration. During forced inspiration the scalene and the sternocleidomastoid muscles contract to further expand the thoracic cavity. The pectoralis minor muscles also play a minor role in forced inspiration. During quiet breathing, relaxation of these muscles causes the volume of the thoracic cavity to decrease, resulting in expiration. During a forced expiration, the compression of the chest cavity is increased by contraction of the internal intercostal muscles and various abdominal
VAP develops in a patient after 48 hours or more of endotracheal intubation. According to a study by Relio et al. (as citied in Fields, L.B., 2008, Journal of Neuroscience Nursing, 40(5), 291-8) VAP adds an additional cost of $29,000-$40,000 per patient and increases the morality rate by 40-80%. Mechanically ventilated patients are at an increased risk in developing VAP due to factors such as circumvention of body’s own natural defense mechanisms in the upper respiratory tract (the filtering and protective properties of nasal mucosa and cilia), dry open mouth, and aspiration of oral secretions, altered consciousness, immobility, and possible immunosuppression. Furthermore, the accumulation of plaque in the oral cavity creates a biofilm that allows the patient’s mouth to become colonized with bacteria.
This essay describes how the anaesthetic machine and airway management equipment are prepared in operating theatres and discusses how they are ensured safe for use. It evaluates the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines related to safe practice and the preparation of the ET tubes, laryngeal masks, guedels, Naso pharyngeal airways and the laryngoscope. The function of the anaesthetic workstation is to deliver a mixture of anaesthetic agents and gases safely to the patient during the induction process and throughout surgery. In addition, it also provides ventilation to support breathing and monitors the patient’s vital signs to minimise the anaesthetic risks to the patient whilst in the care of health professionals. The pre-use check is vital to patient safety as an inadequate check of the anaesthetic machine or airway management equipment can and does lead to significant harm of the patient including mortality (Medicines and Healthcare Products Regulatory Agency (MHRA), 2008 and Magee, 2012).
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
Mrs. Jones, An elderly woman, presented severely short of breath. She required two rest periods in order to ambulate across the room, but refused the use of a wheel chair. She was alert and oriented, but was unable to speak in full sentences. Her skin was pale and dry. Her vital signs were as follows: Temperature 97.3°F, pulse 83, respirations 27, blood pressure 142/86, O2 saturation was 84% on room air. Auscultation of the lungs revealed crackles in the lower lobes and expiratory wheezing. Use of accessory muscles was present. She was put on 2 liters of oxygen via nasal canal. With the oxygen, her O2 saturation increased to 90%. With exertion her O2 saturation dropped to the 80's. Mrs. Jones began coughing and she produced large amounts of milky sputum.
Epidemiology of VAP Hunter, Annadurai and Rothwell defines ventialtor-associated pneumonia as nosocomial pneumonia occurring in patients receiving more than 48 hours of mechanical ventilation via tracheal or trascheotomy tube. It is commonly classified as either early onset (occurring within 96 hours of start of mechanical ventilation) or late onset (>96 hours after start of mechanical ventilation. A ventilator is a machine that is used to help a patient breathe by giving oxygen through an endotracheal tube, which is a tube placed in a patient’s mouth or nose, or through a tracheostomy, which is a surgical opening created trough the trachea in front of the neck. Infection may occur if bacteria or virus enters the tube into the lungs or airways by manual manipulation of the ventilator tubing. Ventilator-associated pneumonia accounts for 80% of hospital-acquired pneumonia, 8-28% of incubate... ...
Although lung cancer is generally operable, by using either traditional open surgery, or one of the less intrusive and more sophisticated video-assisted thoracoscopic surgeries (VATS), often it may not be considered to be the best option for a patient. Where ill-health is a factor, or either the size and location of the tumor is deemed to be a consideration, other forms of treatment may well have to be considered.
Ventilator associated Pneumonia ( VAP) is pneumonia that is acquired after 48 hours of being place on the ventilator. It is the most common nosocomial infection in the Intensive Care Units “ The risk for pneumonia increases 3 – 10-fold in patients receiving mechanical ventilation” ( Auguston, B.2007 ). Mechanical ventilation negates effective cough reflexes. This leads to micro aspiration of organisms into the lungs.
A ventilator- associated pneumonia (VAP) is a critical contamination preventable by a multitude of prevention strategies aimed at the care process. Pneumonia is an infectious disease of the organs of the lungs, with the ventilator as a device that facilitates patient respirations by providing oxygen through a tube. The tube can be located in a patient’s mouth, nose, or through a hole in the front of the neck, with the tube attached to the ventilator. Therefore, a VAP is pulmonary pathogenic infectivity that cultivates in a ventilator patient (CDC, 2010).
Nursing intervention: Position of comfort in semi or high fowlers and change position q2h - facilitates breathing and allows for full expansion of lungs.
Hinkle, Janice, and Kerry Cheever. “Management of Patients with Chronic Pulmonary Disease." Textbook of Medical-Surgical Nursing, 13th Ed. Philadelphia: Lisa McAllister, 2013. 619-630. Print.
In the case study it is the left lung that is in distress, and as the pressure increases within the left lung it can cause an impaired venus return to the right atrium (Daley, 2014). The increased pressure can eventually affect the right lung as the pressure builds in the left side and causes mediastinal shift which increases pressure on the right lung, which decreases the patients ability to breath, and diffuse the bodies tissues appropriately. The increase in pressure on the left side where the original traum... ... middle of paper ... ... 14, January 29).
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
The patient has high temperature-sign of fever, a very fast pulse rate (tachycardia), and chest wheezing when listened to using a stethoscope (Harries, Maher, & Graham, 2004, p.
Kacmarek, R., Stoller, J., & Heuer, A. (2013). Egan's fudamentals of respiratory care. (10th ed., pp. 10, 819-820). St. Louis, Missouri: Elsevier Mosby.