Question

Mr. Nguyen is a 58-year-old patient that had septic shock and developed Acute Respiratory Distress Syndrome. He is orally intubated and on a mechanical ventilator. He is paralyzed and sedated.

• What manifestations might you observe for a patient with ARDS?
• What complications can Mr. Nguyen develop from being mechanically ventilated?
• List priority nursing interventions to prevent complications associated with ventilatory support.
• What interventions can be implemented specifically to prevent the development of Ventilator Acquired Pneumonia (VAP)?
• You are orienting in the ICU, the nurse you are working with is not implementing the VAP interventions. What would you do?

Answer 1

●The manifestation which can be seen in patients with ARDS are

• Respiratory:Tachypnea, laboured breath, cough which is dry ,dyspnea, cyanosis
• CVS:hypotension ,faster pulse
• CNS:Headache ,elevated body temperature,confusion
• Musculoskeletal: weakness

●The complication which can be developed due to mechanical ventilation are

• Injury
• Ventilator associated pneumonia
• Pneumothorax
• Bacterial nosocomial sepsis
• Barotrauma
• Pulmonary embolism

●The priority nursing intervention are

• Propped up position of bed with 30 ° head elevation
• Regular oral care
• Follow asepsis in all procedure
• Hand hygiene to ore ent cross infection
• Providing good nutrition
• Frequent suctioning to clear secretions
• Monitoring vital signs
• Administer antibiotics as per order
• Chest physiotherapy to loosen secretion

●The intervention which has to be specifically done to prevent VAP are

• The exposure to ventilator has to be reduced position the patient head at 30 to 45°
• Meticulous oral hygiene
• Suctioning

●In these case

• Assess the knowledge level of the nurse ,if unaware of the intervention protocol teach the nurse .So that it can be implemented
• If the nurse knews the intervention and does not implement, inform the nurse to implement it for patient safety
• If the nurse ignores or neglects to follow ,report to the concerned supervisor, so that the nurse can be sent to training program.