Question

Identify nursing priorities of Nursing Care Skills/Standards of Care for VENTILATOR MANAGEMENT STANDARDS OF CARE.

Question 1.What are the Nursing Standards of Care and Rationale for ARTERIAL LINE STANDARDS OF CARE.

Answer 1

In a wide variety of settings, message are increasingly likely to care for patient on mechanical ventilators. The evidence based practice guidelines for managing the client with mechanical ventilators are follows.

Care essential 1: Review communications

Communication among care providers promote optimal outcome. For mechanical ventilator patients, CA providers may include primary care physicians, pulmonary specialists, hospitalists, respiratory therapists, and nurse.

To make sure that you are aware of other team members communications about the patient, find out the goals of therapy for patient when obtaining report. Communicating with the patient is essential too. provide writing tools for a communication board so patient can express his or her needs. Aaj simple yes or no questions to which patient can node or shake the head.

Care essential 2. Check check ventilator settings and modes

​​​​When the nurse enter the patient's room, take vital signs, take oxygen saturation, listen to breath sounds, are not changes from previous findings. Osho answers patients pain and density level.

Read the patients order and obtain information about the ventilator. Compare current event little settings with settings described in the order. Familiarise yourself with ventilator alarms and action to take when the alarm sounds. Locate suction equipment and review its use. Look for a bag- valve mask , which should be available for every patient with an artificial airway; be sure you know how to hyperventilate and hyperoxygenate the patient.

Ventilator settings and modes

Generally, ventilators display ordered settings and patient parameters. Check the following settings ;

• Respiratory rate, the number of breaths provided by ventilator each minute. Manually count the patients respiratory rate, because she may be taking her own breaths at the rate above the ventilator settings.
• Fraction of inspired oxygen (Fio2), is expressed as a percentage (room air21%).
• Tidal volume (Tvor VT), the volume of air in held with each breath, express bee in ml.
• Peak inspiratory pressure (PIP), the pressure needed to provide each breath. Target PIP is below 30 cm H2O. Hi pipe may indicate a kinked tube, a need for suctioning, bronchospasm, or length problem, such as pulmonaryedema or pneumothorax.

find out which ventilation mode on method your patient is receiving, check the ventilator itself or respiratory flow sheet. The mode depend on patient variables. Including the indication for mechanical ventilation.

Most include those that provides specific amounts of TV during inspiration, such as assistant control and synchronised intermittent mandatory ventilation (SIMV); and those that provides a preset level of pressure during inspiration search official support ventilation (PSV) and airway pressure release ventilation. PSV allows spontaneously breathing patients to take their own amount of TV at their own rate. assisted control and continuous mandatory ventilation provide a set baby at set respiratory rate. SIMV delivers a set volume at a set rate. but let's patience initiate their own breaths in synchrony with the ventilator.

3. Care essentials 3. Suction appropriately

Patientspatients receiving positive pressure mechanical ventilation have a tracheostomy, endotracheal, or nasotracheal tube. Most initially have an endotracheal tube; if they stay on the ventilator for many days or weeks, a tracheostomy may be done. Tracheostomy decisions depend on patient-specifics. controversy exist as to when a tracheostomy should be considered; general equation have tracheostomy is before being managed on a med-surg unit. Although specific airway management guidelines exist, always check the facilities policy and procedure manual. General suctioning recommendations include the following ;

• Suction only as needed- not according to schedule
• Hyper oxygenator client before and after suctioning to help prevent oxygen desaturation.
• Don install normal saline solution into the endotracheal tube in an attempt to promote secretion removal.
• Limit suctioning pressure to the lowest level needed to remove secretions.
• Section for shortest duration possible.

4. Care essential 4. Assess pain and sedation needs

Eveneven though your patient can't Babli express their needs you will need to assess the pain level using reliable scale.

keep in mind that patients acknowledgement of pain means pain present and must be treated. Two scales that help you to evolve ate your patience edition level are the Richmond Agitation sedation scale and the Ramsay sedation scale.

5. Care essential 5. Prevent infection

Ventilator ventilator associated pneumonia is major complication of mechanical ventilation. Much research has focused on how best to prevent VAP. The management measures are,

• Keep the head of the bed elevated 45 degree at all times.
• Everyday provide sedation and assess readness to extubate,indicated by vital signs are arterial blood class values within normal ranges as well as patient taking breaths on her own.
• Provide peptic ulcer disease prophylaxis, Ash with histamine 2 blocker such as famotidine.
• Perform oral care with chlorhexidine daily.
• Provided deep vein thrombosis prophylaxis

6. Care essential 6 ;​​​​​​ prevent hemodynamic instability

Monitormonitor patients blood pressure every 24 hours especially after ventilator settings are changed or registered. Mechanical ventilation causes thoracic cavity pressure to rise on inspiration, which puts pressure on blood vessels and may reduce blood flow to the heart; as a result, blood pressure may drop. to maintain hemodynamic stability you may need to increase IV fluids or administer drugs such as dopamine or epinephrine if ordered.

7. Care essential 7. Manage the airway

The the cuff of the endotracheal or tracheostomy tube provides airway occlusion. Proper cuff inflation ensures the patient receives the proper ventilator parameters such as TV and oxygenation. Following hospital policy,in flight takeoff and measure for proper inflation pressure using the minimal leak technique for minimal occlusive volume. This technique help to prevent irritation and damage caused by high cuff pressure.

8. Care essential 8. Meet the patients nutritional needs.

For optimal outcomes, ventilator patients must be well nourished and should begins taking nutrition early. But like any patient who can't sollow normally, they need an alternative nutrition route. preferably they should have feeding tubes with liquid nutrition provided through the gut. If this is not possible the health care team will consider parenteral nutrition.

9. Care essential 9: wean the patient from ventilator appropriately

As as the patients indications for mechanical ventilation resolves, and she is able to take more breath her own,the health care team will consider removing her from the ventilator. Training methods may vary by facility and provider preference. All the protocols may be used to guide ventilator withdrawal., The best methods involve teamwork, consistent evaluation of patient parameters, and adjustment based on these changes.

10.​​​​​​ Essential 10. educate the patient and family

Is ease distress in the patient and family ,teach them why mechanical ventilation is needed and emphasize the positive outcome it can provide.

Caring for patient on mechanical ventilation requires teamwork, knowledge of care goals, and intervention based on best practices, response to therapy and patient needs.mechanical ventilation has become common treatment and nurse must be knowledgeable and confident when caring for ventilator patients.

2.ensure that the patient and healthcare provider safety standards are met during this procedure including

• Risk assessment and appropriate PPE.
• Four moments of hand hygiene.
• Procedure safety pause is performed
• Two patient identification.
• Safe patient handling practices
• Biomedical waste disposal policies

answer for moments of hand hygiene are matter when performing assessment and managing monitoring equipment.perform risk assessment and select appropriate PPT based on patient diagnosis and procedure being performed

1. Set up hemodynamic circuit:

RNs in CCTC are responsible for priming, zeroing, levelling and maintenance of hemodynamic pressures.mountain circuit and assessment and monitoring of hemodynamic pressures and waveforms.

2. Maintain accuracy;

Hemodynamic transducers zeroed at each initial setup, with the air fluid interface.

Transducer level should be validated at the beginning of each shift. Prior to each pressure measurement following patient repositioning and prn to validate hemodynamic pressure.

3. Monitor blood pressure

continuous arterial pressure monitoring is indicated for patients requiring BP monitoring q1 h , receiving continuous IV infusion of medications that affect cardiac output or blood pressure,requiring frequent blood gas monitoring for who are hemodynamically neurologically unstable

4. Display waveforms

Invasive arterial line and right hurt catheters must be connected to monitor that provides a continuous waveform display.

5. Maintain arterial line alarms

appropriate alarms must be on for all patients requiring continuous arterial pressure monitoring. Alarm setting should be selected based on the degree of fluctuation in the patients BP.upper and lower alarm limit that represent clinically importance changes are selected for each individual patient.

6. Maintain closed system;

All stopcocks must have dead end.leur lock caps for leur lock connected infusions. This includes stopcocks located on transducers. Aaj ka forth impregnated sampling port cap should be maintained in all sampling ports.

7. Obtain blood samples

RNs main draw blood from indwelling arterial and venous lines . Stopcocks should be turned to 45 degree between syringe changes. Leur lock needleless access cap should be changed before drawing a blood culture and anytime the port has visible blood.

8. Change dressings

Arterial line dressings are changed q7 days and pRN when using CHG transperent dressings, or q24 h when using gauze.

9. Monitor arterial site

Arterial line site/

Dressing should be kept as visible as possible. Check the site q1h I and PRN to assess for bleeding. Use minimal dressing material.

Asess the distal extremity for evidence of compromise to colour, circulation, on motion q1h

10. Document

Record the S/D and M BP in the graphic record q1h I and Prn.

11. Remove the arterial line

RNs marimo the arterial lines in CCTC with an order from a physician. Document the removal in the intravascular device section of the graphic record.