care of pt on mechanical ventilator.ppt

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Care of pt on Mechanical ventilator :

Care of pt on Mechanical ventilator Conducted by: Ms.Monika (clinical instructor) Army college of nursing

Definition :

Definition Caring for pt who requires assisted ventilation by means of a mechanical ventilation .

Purposes :

Purposes To establish & maintain effective ventilation. To prevent complication associated with artificial ventilation To ensure position & patency of Endotracheal & tracheotomy tube. To clear & remove secretions from airway .

Equipments :

Equipments Bed locker with necessary articles ,ventilator. Suction apparatus Continuous monitoring apparatus Resuscitation chart with defibrillator O2 adminstration articles Manual ventilation bag ( ambu bag)

General instructions :

General instructions Assigned nurse for pt on ventilator to have basic knowledge of pulmonary physiology ,complete understanding of ventilator functions & awareness of complication & intervention to be taken in emergencies. Pt on continuous mechanical ventilation to never be left unattended. Vital signs to be checked & recorded every hour ,unless otherwise prescribed .

Cont…………..d:

Cont…………..d Suctioning to be performed under aseptic technique. Sterile catheter & gloves should be used for each time of suctioning . Size of catheter to be less than half the diameter of endotracheal or tracheostomy tube. Suction tubing should be kept transparent so that nature of aspirate can be observed .

Cont……….d:

Cont……….d Ensure that vacuum pressure is not more than 120 mm hg in adult 100 mm hg in children. Endotracheal tube to be rotated daily , to prevent pressure ulcers on pt lip or tongue. Inflation of endotracheal /tracheostomy tube to be monitored regularly. Symptoms to be reported immediately.

Cont……….d:

Cont……….d Aseptic technique to be used when carrying out procedures involving tracheotomy or endotracheal tube. Functioning of ventilator alarms to be checked at beginning of each shift. Ventilator setting to be checked & recorded every hour. Tubing's leading from ventilator to pt must be checked atleast every hour & accumulated moisture to be removed.

Cont……………..d:

Cont……………..d Humidifier to be kept adequately filled with sterile distilled water. In presence of possible ventilator fault ,nurse must always first check clinical state of pt. if this is satisfactory then proceed to detect fault. If pt shows signs of insufficient ventilation the nurse must start manual ventilation whilst waiting for assistance.

Procedure :

Procedure 1.CARE OF ETT/TRACHEOSTOMY. Secure positioning of ETT/tracheostomy tube with adhesive plaster. Inflate cuff once correct positioning has been confirmed. Cuff is inflated with air using a syringe until a ‘hiss’ is heard on auscultation.

2) Maintaining ventilation :

2) Maintaining ventilation Effects of ventilation are assessed by observing pt color ,chest movement ,B>P ,pulse rate ,oxygen saturation. Ventilator make characteristic sounds during inspiration & expiration which nurse must be capable of identifying.

Cont…………..d:

Cont…………..d Ensure pt has adequate fluid & calorie intake. Administer sedation as prescribed to ensure adequate artificial ventilation & promotion of rest.

3) Signs of adequate ventilation.:

3) Signs of adequate ventilation. Improvement in skin color & oxygen saturation more than 90 %. Rhythmic expansion of chest with expiratory phase longer than inspiratory phase. change in pulse rate may indicate decreased cardiac output due to increased in intra thoracic pressure. A drop in blood pressure may reflect decreased cardiac output

Cont……..d:

Cont……..d Audible respiratory rhythm. Absence of any abnormal neurological signs. Absence of hyperventilation or hypoventilation.

4) Signs of inadequate ventilation :

4) Signs of inadequate ventilation Breathing occurs out of sequence with ventilation & pt is restless ,diaphoretic ,flushed or cyanosed. First signs of ventilatory inadequacy & hypoxia may be tachycardia & hypertension. If change in recording of ventilatory volume occur check airway pressure & rate of ventilation. If increase in minute volume ,check the leaks in cuffs seal ,connection & tubings.

Cont………d:

Cont………d If decrease in minute volume ,check for leaks in circuit. If increase in peak airway pressure occur check for obstruction such as secretions ,kinking ,pooling of water ,pneumothorax.

5) Suctioning :

5) Suctioning Explain procedure to pt/family Frequency of suction to be carried out depending on pt’s pulmonary state. Tracheal suction is an aseptic procedure .

Cont……..d:

Cont……..d Sterile catheter & one sterile glove to be used for each suctioning session. Suction is applied while catheter is being withdrawn using intermittent technique not more than 10 to 15 seconds. When secretions are tenacious ,instill 1 to 3 ml.sterile normal saline 0.9 % into endotracheal/tracheostomy tube to liquefy & make removal easier.

6) Weaning :

6) Weaning Inform pt that this is a progressive step in treatment . Repeatedly encourage & reassure pt to avoid fear Withhold sedation & muscle relaxant as ordered by doctor. Watch for respiratory distress ,hypoxia ,tachycardia ,tachypnea ,cyanosis ,hypotension & drop in o2 saturation.

7) Routine nursing care:

7) Routine nursing care Give daily bed bath & change bed linen ,if soiled. Provide 2 hourly attention to pressure sites by turning & repositioning of pt. 4 hourly oral hygiene & whenever needed. 4 hourly eye care. Instill artificial tears to prevent corneal abrasions. Check & record vital signs every hour.

Cont………d:

Cont………d Measure blood ,i/v infusions & fluid intake every hour. Measure blood loss ,urine ,nasogastric ,aspirate etc every hour. Change drainage bags ,chest drainage bottles & tubings as required. Maintain intake /output chart every shift Assess bowel action every third day 8 hourly wound dressing should be done.

Cont……….d:

Cont……….d Change I/V administration sets & dressing of puncture sites everyday. Change suction bottle & connecting tubing everyday. Record pt’s condition & events that have occurred during each shift in nurse progress sheet. Give detailed hand over to nurse on following shift.

Psychological aspect of pt care :

Psychological aspect of pt care Endeavour to allay pt’s & relatives anxiety ,fears & clear doubts as necessary. Motivate pt & relatives to participate in daily care activities. Promote good relationship with pt/family…& encourage them to express fears ,stress factor & feeling.