Care of patient on Ventilator

support
By
Imran Yousafzai
Lecturer, KMU
 Need of Mech Ventilation
• Mechanical ventilation may be required for a
variety of reasons, including the need to
control the patient’s respirations during surgery
or during treatment of severe head injury, to
oxygenate the blood when the patient’s
ventilatory efforts are inadequate, and to rest
the respiratory muscles. Many patients placed
on a ventilator can breathe spontaneously, but
the effort needed to do so may be exhausting
 INDICATIONS FOR
MECHANICAL VENTILATION
• If a patient has a continuous decrease in
oxygenation (PaO2), an increase in arterial carbon
dioxide levels (PaCO2), and a persistent acidosis
(decreased pH), mechanical ventilation may be
necessary.
• Conditions such as thoracic or abdominal surgery,
drug overdose, neuromuscular disorders, inhalation
injury, COPD, multiple trauma, shock, multisystem
failure, and coma all may lead to respiratory failure
and the need for mechanical ventilation.
 NURSING PROCESS:
THE PATIENT ON A VENTILATOR
 Assessment
• The nurse has a vital role in assessing the patient’s status and
the functioning of the ventilator. In assessing the patient, the
nurse evaluates the patient’s physiologic status and how he or
she is coping with mechanical ventilation. Physical assessment
includes systematic assessment of all body systems, with an in-
depth focus on the respiratory system. Respiratory assessment
includes vital signs, respiratory rate and pattern, breath
sounds, evaluation of spontaneous ventilatory effort, and
potential evidence of hypoxia. Increased adventitious breath
sounds may indicate a need for suctioning. The nurse also
evaluates the settings and functioning of the mechanical
ventilator, as described previously.
 NURSING DIAGNOSES
• Impaired gas exchange related to underlying illness, or
ventilator setting adjustment during stabilization or weaning.
• Ineffective airway clearance related to increased mucus
production associated with continuous positive-pressure
mechanical ventilation
• Risk for trauma and infection related to endotracheal
intubation or tracheostomy
• Impaired physical mobility related to ventilator dependency.
• Impaired verbal communication related to endotracheal
tube and attachment to ventilator
• Defensive coping and powerlessness related to ventilator
dependency.
 Planning and Goals
• The major goals for the patient may include
achievement of optimal gas exchange,
maintenance of a patent airway, absence of
trauma or infection, attainment of optimal
mobility, adjustment to nonverbal methods of
communication, acquisition of successful
coping measures, and absence of
complications.
 Nursing Interventions
• ENHANCING GAS EXCHANGE:
• The alteration in gas exchange may be due to the underlying illness or
to mechanical factors related to the adjustment of the machine to the
patient.
• assesses the patient for adequate gas exchange, signs and symptoms
of hypoxia, and response to treatment.
• Interventions to promote optimal gas exchange include judicious
administration of analgesic agents to relieve pain without suppressing
the respiratory drive and frequent repositioning to diminish the
pulmonary effects of immobility.
• Monitors for adequate fluid balance by assessing for the presence of
peripheral edema, calculating daily intake and output, and
monitoring daily weights. The nurse administers medications
prescribed to control the primary disease and monitors for their side
effects.
PROMOTING EFFECTIVE AIRWAY CLEARANCE