Question

Module 04 Discussion - Gas Exchange

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?
• References and in-text citation

Answer 1

Answer:

1. The clinical manifestations that can observe for a patient with ARDS are ;

* Laboured and rapid breathing

* Shortness of breath

* Hypotension

* Confusion

* Tachycardia

* Generalised weakness

2. Complications associated with mechanical ventilation are ;

* Pneumothorax - collapse of lungs due to high pleural pressure.

* Barotrauma - Lung injury due to large tidal volume.

* Reduced cardiac output and hypotension - Due unintended air trapping by auto PEEP.

* Hemodynamic instability - Resulted from positive pressure ventilation

* Oxygen toxicity

* GI bleeding

* Dysrhythemia

*Respiratory acidosis or alkalosis

3. * Assess the respiratory status and level consciousness of the patient

*Monitor the ventilator mode and settings and determine the therapeutic effectiveness

* Suction the ET tube when necessary and perform it for shortest duration as possible

*Follow aseptic techniques and VAP prevention bundles to prevent infection

* Maintain the nutritional status of the patient and Administer liquid foods through nasogastric tube.

* Proper weaning of patient from mechanical ventilation.

4. * Assessment of the patient for readiness to extubate and interruption of sedation daily

* Elevate the head end of the bed to 30 - 45 degree

* Provide routine oral care to the patient with chlorhexidine

* Preventive measures for deep vein thrombosis

* Prophylaxis measures to prevent peptic ulcer disease.

5. Critical care nurse plays an important role in the prevention of VAP. Collaboration among the staff is important for effective treatment.For that I will

* assess the existing knowledge of that nurse regarding VAP intervention

*Teach the importance of VAP prevention

*Educate about VAP prevention strategies

* Teach about VAP prevention bundles

Reference: Kozier and Erb's fundamentals of Nursing, Joice M Black- Medical and surgical Nursing