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?
Full Answer Section
- olutrauma: Lung tissue damage caused by overstretching due to high tidal volumes.
- Atelectasis: Collapse of part of the lung.
- Pressure ulcers: Skin breakdown from pressure and friction.
- Deep vein thrombosis (DVT): Blood clots in the legs.
Priority Nursing Interventions for Ventilation Complications:
- Prevent VAP: Oral hygiene, head-of-bed elevation, subglottic suctioning, ventilator weaning as tolerated, and appropriate antibiotic prophylaxis.
- Prevent Barotrauma and Volutrauma: Monitor ventilator settings, adjust settings based on patient needs, use lung-protective ventilation strategies.
- Prevent Atelectasis: Frequent repositioning, chest percussion and vibration, early mobilization as tolerated.
- Prevent Pressure Ulcers: Regular skin assessments, pressure redistribution devices, skin care regimen.
- Prevent DVT: Early mobilization, compression stockings, pharmacologic prophylaxis if indicated.
Interventions for VAP Prevention:
- Implement all above priority interventions, especially oral care and subglottic suctioning.
- Ensure proper hand hygiene before and after patient contact.
- Use sterile equipment for suctioning and airway procedures.
- Minimize sedation level while maintaining patient comfort.
Orientation Scenario:
- If the nurse you are working with is not implementing VAP prevention interventions, first politely bring it to their attention. Remind them of the specific protocol and rationale behind each intervention.
- If concerns remain, offer to assist in implementing the interventions or suggest contacting the charge nurse for guidance.
- Always maintain a professional and respectful tone while advocating for patient safety.
Remember, communication and collaboration are key when ensuring optimal care for patients like Mr. Nguyen.