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CARE OF PATIENTS WITH MECHANICAL VENTILATOR OBJECTIVES: After 4 hours of varied classroom activities, the level IV students will

be able to: 1. define the following terms: 1.1) mechanical ventilator 1.2) mechanical ventilation 1.3) positive pressure 1.4) negative pressure 2. discuss mechanical ventilation according to its: 2.1) purpose 2.2) indications/ criteria for use in patient 2.3) criteria/ situations of discontinuing the use in patients 3. identify the different types/ classifications of mechanical ventilator 4. cite the various ventilator modes 5. explain the nursing care to a patient with a mechanical ventilator DEFINITION OF TERMS 1.1 Mechanical ventilator- a device used to move air in and out of patients lungs. Although the equipment serves to ventilate a patient, it doesnt ensure adequate gas exchange. This may use either positive or negative pressure to ventilate patients. 1.2 Mechanical ventilation- is the use of a mechanical device (machine) to inflate and deflate the lungs. 1.3 Positive pressure- exerts a positive pressure in the airway, which causes inspiration while increasing tidal volume. 1.4 Negative pressure- act by creating negative pressure which pulls the thorax outward and allows air to flow into the lungs.

PURPOSE 1. To support ventilator or oxygenation failure 2. To assist in maintaining homeostasis 3. To reduce the pulmonary system with the support needed to maintain an adequate level of alveolar ventilation 4. To increase oxygen transfer and oxygenation to body organs and tissues. 5. Provides the force needed to deliver air to the lungs in a patient whose own ventilatory abilities are diminished or lost. INDICATIONS 1. acute respiratory failure -exists when the patient's breathing apparatus fails in its ability to maintain arterial blood gases within the normal range. 2. hypoxemic respiratory failure - occurs when there is insufficient oxygen for the body tissues to function. This can be a result of a low oxygen level in the blood, an inefficient blood supply to the tissues or a toxic substance which prevents cells from using the oxygen that is supplied. 3. major surgery - the ventilator is always used when general anesthesia is given, as the drugs make it impossible for the patient to take breaths without assistance. It may also be used for patients who are so sick or injured that they have difficulty breathing without assistance. 4. hyperventilation therapy - is a condition in which you breathe too quickly or deeply. Usually, hyperventilation occurs with anxiety. Overbreathing can cause imbalances in the levels of oxygen and carbon dioxide in your blood. These imbalances can make you feel breathless, dizzy, light-headed, confused or weak. Treatment for hyperventilation is aimed at increasing carbon dioxide levels in the blood, usually by adjusting your breathing rate. 5. impending respiratory failure - indicated clinically by obtundation, monosyllabic speech, slumped posture, and shallow breathing. ABGs showing worsening hypercapnia are also an indication, although blood-gas confirmation is not required Oral intubation is preferred over nasal because a larger endotracheal tube, which decreases airway resistance and permits easier suctioning, can be used. 6. apnea or absence of breathing - s a term for suspension of external breathing. During apnea there is no movement of the muscles of respiration and the volume of the lungs initially remains unchanged.

CRITERIA IN DICONTINUING THE USE OF VENTILATORS 1. When the patient is able to generate a minimum vital capacity of 15ml/kg of body weight or a vital capacity twice as large as the predicted normal resting tidal volume. The minimum required volume is usually in the range of 1000ml in a normal adult. 2. An inspiratory force at least -20 cm H2O pressure 3. A PaO2 of greater that 60% with an FIO2 less than 0.5 4. Vital signs that is stable.

TYPES/CLASSIFICATION OF MECHANICAL VENTILATION A) Negative pressure ventilators 1) Drinker Respirator Tank (Iron Lung)

2) Body Wrap (Pneumowrap)

3) Chest Cuirass ( Tortoise shell)

B) Positive Pressure Ventilators

1. Pressure-cycled ventilators 2. Time-cycled ventilators 3. Volume cycled ventilators

4) Cite the various ventilator modes

a) Assist-control Mode ventilator delivers a preset rate; however the patient can initiate additional breaths, which trigger the ventilator to deliver the preset tidal volume (V1) at positive pressure.

b) Control Mode the ventilator delivers a preset V1 at a fixed rate regardless of whether the patient is breathing spontaneously. 5) Nursing care to a patient with a mechanical ventilator -Verify the doctors order for ventilator support. - Prepare patient for intubation, if not intubated already. - Explain procedure to patient and family. - Assess the patient most importantly the patients ABG. - Make sure patient is adequately oxygenated. - Suction patient when necessary. - Use gloves when connecting the ETT to the ventilator. Observe for chest expansion and auscultate for bilateral breath sounds.

- Monitor ABG values after initial ventilator setup. (usually 20-30 minutes) - Check ventilator tubing frequently for condensation and drain as needed. -.Inspect the humidification device regularly. The heated humidifier should be set to deliver an inspired gas temperature (33C) plus or minus (2C) and should provide a minimum of 30 mg/L of water vapor with routine use to an intubated patient. -Check the in0line thermometer to make sure the temperature of the air delivered to the patient is close to the body temperature. -When monitoring vital signs count the number of spontaneous breaths as well as ventilator-delivered. -Change, clean, or dispose of the ventilator tubing and equipment according to hospital policy. -Provide emotional support to the patient during all phases of mechanical ventilation. -Make sure ventilator alarms are on at all times. -Unless contraindicated, turn patient from side to side every 1-2 hours and perform passive ROM exercises for all extremities. -Assess patients peripheral circulation and monitor input and output for signs of decreased cardiac output. -Watch for signs of fluid volume excess or dehydration. -Place the calls light within the patients reached and establish a method of communication. - Make sure patient gets adequate rest and sleep. Complication: Ventilator-associated pneumonia (VAP) is a sub-type of hospital-acquired pneumonia which occurs in people who are receiving mechanical ventilation. VAP primarily occurs because the endotracheal or tracheostomy tube allows free passage of bacteria into the lower segments of the lung in a person who often has underlying lung or immune problems. bacteria colonize the endotracheal or tracheostomy tube and are embolized into the lungs with each breath.