Ch. 21 Pilbeams Flashcards
Most patients receiving mechanical ventilation require ventilatory support for less than ______ days.
7
Approximately ____ % of those patients requiring more than ____ days cannot be successfully weaned from ventilatory support and require ______.
5, 7, LTMV
Patients receiving LTMV are divided into 2 groups:
- Those recovering from an acute illness and unable to maintain adequate ventilation for prolonged periods.
- Chronic progressive cardiopulmonary disorders.
Key point 21.1
Long term ventilator-assisted patients are defined by the American College of Chest Physicians (ACCP) as individuals requiring mechanical ventilation for at least 6 hours per day for 21 days or more.
What are the goals of LTMV?
- Enhancing an individual’s living potential
- Improving physical and psychological level of function
- Reducing morbidity
- Lessening hospitalizations
- Extending life
- Providing cost effective care
What are some sites for ventilator dependent patients?
• Acute care sites
• Intermediate care sites
• Long term care sites
Acute care sites include:
- ICU
- Specialize respiratory care units.
- Long-term acute care hospitals
Intermediate care sites include:
• subacute care units
• long-term care hospitals
• rehabilitation hospitals
These patients may still require high levels of PEEP or FIO2
Patient selection (3 groups):
- Disease process and clinical stability
- Psychological evaluation of patient and family
- Financial considerations
Long term care sites include:
SNF
Long term care sites are not the ideal site for weaning a patient from ventilation
Least expensive and provide a better quality of life and more independence for the patient
Preparation for discharge to home:
Respiratory therapists who are assigned to prepare a ventilator-assisted patient for transfer to another facility or home must ensure that the receiving site can accommodate the patient’s and family’s.
What are some questions to ask the patient?
• are you feeling anxious?
• are you getting a deep enough breath?
• does the breath last long enough?
• is it too long?
• do you have enough time to get all your air out?
• do you need more breaths? Do you need fewer breaths?
What is a piece of equipment that can be used for home care ventilation?
Tracheostomy tube
What are some important factors in choosing a ventilator?
• Reliability
• Safety
• Versatility
• User friendly
• Easy pt cycling
What is the most common complication with long term ventilation?
Vocal cord injury or paralysis
What’s are some psychological problems that can occur in ventilator assisted individuals (VAIs)?
• Severity of illness
• longevity of illness
• multiple medications
• sleep disruption
• Delirium
• Anxiety
• Depression
What are some alternatives to invasive mechanical ventilation at home?
• NIV
• NPV
• diaphragmatic pacing
• Tank ventilators/iron lung
• chest cuirass
• body suit
What are some additional noninvasive devices?
• rocking bed
• pneumobelt
• CPAP systems
What are some expiratory muscle aids?
• Assisted coughing
• mechanical oscillation
• mechanical insufflation-exsufflation
What is an example of a Trach speaking valve?
Passymuir
What is the time limit for vents for infants?
2-3 months for evaluation for 2-3 years of life
What are Trach buttons and decannulation?
The removal of a trach to start the process of natural breathing
What is some ancillary equipment?
Disinfection with distilled water and vinegar
distilled water has no minerals
