Patient Care Considerations

Question 1

What monitoring is required for ventilated patient?

Answer 1

1:1

Patient
- Cardiac, Spo2 and ETCO2 monitoring
- BP (preferably invasive)
- T (preferably core)
- FBC
- Head-to-toe assessment at least once per shift
- Tube position and pressure
- Tube tie (replace if wet)
- HME filter
- Mouth care
- Eye care
- Pressure area care

Ventilator
- Settings and alarms
- Circuit is firmly attached and unobstructed
- Ventilation record documented Q30/60

Question 2

How often should arterial blood gasses be performed?

Answer 2

• Q4/24 minimum

Question 3

How often should tube position and cuff pressure be checked?

Answer 3

At least once per shift

Question 4

How often should HME filter be checked?

Answer 4

Checked and changed at least once per shift or when moist

Question 5

How often should mouth care be performed?

Answer 5

Q2/24 using artifical saliva spray

Question 6

How often should eye care be performed

Answer 6

Q2/24 using artifical tears

Question 7

How often should pressure area care be performed

Answer 7

Q2/24

Question 8

Why is temperature monitoring important in intubated patients

Answer 8

Ability to thermoregulate is lost when paralysed and sedated

Question 9

What position should the ventilated patient be nurses in?

Answer 9

30-45 degrees

Question 10

List common complications of ventilated patients

Answer 10

• Barotrauma
• Gas Trapping
• Oxygen Toxicity
• Hypotension
• Abdominal distension, gastric ulcers / ischaemia + GI bleeds
• Elevated ICP

Question 11

Explain barotrauma as a complication of intubaton

Answer 11

Increased alveolar pressure
Causes alveolar injury and rupture
Air escapes from alevoli into:
- pleura (PTx)
- under skin (subcut emphysema)
- mediastinum (pneumomediastinum)
- pericardium (pneumopericardium)

Question 12

Explain gas trapping as a complication of intubation

Answer 12

If not enough time is given to allow for exhalation gas is trapped in the alveoli (increase in amount of spontaneous PEEP (aka. auto PEEP))

–> can be caused by inadequate I:E and RR settings

Question 13

Explain O2 toxicity as a complication of intubation

Answer 13

Prolonged exposure to high amounts of O2 causes lung injury

FiO2 must be appropriately titrated down using regular ABG results to avoid O2 toxicity

Question 14

Explain hypotension as a complication of intubation

Answer 14

Ventilation causes ^intra-thoracic pressure
–> decreases venous return and cardiac output
–> hypotension

Question 15

Explain abdominal distension as a complication of intubation

Answer 15

• Air may be swallowed or forced into stomach

–> importance of salem sump insertion

Question 16

Explain gastritis/ gastric ulcers / GI bleeds as a complication of intubation

Answer 16

Decreased gastric blood flow can result in ischaemia to gastric tissue, causing gastritis, ulcers and GI bleeds

Question 17

Explain elevated ICP as a complication of intubation

Answer 17

Increase in SVC pressure and JV pressure
–> reduced cerebral venous outflow
–> increased iCP

Question 18

How should you prepare the intubated patient for transport?

Answer 18

• Ensure adequate sedation analgesia and muscle relaxant for the transfer
  –> administer bolus muscle relaxant prior to transport
• Plan in case of deterioration / tube dislodgement

Question 19

How should you prepare the ventilator for transport?

Answer 19

• Ensure batteries are fully charged
• Ensure several tanks of O2