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Indications and goals for mechanical ventilation
Indications: failure to generate spontaneous ventilations (trauma, drug overdose, etc), hypoxia & hypercarbia (ARDs, COPD)
Goals: Maintain alveolar ventilation appropriate for the pt, correct hypoxemia and max oxygen transport
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Intubation Equipment
Ambu bag, larynogoscope & ET tubes, suction equipment, ventilator, tape to secure ET tube
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Oral ET Tube
easier insertion, larger diameter tubes can be used, less chance of sinus infections and VAP
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Nasal ET Tube
better tolerated, better access for oral care, can increase work of breathing (farther distance to lungs)
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Tracheostomy
Most comfortable, more permanent and stable, less dead space
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Balloons in ET Tubes are used for:
preventing aspiration and to keep air from escaping, pressure in the balloon is checked once a shift
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Nursing Considerations
Impaired communication, ineffective airway clearance, ineffective breathing pattern, anxiety, risk for infection
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What do long-term trach pts use to speak?
Passy Muir Speaking Valve
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VAP prevention
HOB: 30-45 degrees, provide routine oral care, use ETT w/ dorsal lumen above ETT cuff to allow drainage by continuous suctioning of subglottic collections of secretions, do NOT routinely change ventilator circuit
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Post Extubation Care
Assess for airway trauma, assess resp rate, resp rhythm, quality, breath sounds, pulse ox, assess vital signs, pulmonary hygiene q2 hrs, keep oxygen device in place
if trauma (strider/difficulty breathing) immediate replacement of tube
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