Case Study: Ventilator Acquired Pneumonia

Today, I learned about three different modes in the PB-840 ventilator. I learned about the different between volume control, pressure control, and SIMV. Also, I review with my instruction the settings and alarms for the mechanical ventilator. During the say, my RT didn’t have many patients to take care. Therefore, another RT decided to give me a case study about a patient that needs mechanical ventilation. He told me that I have to decide what kind of mode and settings to choose for that specific patient. It was really helpful because I learned two formulas that can help me determinate the desired minute ventilation and PCO2. Today, it was not a busy day but it was a good day to review.

For this vSim assignment, I had to repeat the scenario three times before obtaining 100% on it, since I had forgotten about a few important steps when assessing my patient, and in my second try, I had forgotten to check the patient 's electronic health record even though I had already fixed my previous mistakes in the assessment. Three of the most important things I had to do differently in this scenario were to ask the patient about allergies to maintain patient safety before administering any drugs ordered, use the incentive spirometry to improve breathing and educate her about it since she had a hard time breathing due to pain, and educate the patient about wound care at the end before discharging her. Performing the procedures I missed in

On June 30, 2011, the Centers for Medicare and Medicaid Services (CMS) presented their final ruling on non-payment policies for provider preventable conditions (PPCs). One of the other provider preventable conditions includes the development of deep vein thrombosis (DVT) prophylaxis in any health care setting (Federal Register, 2011, p. 32817). Due to the significant cost of providing care for preventable conditions that are now not reimbursed through the CMS and many health insurance companies, hospitals around the country have implemented new policies to ensure patients remain free of venous blood clots during their hospital stay. The practice of injecting either Lovenox or heparin

This allowed staff to become an emotional and in some ways spiritual support for patient. Patient did not desire religious spiritual leader, because he is agnostic. Also, by providing staff that knew that patient’s non-verbal cues this helped increase communication between staff and patient.

Historians in the medical field such as Hippocrates and Pasture have referenced symptomologies associated with sepsis of today (Angus & Van der Poll, 2013). Sepsis received its official definition of severe sepsis and septic shock in 1992; with terminology being based on the accompanying disease processes present (Angus & Van der Poll, 2013). The definition of severe sepsis indicates the presence of organ dysfunction along with sepsis. Additionally, septic shock is related to the presence of hypotension not responding to fluid resuscitation (Cawcutt, & Peters, 2014). A diagnosis of severe sepsis or sepsis shock has an increased risk of patient mortality, length of stay, and a higher probability of long-term disability (Cawcutt & Peters, 2014; Whittaker, et al. 2015).

Mr. A is admitted to the critical care unit post bowel resection, splenectomy, acute respiratory distress syndrome (ARDS) and patient-ventilator dyssynchrony (PVD). He is an eighteen-year-old African American man who is placed on an IV infusion of Norcuron and Ativan. The major outcomes expected for Mr. A would be for him to be able to wean of the ventilator, be hemodynamically stable, heal adequately, tolerate his diet, have adequate bowel elimination, and be able to adjust to his life with optimal functioning.

Preventing and reducing the risk of healthcare-associated infection is one of the major concern in an in-patient setting. Patients

Mr. Ronald bates presented to the emergency department with shortness of breath (Respiratory rate- 24 breaths/min) and general discomfort (pain score- 4/10) and it was started in the morning and worsens when doing activities. The above presenting complaints lead to a possible cardiac event, so that this presentation would be triaged as category 2. Therefore, medical officer would be notified regrading patient presentation and put Mr. bates to semi fowler’s position in the Emergency bed if this position is comfortable for him. Further primary systemic assessment of the patient starts with an order with an assessment of

Electronic health records are essential in allowing physicians to monitor their patients’ health, notice trends, and potentially prevent hospital readmissions, quickly diagnose diseases, and reduce medical errors.

I sat on the shelf. People walked by, but none of them wanted me. It was almost the end of the season. If no one chose me, I 'd be put on clearance. Finally, someone picked me up. I billowed in the soft breeze she made as she briskly walked toward the checkout counter. I was stuffed into the bottom of a paper bag and dozens of articles of clothing were shoved on top of me. I could barely breathe. Finally, she took me out of the bag. She gently folded me and lay me on her shelf. She wore me loads of times that season. We went to parks, the grocery store, her work, and many more places. Then, one day she put me away and I didn 't come out at all that winter. I just got lower and lower in the stack of clothes. In the spring,

Next, by implementing the VAP bundle, it did help to prevent further decline. All aspects of the bundle should be continued; the Heparin, sequential compression devices, oral care, Pepcid, and all other bundle activities. Having the head of the bed up was essential to prevent VAP, but it did end up making her body move to the foot of the bed. Pillows were used to help keep her further up and off the side of the bed. The wedges might have been more efficient to place under the bottom of the patient, to help double as pressure relief and to keep her up in the bed. She was previously diagnosed with pneumonia, so it was not associated with ventilation and she was being treated for this with Vancomycin and Piperacillin-tazobactam,

The RN would first review the goals and outcomes of the patient care plan. The next step would be to collect Reassessment Data, " Assess the client response to the interventions."(pg. 128 Treas, Wilkinson) in which include vitals, auscultation of breath sounds, observation of activity, and asking the patient how they are feeling and family for observation. The RN would record the evaluation summary in the nursing note or care plan about the conclusion whether the outcome was achieved and the reassessment data supports the judgment. In order to revise a care plan, an RN must " review all the steps of the nursing process."(pg. 130 Treas, Wilkinson).

Northwell Health created a special Task Force focused on reduction of sepsis related deaths in the Emergency Department, as stated in the article “Reducing Sepsis Mortality.” The goal is to teach medical staff to recognize the signs and symptoms within an hour of patients arriving to the Emergency Department. This recognition then leads to a course of specific actions, such as, “ Early administration of antibiotics to septic patients, returning serum lactate test results to physicians, who could identify severe sepsis, starting empiric fluids quickly and appropriately,” as explained by Friedman, Gallo, Riebling and Doerfler. Northwell Health’s dedication and desire to improve the outcome of these patients lead to an understanding of the need

My concept of concern is safety of the intubated patients in intensive care units (ICU's). On all the three ICU's where I work, we are asked not to use restraints. My PICO question is stated below. The use of restraints is overused. The research data states that safety is compromised when restraints are used. Different measurement tools are being used to increase awareness of which patients are safety risk for themselves and to others. Management of the cause of the agitation, use of chemical restraints safely and evaluation of patients medication.

The anaesthetist removed the ETT and proceeded to place a tight fitted mask on patients face. (REF)She then alerted the team that there was a problem with the patient airway (REF). The mask did not mist up – indicating of no air movement return, there was no carbon dioxide trace on the capnography and the patient oxygen saturation dropped steadily from 100% to 90%. He instigated vigorous jaw thrust to improve oxygenation, and using continuous positive airway pressure(CPAP) to deliver 100% oxygen flow through the breathing bag attached to the anaesthetic machine but all this effort was not having any effect on the ventilation. He then asked my mentor the Operating Department Practitioner (ODP) to administer 50mg/5ml of intravenous Propofol. An open airway was established within minute which confirmed the anaesthetist suspected diagnosis that the patient had a severe laryngospasm and the anaesthetic effect relaxed the patient’s vocal cords.( REF algorithm of Laryngospasm)DAS