Awake Extubation Case Study

This situation is comparable to a patient, unconsciously lying in bed for operation. The patient has a tendency to have difficulty in breathing. Surgeons normally use endotracheal tube with subglottic suction to secure patients ability to breath. It serves as an open passage through the upper airway. In that sense, if the patient loses its capacity to breath, the tube

First of all, we have to be confident the reason for initial intubation needs to be resolved. For example if a patient was intubated for pneumonia or severe asthma, that pathology is reversed first and lungs appears clear. If the patient was intubated for shock the patient should be free of mental status changes and be from vasopressors to support boood pressure. Secondly, Patient should be able to maintain normocapnia or adequate ventilation without positive pressure ventilation.

Justin is the registered nurse that has been given the handover for Kelly Malone’s postoperative care in the surgical unit. Kelly Malone is a 49 female patient who has had a septoplasty and a right ethmoidectomy. Justin is working with Kelly to identify Kelly’s needs in order for Kelly to be discharged from the hospital. Kelly’s postoperative observations were a temperature of 36.2 degrees celsius; heart rate of 68 beats per minute; respiratory rate of 18 breaths per minute, blood pressure of 111 systolic over 73 diastolic millimetres of mercury; oxygen saturation at 93 percent of room air and a self-rated pain score of two out of ten. Kelly has a history of ‘not being able to breathe well through her nose’ and a history of disturbed sleep.

Background Information: Patient R.S. is a 78-year-old male with a background in accounting; his career prior to retirement 13 years ago as an accountant. R.S. was diagnosed with COPD, community acquired pneumonia, impaired gas exchange, TURP and shortness of breath. R.S. appeared to be worn out and exhausted, he was wearing the hospital gown, had a Foley catheter in, two PICC lines bilaterally in the antecubital area, air compression legs wraps bilaterally, and heart monitor and was also wearing oxygen. He was very friendly and cooperative with having to have his vitals taken, medication given, and bed bath done. R.S. spoke in a low, happy voice.

• During conscious sedation policies were not followed properly. It is required to have vital signs, continuous pulse ox. and ECG monitoring. This needs to be done pre and post procedure. • Post sedation procedures were not followed accurately.

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. The problems that are to be manage include, being on the ventilator, being sedated, having an elevated temperature, having a low hemoglobin, post surgical bowel resection, splenectomy, hypoxia and diet intolerance.

Followed by the application of 12 lead electro cardiogram (ECG). It is important to determine whether it is cardiogenic or non-cardiogenic by doing primary and secondary survey. Glycerol trinitrate (vasodilator) to draw the fluid out of the lungs, aspirin (antiplatelet) to prevent or reduce platelet aggregation and flusemide (loop diuretic) that promotes the secretion of sodium and water are administered when a patient has cardiogenic pulmonary oedema. Whether the patient has cardiogenic or non-cardiogenic pulmonary oedema the following procedures will apply, IPPV (Intermittent Positive Pressure Ventilation), PEEP (Positive end –expiratory pressure) and CPAP (Continuous positive airway pressure. Transport immediately to the nearest hospital and reassess every five minutes (Mursell,

So now that he was unable to get IV access, he had to obtain an intraosseous infusion (IO). Upon insertion of the IO, you could hear the drill perforate through the tibia. Through the access, Narcan was administered. The advance support provider then took over to establish an advanced airway. He was asking for certain equipment and I can remember feeling my adrenaline pump through my veins, it was really a mix of

The secondary evaluation was an analysis according to the route of intravenous verses topical administration. If the data in regards to laryngeal spasm had a classification of severity, they only included data was only that of severe laryngospasm. Each of the random controlled trials evaluated were assessed for risk of bias as described by the Cochrane Handbook for Systematic Reviews of Interventions.

Include one intervention to address each of the nursing diagnoses that are still applicable. In 24 hours the patient goal was not met regarding Impaired Gas Exchange. The patient oxygen saturation was at 94 percent

While auscultating sounds of lung fields no wheezing was found, and VS were within normal range for patient as determined through comparison of chartings on 10/23/2015 thru the morning and lunch VS of 10/26/ 2015 before impaired gas exchange was detected. 10/26/2015 2. Administer O2 @ 2L N/C

Increasing doses of propofol, up to 420mg, were administered

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,

" You have one shot to get him intubated!" , the emergency room doctor said. “This are why this job is stressful, you have people lives in your hands. One mistake and it can be a deadly

Sedation Management Over-sedation in mechanically ventilated patients is common issues in a critical care setting. According to findings by Wøien, Vaerøy, Aamodt, and Bjørk (2012), as much as "30-60% of intensive care patients receive periods of prolonged sedation" (p. 1552). Also, deep sedation was associated with an "increase in mortality, prolonged mechanical ventilation, and increased intensive care unit length of stay" (DAS-Taskforce, 2015). Current literature generates a level of personal interest and clinical significance to nursing practice.