Page 64 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 49

TABLE 2–6 High Priority Patients for MV (Continued)
Problem Defining the Problem Medical Diagnoses
Failure to ventilate Air can not get down the Asthma
(upper airway) tubes to the lungs due
to poor neuromuscular Bronchospasm after extuba-
effort or swelling of the tion
airways Musculoskeletal diseases
Spinal cord injury
Edema of the upper airways
such as in traumatic airways
injury
Failure to protect the Inability to cough effec- Drug overdose
airway (aspiration tively and clear secre- Aspiration pneumonia
and airway clear- tions
ance) Mucous plugging
Neuromuscular blockade
General surgery Inability to perform sur- Open-heart surgery
gery without control of Lung surgeries
organs or paralysis of
organ Abdominal surgery
Head and neck surgery Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
∗ indicates the largest group requiring MV.

By far the largest group of patients who frequently require MV are those
with pneumonia* from chronic obstructive pulmonary disease (COPD).
Patients with COPD have long-standing decreased lung capacities that cause
them to retain pCO . When they develop pneumonia on top of their disease,
2
their lungs cannot keep up with the work of breathing. Decreased oxygen
entering the alveolus and increase carbon dioxide retention, leading to severe
oxygen deficits. The end result is cerebral hypoxia, which can lead to infarction,
permanent brain damage, and death within 4 to 6 minutes.

NURSING ALERT
Always monitor the SaO in high-risk patients, especially if they are symptomatic. A
2
turn for the worse is signified by a decreasing SaO while increasing the oxygen deliv-

2
ery, and a steady trend in elevation of other vital signs (VS) (heart rate [HR], respira-
tions, and BP). NURSING ACTION: The nurse must act swiftly in this instance. Obtain
ABGs and prepare for administration of oxygen from a (bag-valve-mask) BVM and
equipment for emergency intubation.