Page 65 - Critical Care Nursing Demystified

50 CRITICAL CARE NURSING DeMYSTIFIED

A smaller percentage of patients require MV because they cannot get air into
their lungs. These patients fail to ventilate their alveoli due to either swelling
of the airways (status asthmaticus, bronchospasm) or musculoskeletal weaken-
ing diseases (multiple sclerosis, Guillain-Barré syndrome). Occasionally, dam-
age done to the central nervous system creates conditions where the brain fails
to tell the lungs to work (stroke), or paralysis of the diaphragm (cervical level
4–5 spinal cord injuries) occurs.

NURSING ALERT

A patient with a head injury or spinal cord injury should be monitored carefully for
respiratory depression. NURSING ACTION: Resuscitation equipment must be handy
for emergent care of patients with these diagnoses.

Another reason why MV may be performed is to protect the airway. In a
patient who is unable to cough, many interventions are performed to help aid
the mobilization of secretions. When normal nursing interventions fail, the
patient may need intubation and MV to prevent secretions solidifying into
mucus plugs. Mucus plugs act like a cork plugging a bottle. If they are large 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.
enough and lodge in the main stem bronchus, they can prevent airflow to an
entire lung, leading to pneumothorax. Also, atelectasis or collapse of alveoli can
occur from underinflated alveoli and thick secretions.
Patients who have aspirated or have an increased potential to do so from
drug or alcoholic intoxication may need MV until they can protect their own
airways. Aspiration of stomach contents can irritate delicate lung tissue and can
cause chemically induced pneumonia.
When the muscles of respiration require paralysis to administer general anes-
thesia and surgical intervention, a temporary ETT and MV are used. Open-
heart surgery, abdominal surgery, and open lung biopsies are done under general
anesthesia. These surgeries require the target organs to be immobilized. Once
the surgery is completed and the patient has recovered successfully, the tube is
withdrawn and MV is stopped.

Ventilator Settings

Ventilator settings are ordered by the health care provider. Generally, a respira-
tory therapist (RT) sets up the ventilator and changes the settings. Settings are
regulated according to the patient’s assessment, expected outcome, and changes
in ABGs. Table 2–7 contains settings and modes that can be used in the treat-
ment of the patient. Get ready for lots of initials and terminology.