Page 70 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 55

4. Reposition to prevent contractures, pneumonia, etc.
5. Oral care and watching for skin breakdown around the airway to prevent
ventilator-associated pneumonia (VAP).
6. Keep a BVM at the bedside at all times to use to support the patient in the
event of electrical or MV malfunction.
7. Keep the stomach decompressed by inserting a nasogastric tube to pre-
vent aspiration.
8. Monitor the urinary intake and total output for signs of dehydration or
fluid overload.
9. Initiate nutritional support when ready with tube feedings or hyperali-
mentation to prevent negative nitrogen balance and malnutrition.
10. Get the patient out of bed as soon as possible to prevent hazards of
immobility.
11. Administer antiulcer medications to prevent stress ulcers.
12. Explain all procedures to the patient and family to prevent undue stress.
13. Develop a method of communication so the patient has a voice in his or
her care.
14. Let the patient control what he or she can to provide a decreased sense of 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.
powerlessness.

Ongoing Assessments for Complications of MV

Aspiration Pneumonia
Aspiration pneumonia occurs when a patient inhales his or her secretions or
tube feedings. It occurs with such frequency that when a patient is intubated
and placed on a ventilator, a nasogastric tube is inserted to keep the stomach
decompressed. This is prophylactic for the prevention of vomiting and aspira-
tion. The gastric tube is then connected to suction. A chest x-ray confirming
ETT placement will also confirm the gastric tube location.
Aspiration pneumonia is also possible if the patient is receiving tube feedings
as nutritional supplementation during MV. There are many controversies in
preventing aspiration pneumonia. A chest x-ray is a must to confirm the place-
ment of a feeding tube, but a chest x-ray cannot be done once every shift to
confirm placement. All sources are in agreement that aspiration of tube feed-
ings should be done at frequent intervals throughout the day; every 4 hours is
usually the minimum and whenever needed. According to guidelines,aspiration
of tube feedings should be done at frequent intervals throughout the day:
usually every 4 hours and whenever needed. According to guidelines, aspiration