Page 74 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 59

Inadequate Nutrition
Patients receiving MV cannot eat because of the ETT or tracheostomy. Due to
increased caloric needs to support their work of breathing, they need to have
supplemental nutrition. In the short term this is usually done by feedings intro-
duced through a nasogastric tube or small-bore feeding tube. Every effort must
be made to insure safe feedings by limiting the volume initially and slowly increas-
ing the volume and rate as well as checking for residual feedings to prevent
gastric overfilling. If the patient is severely malnourished, hyperalimentation via
intravenous lines may be started.

Nursing Interventions for the Weaning Patient
Once the patient can start breathing on his or her own and the reason for MV
has been resolved, the health care team may decide to wean the patient. Wean-
ing is not always done as in the case of a patient recovering from surgery. If the
patient is breathing spontaneously, awake, and able to follow commands and
vital signs are normal, the patient is extubated without a weaning period. Wean-
ing is an organized trial that follows a pattern where the patient is allowed to
breathe spontaneously for longer and longer periods of time until the patient is
able to breathe on his or her own and is taken off MV. 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.
To safely wean a patient, baseline vital signs and hemodynamics should be
recorded, if available. Baseline PFTs like a vital capacity and tidal volumes need
to be taken. Then the patient is either placed on synchronized intermittent man-
datory ventilation (SIMV) with pressure support, CPAP, or a trial on a T piece.
Weaning done using the first two methods is safer as the patient is still attached
to the ventilator and alarms can warn the nurse of impending respiratory failure.
Weaning the patient on a T piece involves disconnecting the patient from the
ventilator and attaching the patient to an oxygen delivery system via a short
T-shaped connector. Either way, the patient is monitored continuously and if
respiratory fatigue occurs, the patient is placed back on MV. Every effort to
physically and psychologically support the patient during this time is critical.

Commonly Used Respiratory Medications in

Critical Care for the Patient on MV

6 There are many medications that can be used in the care of the patient on
MV. The following will detail those most frequently used for control and com-
fort of the patient. These medications include morphine, fentanyl, Diprivan,
benzodiazepines, and paralytics.