Page 76 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 61

Paralytics (Neuromuscular Blocking Agents)

Neuromuscular blocking agents (NMBAs) are frequently used in the critical care
areas to block the transmission of impulses at the myoneural junction (see Table
2–9). These agents all decrease voluntary muscular activity and chest wall move-
ment during breathing. Their most frequent use is when a patient is not breathing
synchronously with the MV. The desired effect is to keep neuromuscular blockade
in the 80% to 90% range to allow for fewer side effects of these medications.
NMBAs may be monitored by peripheral nerve stimulators (PNSs). The nurse
must be aware that although NMBAs block nerve transmission, the patient can still
hear, feel, and sense what is going on about him or her. Therefore, concomitant
administration of antianxiety medications as well as analgesics is imperative.

TABLE 2–9 Types of Neuromuscular Blocking and Musculoskeletal Relaxants
Vecuronium bromide Norcuron
Pancuronium bromide Pavulon
Cisatracurium besylate Nimbex
Succinylcholine chloride Anectine 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.

NURSING ALERT

Even though a patient cannot respond and may appear to be unconscious, the patient
can hear, feel, and sense what is going on around him or her. Therefore, the nurse MUST
administer either analgesics AND/OR antianxiety medications on a round-the-clock basis
when the patient is on an NMBA and Diprivan. All health care members must also be
aware that the patient can hear and feel everything that goes on around the bedside.

Respiratory Conditions Requiring Critical Care

Acute Respiratory Failure (ARF)
What Went Wrong?
ARF is a state where the body fails to maintain adequate gas exchange. There
are two types: Type I and Type II. In Type I ARF, the patient has a low oxygen
level (hypoxia) and a normal carbon dioxide level. In Type II, there is hypoxia
again, but the carbon dioxide level is high (hypercarbia). Hypoxia results in less
oxygenated blood traveling to the left side of the heart (shunting). This condition