Informatics and the Ventilated Patient

ICU nursing frequently involves caring for the patient who is artificially ventilated.  This could be for numerous reasons: i.e. failure to wear off ventilator following surgery, respiratory failure, PE, pneumonia, etc.  Without advances in informatics, care of this difficult patient would be made even more difficult.  Assist controlled ventilation is the most often used.  In this mode, tidal volume and rate are pre-set.  In other words the ventilator is taking over the work of breathing, filling the lungs with air and enabling gas exchange to occur so the patient remains well-oxygenated.  If the patient does indicate respiratory effort, the ventilator is programmed to respond though it still delivers the preset tidal volume.  Nurses must be attentive to the patient’s respiratory rate and the ventilator’s assistance in order to avoid hyperventilation and subsequent respiratory alkalosis.  Generally, the nurse checks and records ventilator settings and respiratory effort frequently throughout the shift.  The patient will be monitored with vital signs, cardiac rate and rhythm, respiratory rate and pulse oximetry, via electronic monitors which transmit information directly to nurses in preset intervals (often as frequently as 2-5 minutes) and alarm when abnormals occur.  Without this form of monitoring, care of this patient would be much more difficult.  If the ventilator is alarming, the nurse attends to the patient first, then, if all is well, attends to the alarms which may indicate water in the tubing or a loose connection.  The patient should be assessed for skin color (nail beds and lips particularly), lung sounds, bilateral chest expansion, need for suctioning and respiratory effort.  The physician may order labs, arterial blood gases, chest x-ray or alteration of settings.  Again, thanks to computerized information retrieval continuity of care on a multi-disciplinary level is more accessible than in the past.  In most ICUs, physicians, nurses and respiratory therapists have access to electronic bedside charting to allow for continuous monitoring.  This form of charting makes the work of documentation and information retrieval safer for the patient.  Simply put, breathing supplies the human anatomy with life-giving oxygen a necessity for every cell in the human body; thus the “A” in ABCs.  Nurses always must attend to airway first, for without a patent airway, no other intervention could help the patient achieve homeostasis.

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