Week 3 chapter 20 Chapter on Mechanical Ventilation & Pneumothorax

Definition: Mechanical ventilation is a life-support technique used when a patient cannot effectively perform gas exchange via their lungs due to alveolar collapse or impaired airway function.
Indications for Mechanical Ventilation:
- Respiratory failure: Insufficient oxygen exchange or carbon dioxide removal.
- Compromised airway: Issues affecting the trachea or windpipe that impede airflow.
- Medical procedures: Patients under anesthesia require mechanical ventilation to support breathing.

Positive Pressure Ventilation:
- Commonly used methods include CPAP (Continuous Positive Airway Pressure) and BiPAP (Bilevel Positive Airway Pressure).
- CPAP: Maintains consistent airway pressure (e.g., CPAP setting of 5 cm H2O provides 5 cm H2O pressure during both inhalation and exhalation).
- BiPAP: Provides different pressures for inhalation and exhalation (e.g., settings of 7 cm H2O for inhalation and 4 cm H2O for exhalation).
Negative Pressure Ventilation:
- Less common; used in specific ICU settings for certain patients.
- Noninvasive ventilation through devices that do not require intubation.

Equipment Use:
- Masks can be either nasal prongs or full face masks to create a seal for positive pressure delivery.
- Ensuring a good seal is crucial; leaks can significantly reduce effectiveness, leading to alarms on the ventilator.
- Nursing function involves troubleshooting leaks and collaborating with respiratory therapy when issues arise.
Nursing Adjustments:
- Nurses may adjust CPAP or BiPAP settings with a physician's order, based on patient needs.
Contraindications for Noninvasive Ventilation:
- Respiratory arrest: Patients unable to breathe independently need invasive ventilation.
- Serious dysrhythmias: If heart function is severely compromised, noninvasive measures may not be adequate.
- Cognitive impairments: Patients prone to remove masks or disrupt ventilation require sedation or intubation instead.
- Head and facial trauma: Difficult to achieve a secure mask fit.

Systematic Assessment:
- Ongoing respiratory assessments: Check lung sounds, respiratory rates, and oxygen saturation (SpO2).
- Draw arterial blood gases if in ICU to assess gas exchange.
- Monitor neurological status; changes can indicate gas exchange impairment.
- Assess equipment: Regular checks on ventilator settings and performance are vital.
- Handle alarm fatigue: Maintain response to alarms; continuous monitoring is critical to prevent patient decompensation.
Enhancing Gas Exchange:
- Providing analgesics to manage pain without suppressing respiratory drive.
- Frequent repositioning to allow for better pulmonary function and prevent bedsores.
- Establish and monitor fluid balance, noting that immobility may lead to peripheral edema.
- Monitor intake and output (I&O) to ensure hydration and nutrition via tube feeding or IV fluids, especially if not eating orally.

Assessment:
- Lung sounds should be checked every 2-4 hours while on mechanical ventilation.
- Use suctioning only when necessary and not contraindicated (e.g., hydrocephalus).
Chest Physiotherapy (CPT): Includes techniques like percussion and positioning to help clear the airway.
Humidity: Ensure ventilators provide humidified air to prevent drying of mucous membranes and avoid mucus plugs, which can be a medical emergency.
Bronchodilators: Administer to aid lung expansion and help loosen phlegm.

Maintain sterile technique for intubated patients and proper oral care for noninvasive ventilation.
Ensure cuffed tubes are inflated correctly to prevent aspiration; regular checks necessary.
Avoid flat positioning in bed to prevent hospital-acquired pneumonia (HAP).

Encourage range of motion exercises and facilitate communication methods.
Provide stress-reducing techniques for comfort.
Support family involvement in the care process.
Consider nutritional assessments as the patient might rely on artificial feeds for recovery.
Prepare for potential discharge discussions, particularly regarding at-home care for patients needing CPAP/BiPAP or ventilators.

Definition: A pneumothorax refers to air in the pleural space that can lead to lung collapse.
- Types of pneumothorax:
- Traumatic Pneumothorax: Air from an external puncture leads to lung collapse.
- Simple/Spontaneous Pneumothorax: No obvious injury causes lung to collapse; often seen in young males.
- Tension Pneumothorax: Air trapped in pleural space creates pressure that displaces thoracic structures, requiring immediate intervention.

Normal appearance of healthy lungs is pink and inflated; damage results in collapse.
Tracheal Deviation: Determines the side of collapse; deviates away from the injured lung.

Purpose: Reinflate lung, remove fluid, or manage both.
Types: Either wet suction or dry suction systems.
- Wet Suction: Utilizes water to create negative pressure.
- Dry Suction: Uses a dial to set the suction without water.
Monitoring: Observe the water levels in the chest tube system to ensure appropriate functioning; any collection of fluid is visible but not air.

As part of patient care in mechanical ventilation and related interventions, it's crucial to understand the responsibilities of nursing in managing equipment, monitoring safety, and ensuring effective communication with the healthcare team and family members.