Care of an Intubated Patient
Pressure Area Care; Pressure areas develop on bony sections of the body due to; pressure, shear, or friction. Decreased mobility leaves Paul at risk of these injuries.
Injury caused by tubing resting on face, ears ect.
Placing cotton pads under tubing
Moving tubing frequently
Regular skin inspection
Support equipment eg. Roho cushions, pressure mattresses & heel elevation
Maintain pt. movement and 2hrly repositioning
Incontenence and Mositure
Nutrition
Documentation and recording of description of all pressure injuries
NG feed tube insitu
Fluid balance for input/output monitoring
IV fluid
Body inspection for signs of malnutrition and dehydration
Physiotherapy; Intubation seriously impacts cough reflex, and mucociliary escalator function, leading to increased secretions in the lower airways. This exposes pt.'s too complications such as; ventilator associated tracheobronchitis, & ventilator associated pneumonia. Increasing chance of mortality.
The key tasks of ICU therapists is to reduce or remove airway secretions, optimise lung compliance, & decrease WOB.
This is done by:
Diversify breathing methods
Manual techniques
Mechanical devices
Body positioning
Chest wall vibrations
Suction
Rib Springing
Whanau
Inform of pre-plan
Educate around intubation
Ensure pt. care is gentle and empathetic
Act in a confident and calm manner
Avoid false hope
Answer all questions
Avoid negativity
Build therapeutic relations
Psychological
Provide Reassurance
Educate surrounding procedure
Encourage whanau support
Manage comfort and pain
Infection Control
Effective infection control measures, education and training, alcohol-based hand-rubbing as the main measure of hygiene, and isolation to reduce cross-infection with MDR pathogens should be used routinely.
Monitoring of high-risk patients to determine trends and detect outbreaks.
Keeping the teeth and mouth clean, preventing the build-up of dental plaque on teeth or secretions in the mouth may help to reduce the risk of developing VAP.
Unnecessary intubation and repeated intubation should be avoided. Non-invasive positive pressure ventilation should be used whenever possible.
The main cause of VAP is due to the aspiration of secretions containing bacterial pathogens into the lower respiratory tract. Aspiration of subglottic secretions requires the use of specially designed endotracheal tubes containing a separate dorsal lumen that opens into the subglottic region. The use of endotracheal tubes with subglottic secretion drainage has shown to be effective for the prevention of VAP
Contaminated condensate should be carefully emptied from ventilator circuits and condensate should be prevented from entering either the endotracheal tube or inline medication nebulizers.