11 Mechanical Ventilation & Endotracheal Intubation Nursing Care Plans and Management PDF

Menu HOME » NURSING CARE PLANS » 11 MECHANICAL VENTILATION & ENDOTRACHEAL INTUBATION NURSING CARE PLANS AND MANAGEMENT 11 Mechanical Ventilation & Endotracheal Intubation Nursing Care Plans and Management UPDATED ON APRIL 30, 2024 BY PAUL MARTIN, BSN, R.N. Use this nursing care plan and manageme...

Menu HOME » NURSING CARE PLANS » 11 MECHANICAL VENTILATION & ENDOTRACHEAL INTUBATION NURSING CARE PLANS AND MANAGEMENT 11 Mechanical Ventilation & Endotracheal Intubation Nursing Care Plans and Management UPDATED ON APRIL 30, 2024 BY PAUL MARTIN, BSN, R.N. Use this nursing care plan and management guide to help care for patients who are mechanically ventilated or with endotracheal intubation. Learn about the nursing assessment, nursing interventions, goals and nursing diagnosis for mechanical ventilation and endotracheal intubation in this guide. Table of Contents What is a Mechanical Ventilator? Nursing Care Plans & Management Nursing Problem Priorities Nursing Assessment Nursing Diagnosis Nursing Goals Nursing Interventions and Actions 1. Managing Mechanical Ventilation 2. Promoting Patent Airway Clearance 3. Reducing Anxiety and Fear 4. Administering Medications and Pharmacological Support 5. Preventing Respiratory Injury Risk 6. Optimizing Cardiac Function 7. Facilitating Weaning Process 8. Promoting Communication & Alternative Communication Methods 9. Initiating Measures for Infection Control & Management 10. Promoting Optimal Nutrition Balance 11. Providing Patient Education & Health Teachings Recommended Resources See Also References What is a Mechanical Ventilator? A mechanical ventilator is a positive- or negative-pressure breathing device that can maintain ventilation and oxygen delivery for a prolonged period. It is a machine that assists the client in breathing. Usually, the client is intubated before he is connected to the ventilator. An endotracheal tube or a tracheostomy tube is connected by oxygen tubing to the ventilator. If a client has evidence of respiratory failure or a compromised airway, endotracheal intubation and mechanical ventilation are indicated. This clinical evidence may be corroborated by a continuous decrease in oxygenation (PaO2), an increase in arterial carbon dioxide levels (PaCO2), and persistent acidosis (decreased pH). Mechanical ventilators were traditionally classified according to the method by which they supported ventilation. The two general categories are negative-pressure and positive-pressure ventilators. Positive-pressure Ventilators Positive-pressure ventilators or PPVs inflate the lungs by exerting positive pressure on the airway, pushing air in, and forcing the alveoli to expand during inspiration. Endotracheal intubation or tracheostomy is usually necessary. Volume-cycled ventilators. These deliver a preset volume of air with each inspiration. Once this preset volume is delivered to the client, the ventilator cycles off, and exhalation occurs passively. The volume of air delivered by the ventilator is relatively constant. Pressure-cycled ventilators. When the pressure-cycled ventilator cycles on, it delivers a flow of air until it reaches a preset pressure, and then cycles off, and expiration occurs. High-frequency oscillatory support ventilators. These ventilators deliver very high respiratory rates (180 to 900 breaths/minute) that are accompanied by very low tidal volumes and high airway pressures. These small pulses of oxygen-enriched air move down the center of the airways, allowing alveolar air to exit the lungs along the margins of the airways. Noninvasive positive-pressure ventilation (NIPPV). NIPPV is a method of positive-pressure ventilation that can be given via facemasks that cover the nose and mouth, nasal masks, or other oral or nasal devices such as the nasal pillow. NIPPV eliminates the need for endotracheal intubation or tracheostomy and decreases the risk of nosocomial infections such as pneumonia. Pressure-controlled ventilation with pressure support, the most comfortable mode, eases the work of breathing and enhances gas exchange. Negative-pressure Ventilators Negative-pressure Ventilators or NPVs are applied to the thorax and abdomen to achieve lung inflation by distending the rib cage and abdomen. NPVs are not used as often as PPVs but many hospitals utilized this method for patients with acute respiratory failure until the Copenhagen polio epidemic in the 1950s. Iron-lung or Tank ventilators. These are large, sealed horizontal cylinders or “tanks” in which the patient lies, with their head protruding from a sealed opening at one end of the tank. The lowering and raising of air pressure in the cylinder cause the patient’s chest to rise and fall, stimulating inhalation and exhalation through the patient’s nose and mouth. Cuirass ventilator. A much smaller version of the iron lung, this ventilator is known as a chest shell, turtle shell, or tortoiseshell ventilator. This ventilator only encloses the patient’s  torso and is sealed around the patient’s neck and waist, and is depressurized and repressurized by an external pump or portable ventilator. Exovent ventilator. This ventilator is a modern device similar to the cuirass ventilator. This NPV was developed in 2020, in response to the COVID-19 pandemic. Jacket ventilator. Also known as a poncho or raincoat ventilator. This NPV is a lighter version of the iron lung or the cuirass ventilator, made from an airtight material lined inside with a plastic or metal grid, a suction pump, and a back plate that goes to the patient’s hips, and depressurized and repressurized by a portable ventilator. Ventilator mode refers to how breaths are delivered to the client. The most commonly used modes are controlled mechanical ventilation, continuous mandatory ventilation or assist-control (A/C), intermittent mandatory ventilation (IMV), synchronized intermittent mandatory ventilation (SIMV), pressure support ventilation, and airway pressure release ventilation. Nursing Care Plans & Management The major goals for patients with endotracheal intubation and/or tracheostomy receiving mechanical ventilation include improvement of gas exchange, maintenance of a patent airway, prevention of trauma, promoting optimal communication, minimizing anxiety, and absence of cardiac and pulmonary complications. Nursing Problem Priorities The following are the nursing priorities for patients receiving mechanical ventilation : 1. Ensuring a patent airway and proper placement of the endotracheal tube 2. Monitoring and managing the patient’s respiratory status, including assessing lung sounds, oxygen saturation levels, and end-tidal carbon dioxide (EtCO2) monitoring. 3. Monitoring and managing sedation levels and pain control for patient comfort and to promote synchrony with the ventilator. 4. Assessing for and managing any potential complications or emergencies, such as tube dislodgement, pneumothorax, or airway obstruction, and promptly initiating appropriate interventions. 5. Preventing complications associated with mechanical ventilation, such as ventilator-associated pneumonia and ventilator-induced lung injury 6. Collaborating with the healthcare team to optimize ventilator settings, weaning protocols, and extubation readiness assessments, while providing ongoing patient and family education and support. Health insurance Nursing Assessment Assess for the following subjective and objective data: Adventitious breath sounds Apnea Apprehension Arterial ph less than 7.35 Decreased tidal volume Decreased oxygen saturation (Sao2 50 to 60 mm Hg) Diminished lung sounds Dyspnea Forced vital capacity less than 10 mL/kg Increased Paco2 level (50 to 60 mm Hg or higher) Increased or decreased respiratory rate Inability to maintain airway (emesis, depressed gag, depressed cough). Restlessness Abnormal breath sounds Excessive secretions Increased peak airway pressure Ineffective cough Assess for factors related during mechanical ventilation: Acute respiratory failure Noncompliant lung tissue Respiratory muscle weakness or paralysis Altered O2/CO2 ratio Decreased energy and fatigue Endotracheal intubation Stasis of secretions Nursing Diagnosis Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with this condition based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be