A patient with a mechanical ventilator attached to an endotracheal tube needs sufficient oral care. This is because oral cavity is a primary source of contamination of the lungs in the intubated and compromised patient (Smeltzer and Bare, 2004).
The frequency of oral care for an intubated patient can vary from every two to four hours, or every twelve hours brushing plus oral moistening every two hours (Abidia, 2007).
The registered nurse is responsible for providing oral care and over-all hygiene for the intubated patient.
Discussion Ventilator-associated pneumonia or VAP is defined as pneumonia that occurs in a patient attached to a mechanical ventilator for more than 48 hours (Torpy, 2007).
There are risk factors on how a patient becomes susceptible to contracting this disease and these are as follows, if the patient is attached to a mechanical ventilator and has endotracheal intubation, if the patient is attached on a mechanical ventilator for a long duration of time already, advanced age, diminished level of consciousness, lung disease, immune system is suppressed and malnutrition (Torpy, 2007).
If any of these risk factors are present the patient may become infected with ventilator-associated pneumonia. When a patient is showing signs of increased temperature, increased white blood cell count, and new or changing lung infiltrate on chest x-ray he or she is most likely suffering from VAP already (Torpy, 2007).
The aim of this experimental study is to examine the effectiveness of adding toothbrushing to the usual oral care on the prevention of VAP in ICU patients. Objectives are: i. To explore the relationship between oral health status and the development of VAP in ICU patients. ii. To explore the relationship between oral care and the development of VAP in ICU patients. iii. To evaluate the effect of ...
Physicians would ask for a culture of the tracheal aspirate and this can assist in identifying which bacteria or fungus is responsible and a bronchoscopy is also required (Torpy, 2007).
The nurse can implement interventions to help the patient in preventing acquisition of the disease. Pruitt and Jacobs suggest elevating the head of the bed 30 to 45 degrees, giving the patient a daily sedation vacation, administering peptic ulcer disease prophylaxis, most especially sucralfate, instigating deep vein thrombosis prophylaxis and a consistent oral care (Pruitt and Jacobs, 2006).
Starting the patient on broad-spectrum antibiotics is also advised and the use of non-invasive positive pressure ventilation instead of intubation and mechanical ventilation can also help in preventing VAP.
According to Zoidis, the use of non-invasive positive pressure ventilation is said to offer flexibility of use, avoidance of complications such as pneumonia, preservation of the ability to speak and swallow, and improved patient comfort (Zoidis, 1998).
Patients who are attached to a mechanical ventilator receive their nutrition via enteral feedings since most of them are either unconscious or because of the presence of an endotracheal intubation.
Enteral feedings make patients that are attached to a ventilator susceptible to ventilator-associated pneumonia because the nasogastric tube bypasses the small amount of gastric contents through to the oropharynx and the food stuff can be easily aspirated into lower airways most especially in patients who have no more control of their swallow or gag reflex (Teramoto et al. , 2006).
The nurse’s role is vital to preventing the occurrence of VAP because as aforementioned, the nurse is the one to maintain oral care for the patient.
Also, the procedures mentioned above, i. e. positioning, administration of anti-ulcer meds, is to be carried out by the nurse. Conclusion VAP is a preventable disease because given the aforementioned, easily doable interventions that a nurse can implement for prevention, the disease can be avoided. However, VAP’s occurrence can be attributed to the lack meticulous care and keen observation that nurses forget to give to the patients because of the workload and limited time. Studies have been done and it showed that if strictly enforced, all the preventive interventions can ensure that the patient does not suffer from VAP.
The purpose of this assignment is to compare and contrast the current literature related to advanced nursing practice. And to relate this literature to my practice and the role of the palliative care nurse across clinical settings. In my current role as a pain nurse specialist, I am involved in the care and management of patients with intrathecal (IT) catheters mainly for patients with intractable ...