Monitor patient's vital signs every hour when changing ventilator settings. Fever, tachycardia, tachypnea, and elevated blood pressure may indicate hypoxemia.- Auscultate for breath sounds every 2 hours and report deviations. Adventitious sounds may precede respiratory failure.
Place patient in a comfortable position (preferably Fowler's) to facilitate adequate chest expansion and drainage.
Describe all weaning procedures to patient. Explain that he may experience changes in breathing rate and pattern, increased difficulty breathing, and fatigue to decrease anxiety.- If patient is receiving intermittent mandatory ventilation (IMV), begin to decrease IMV by increments of 2 breaths/minute. This process may take place over days or weeks. Lowering IMV encourages patient to take own breaths, thereby exercising respiratory muscles.
- Monitor ABG levels with every ventilator change to assess for adequate oxygenation and acid-base balance.
- Include periods of rest between ventilator changes, especially at night, to reduce tissue oxygen demand.
- If patient tolerates IMV of 2 to 4 breaths/minute, try pressure support ventilation (PSV). PSV prolongs positive airway pressure during inspiration, allowing patient to regulate own respiratory rate and tidal volume.
- When patient is breathing adequately without IMV, place the patient on continuous positive airway pressure (CPAP) of 5 cm H2O to prevent alveolar collapse.
- When patient tolerates CPAP, place on T-piece (T-bar) of 30% to 50% fraction of inspired oxygen. This allows patient to breathe independently, continue to receive oxygen, and remain intubated in the event of respiratory compromise.
- When patient tolerates longer weaning periods, incorporate activities of daily living into patient's daily routine to increase muscular strength and endurance.
- When patient has satisfactory respiratory status, weaning parameters, and ABG levels, assist with the removal of the ventilator tubes and keep the oxygen mask on hand to prevent respiratory compromise.
- Assess patient for stridor, respiratory distress, and dysphonia and report these findings to the physician to monitor the need for renewed ventilatory assistance.
- Perform chest physiotherapy and suctioning, as needed, to maintain a patent airway.
- Monitor the respiratory effects of medications closely and evaluate the response to bronchodilators to detect respiratory status compromise. Avoid respiratory depressants.
Suggested NIC Interventions
Acid-Base Management; Airway Management; Anxiety Reduction; Aspiration Precautions; Mechanical Ventilatory Weaning; Respiratory Monitoring; Support System Enhancement; Teaching: Procedure/Treatment; Vital Signs Monitoring |