Nursing Care Plan Ventilatory Assistance (Mechanical)

CARE SETTING

Patients on ventilators may be cared for in any setting; however, weaning is usually attempted/accomplished in the acute, subacute, or rehabilitation setting.

RELATED CONCERNS

1. Cardiac surgery: postoperative care
2. Chronic obstructive pulmonary disease (COPD) and asthma
3. Hemothorax/pneumothorax
4. Spinal cord injury (acute rehabilitative phase)
5. Total nutritional support: parenteral/enteral feeding
6. Psychosocial aspects of care
7. Patient Assessment Database
8. Gathered data depend on the underlying pathophysiology and/or reason for ventilatory support. Refer to the appropriate plan of care.
9. Discharge plan
10. DRG projected mean length of inpatient stay: 9.5 days (or more)
11. If ventilator-dependent, may require changes in physical layout of home, acquisition of
12. equipment/supplies, provision of a backup power source, instruction of SO/caregivers, provision for continuation of plan of care, assistance with transportation, and coordination of resources/support systems
13. Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

1. Pulmonary function studies: Determine the ability of the lungs to exchange oxygen and carbon dioxide, and include but are not limited to the following:
2. Vital capacity (VC): Is reduced in restrictive chest or lung conditions; normal or increased in COPD; normal to decreased in neuromuscular diseases (Guillain-Barré syndrome); and decreased in conditions limiting thoracic movement (kyphoscoliosis).
3. Forced vital capacity (FVC): Measured by spirometry, is reduced in restrictive conditions and in asthma, and is normal to reduced in COPD.
4. Tidal volume (VT): May be decreased in both restrictive and obstructive processes.
5. Negative inspiratory force (NIF): Can be substituted for vital capacity to help determine whether patient can initiate a breath.
6. Minute ventilation (VE): Measures volume of air inhaled and exhaled in 1 min of normal breathing. This reflects muscle endurance and is a major determinant of work of breathing.
7. Inspiratory pressure (Pimax): Measures respiratory muscle strength (less than -20 cm H2O is considered insufficient for weaning).
8. Forced expiratory volume (FEV): Usually decreased in COPD.
9. Flow-volume (F-V) loops: Abnormal loops are indicative of large and small airway obstructive disease and restrictive diseases, when far advanced.
10. ABGs: Assesses status of oxygenation, ventilation, and acid-base balance.
11. Chest x-ray: Monitors resolution/progression of underlying condition (e.g., adult respiratory distress syndrome [ARDS]) or complications (e.g., atelectasis, pneumonia).
12. Nutritional assessment: Done to identify nutritional and electrolyte imbalances that might interfere with successful weaning.

NURSING PRIORITIES

1. Promote adequate ventilation and oxygenation.
2. Prevent complications.
3. Provide emotional support for patient/SO.
4. Provide information about disease process/prognosis and treatment needs.

DISCHARGE GOALS

1. Respiratory function maximized/adequate to meet individual needs.
2. Complications prevented/minimized.
3. Effective means of communication established.
4. Disease process/prognosis and therapeutic regimen understood (including home ventilatory support if indicated).
5. Plan in place to meet needs after discharge.