Intensive Care Nursing - Equipments .pptx

For 4th semester students, for 3rd B.Sc. Nursing students.

1. CRITICAL CARE NURSING - III EQUIPMENTS Presented By: Mr. NANDISH.S Associate Professor Mandya Institute of Nursing Sciences

2. VENTILATOR : Mechanical ventilation is the process by which room air or oxygen enriched air is moved into and out of the lungs mechanically . A Mechanical Ventilator is a medical device designed to assist or replace the natural breathing process of a patient who is unable to breathe adequately on their own. They are machines act as bellows to move air in and out of your lungs. it provides respiratory support by delivering controlled amount of oxygen to the patient’s lungs.

3. TYPES OF VENTILATORS : There are Two major types. Negative pressure ventilator Positive pressure ventilator Negative Pressure Ventilator : They involve use of chambers that encase the chest or body and surround it with intermittent negative pressure / create vacuum. It causes air to flow into the lungs when the pressure inside chamber decreases. Expiration is passive.

4. Positive Pressure Ventilators : It is the primary method used in acutely ill patients. During inspiration, ventilator pushes air into the lungs under positive pressure. Types under positive pressure ventilators: Volume cycled ventilators – Deliver a set / predetermined Tidal volume with each breath / inspiration. Pressure cycled ventilators – Deliver breaths until a preset airway pressure is reached.

5. OTHER TYPES OF VENTILATORS : 3. High Frequency V entilators : Deliver very rapid breaths at a high frequency in the range of 100 to 300 breaths per minute. 4. Home Ventilators: Designed for use in the home setting. They are more compact & user friendly for the patients who require long term respiratory support.

6. SETTINGS OF VENTILATOR : PARAMETER DESCRIPTION Respiratory Rate (F) Number of breaths the ventilator delivers per minute. Tidal Volume ( Vt ) Volume of gas delivered to patient during each breath. Oxygen Concentration (FIO 2 ) Fraction of Inspired Oxygen delivered to patient. It is set between 21% to 100 %. I : E Ratio Duration of Inspiration to duration of Expiration. Usual setting is 1 : 2. Flow rate Speed with which the Vt is delivered. Normal setting is 40 to 100 L/Min. Sensitivity Trigger It determines the amount of effort that patient must generate to initiate ventilator breath(0.5 – 1.5cm of H 2 O)

7. MODES OF MECHANICAL VENTILATION : Controlled Mandatory Ventilation (CMV): Breaths are delivered at a set rate per minute and tidal volume which are independent of patient’s ventilatory effort. it is used when patient have no drive to breath. Anesthetized patient, Paralyzed patient. 2. Assist C ontrolled M echanical V entilation (ACV): Ventilator delivers pre set Tidal Volume at a pre set frequency and when the patient initiates spontaneous breath, full Vt is delivered. Patient can breathe faster than the preset , but not slower.

8. 3. Synchronized Intermittent Mandatory Ventilation (SIMV) Ventilator delivers pre set Vt at a pre set frequency in synchrony with patient’s spontaneous breathing. This mode is commonly used during weaning. Benefits include improved patient – ventilator synchrony, lower mean airway pressure and prevent muscle atrophy. 4. Pressure S upport Ventilation : Positive pressure is applied to the airway only during inspiration in conjunction with patient’s spontaneous respiration. As the patient initiates breathing, machine senses the spontaneous effort & supplies rapid flow of gas. Benefits include increased comfort, decreased WOB & Oxygen consumption.

9. 5. Pressure Controlled Inverse Ratio V entilation : This mode combines pressure with inverse ratio of Inspiration to Expiration. (I:E – 1:2) Prolonged positive pressure is applied with increased inspiratory time, which expands alveoli and prevents collapse.

10. Other Modes : Positive End Expiratory Pressure (PEEP) : In this mode, positive pressure is applied to the airway during exhalation. Here Exhalation remain passive, but pressure comes in pre set level, usually 3 to 20 cm of H2O. Benefits include increase Functional Residual Capacity (FRC) and improves Oxygenation. 2. Continuous Positive Airway Pressure (CPAP): It is commonly used to treat Obstructive sleep apnoea. It increases work of breathing because patient must forcibly exhale against pressure. It is administered through tight fitting mask or ET Tube.

11. COMPLICATIONS : Barotrauma (occurs due to high pressure). Volutrauma (occurs due to high tidal volume). Oxygen Toxicity (occurs due to prolong exposure to high levels of oxygen). Ventilator Associated Pneumonia Ventilator Induced Lung Injury (VILI) Acid Base Imbalance (Respiratory Acidosis / Alkalosis) Displacement of Tubes and Devices.

12. NURSING MANAGEMENT : Impaired Gas Exchange related to poor lung compliance as manifested by cyanosis. Monitor ABG, oxymetry & ventilator settings. Adjust FiO2 and ensure that patient receive humidified oxygen. Perform endotracheal suctioning as needed. Administer prescribed bronchodilators & nebulization as ordered. 2. Ineffective airway clearance related to accumulation of secretions in lungs as manifested by dyspnoea. Elevate the head end to 30 degrees to reduce risk of aspiration. Provide oral care as needed. Collaborate with respiratory therapist (coughing & deep breathing exercise).

13. 3. Imbalanced nutrition, less than body requirement related to endotracheal intubation as manifested by NG Tube feeding. Regularly monitor patient’s nutritional status (weight, BMI). Administer enteral feeding as ordered. Maintain intake output chart. Collaborate with dietitian for appropriate parenteral nutrition. 4. Anxiety related to mechanical ventilation as evidenced by family members asking more doubts regarding progress. Provide information on purpose & function of ventilator. Use calming communication. Encourage the patient to Express themselves by writing. Encourage family visits and support.

14. 5. Ineffective therapeutic regimen management regarding progress related to lack of knowledge as evidenced by seeking for more information. Identify the specific areas of knowledge deficit. Develop an invidualized education plan based on patient’s specific needs and learning preference. Utilize multimedia resources to enhance learning & engagement. Provide educational materials such as pamphlets, Brochure, Handouts that explain about treatment and progress.

15. DEFIBRILLATOR : It is a medical device that delivers an electric shock to the heart in order to restore its normal rhythm during life threatening cardiac conditions. It is a standard emergency equipment, which pass Direct Current (DC) electrical shock through the chest wall or directly to heart that is sufficient to depolarize the cells of the Myocardium. It is most effective when the myocardial cells are not anoxic. It allow the heart to re-establish regular rhythm.

16. Types of Defibrillator : Automated External Defibrillator (AED) They are portable, life saving devices designed for life saving. They are a type of computerized defibrillator that automatically analyze heart rhythm in people experiencing cardiac arrest, when appropriate it delivers electrical shock. Public access AED – it can be found in Airports, community centres, schools, shopping malls & other public locations. Professional Use AED - they are used by first responders such as Emergency Medical Technicians (EMT) & paramedics who got additional AED training.

17. 2.Manual External Defibrillator : They are typically used by trained medical professionals like hospital staffs. They allow the operator to manually control the timing & intensity of the electrical shock. It provide more flexibility in certain situations. 3. Implantable Cardioverter – Defibrillator : It is a type of defibrillator which is surgically implanted under the skin in chest area. It is a small battery powered device, it detects & stops irregular heart beats a nd delivers electric shock when needed.

18. OTHER TYPES : 4. Monophasic Defibrillator: It deliver a shock in a single direction. The electrical current flows in one direction. Typical energy level range from 360 to 400 joules. 5. Biphasic Defibrillator : It deliver a shock in two directions. The electrical current flows from one electrode to another & then reverses direction. They use lower energy from 120 to 200 joules.

19. INDICATIONS : Cardiac Arrest Ventricular Fibrillation Ventricular Tachycardia Atrial Fibrillation Pulseless Ventricular Tachycardia Asystole (Cardiac Standstill)

20. ROLE OF NURSE : Assessment & Recognition identify the signs of life threatening arrhythmia. Monitor vital signs, observe patient’s level of consciousness. Initiating Code Blue or Emergency Response Coordination with the health care team Application of Defibrillator pads Safe operation of the Defibrillator Clearing the Area Administration of Medications – Antiarrhythmic drugs Post defibrillation care Documentation

21. INFUSION PUMP : DEFINITION : It is a medical device used to deliver fluids like medications, nutrients or fluids for hydration into patient body in a controlled manner. They are devices that are used to deliver therapeutic fluids which can be either medication or nutrients at a predetermined rate.

22. INDICATIONS : When precise & controlled administration of fluids or medications is required. Intravenous therapy Chemotherapy Pain management therapy Antibiotic Administration Any nutritional support

23. PURPOSES : Accurate Delivery : Precise & controlled administration of fluids & medication. Patient safety : Minimize risk of medication error & fluid overload. Convenience :It allows for continuous infusion. Customization : They can be programmed to meet individual patient needs. Enhanced patient comfort : They provide steady & controlled flow of medications.

24. STEPS OF USE : Preparation Priming Programming Connection Start infusion Monitoring Discontinuation

25. ROLE OF NURSE : Preparation & Set up : Gather all necessary supplies including medications, IV Tubing, Infusion pump. make sure that pump is working. Programming & Monitoring : Program the infusion pump according to health care provider’s orders. Monitor the infusion closely. Regularly check the pump settings to ensure accurate delivery.

26. Patient Assessment & Education Monitor patient’s condition before, during & after infusion. Educate family members about purposes, uses and any side effects to watch out for. Troubleshooting & Intervention Recognize & R espond to any alarm or alert generated by pumps . In case of emergencies, initiate appropriate interventions. (stop infusion / notify higher authorities) Documentation & Communication : Maintain accurate & detailed documentation of the procedure. Communicate effectively with other members of health care team like physician, pharmacist, etc.

27. CARDIAC MONITOR : It is a device that shows the electrical activity and pressure waveform of cardiovascular system for the measurement and treatment. It is used to continuously monitor cardiac rhythm, heart rate, Blood pressure, Respiratory rate, SPO 2 and also temperature . This device is commonly used in Emergency Department and Intensive Care Unit to observe critically ill patients.

28. THANK YOU