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by LisaRn21

Hey guys I need your help. My dad was placed on a vent yesterday and his last words prior to being intubated was help... I want to help him so bad but I just don't know how. i've never worked with vented patients before so I"m not sure how much they know is going on. The doctors promised me they would keep him sedated but they also put his in soft wrist restraints so how sedated can he be? I can't do mouth care obviously....and he's 300 lbs so I can't reposition him tooo much myself.. any suggestions on hwat I can do to make him more comfortable would be greatly appreciated.

[avery]

Re: vented patients

Hi!
I understand your concerns. I take care of vented patients everyday. If the patient is properly sedated and has something for pain, the patient usually does not even remember the time they were intubated. I say this with certainty because when my vented patients are extubated and they are off they vent, I ask them. Most remember nothing at all.
The purpose of the restraints is this: Even though the patient is sedated, they are not paralyzed and thus can still move. It is to inadvertantly prevent self- extubation before the patient is ready.
Mouth care is important, we do it q2hrs. Turning may not be possible depending on the stability of the patient.
Hope this helps some,
Avery

[LisaRn21]

Re: vented patients

how do you do mouth care? I was doing it when he was on the cpap cause his mouth was exposed but now the tube and the ties and all that are in the way... do you just go around it?

[avery]

Re: vented patients

Yes, we have the green little sponge things. It is still possible to do mouth care. We have this chlorohexadine rinse we do once per shift to prevent vent acquired pneumonia and then every two hours use the stuff that comes in the kit with the green sponges. Are the nurses not doing mouth care? What state are you in?
Avery

[LisaRn21]

Re: vented patients

no they are well they were doing it when he had the cpap on..but they placed the tube last night and shortley after we left... so I am not sure if they are or aren't I would imagine they are.. I'm in pa

[traumaRUs]

Re: vented patients

Some of these questions could best be answered by your Father's nurses at the bedside who know the ins and outs of his care. Please know you and your father are in our thoughts.

[GardenDove]

Re: vented patients

They will probably do a sedation vacation each AM, you might want to be there when they do that. The nurse will turn off the propofol prior to RT assessing the pt for weaning potential when they are unsedated. We do it early where I work when RT arrives. This would be your opportunity to interact with him.

[Bluehair]

Re: vented patients

We do the sedation vacation too - but be aware, he may not have a clue what the heck is going on when he does arouse. Don't expect too much from him. It is a chance for him to know you are all there and that things are okay. He may be interactive, more likely for him it will be like waking up in a very strange hotel instead of his own bed, and he will be trying to piece it all together. First thing is trying to take that hose out of his mouth that doesn't belong there, hence the restraints. Many patients do re-orient to their environment much more quickly when family is there to help them realize what is going on and it is all okay.
It is much harder mentally/emotionally to have a family member/loved one so sick. I take care of these patients every day with no problem, but when it was my dad I nearly fainted in the room first time in to see him. My thoughts and prayers will be with you!

[AliRae]

Re: vented patients

Originally Posted by GardenDove

They will probably do a sedation vacation each AM

I've never heard of this as a routine thing. Is this unique to the adult world? I work PICU, and the only time we cut our sedation is if we really think we're going to go for it.

[GardenDove]

Re: vented patients

Originally Posted by AliRae

I've never heard of this as a routine thing. Is this unique to the adult world? I work PICU, and the only time we cut our sedation is if we really think we're going to go for it.

It's part of our ventilator bundle protocol

• Elevation of the Head of the Bed
• Daily "Sedation Vacations" and Assessment of Readiness to Extubate
• Peptic Ulcer Disease Prophylaxis
• Deep Venous Thrombosis Prophylaxis

Institute for Healthcare Improvement: Implement the Ventilator Bundle