vented patients

Nurses General Nursing

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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.

it is a paradoxical phenomenon but even when vented pts appear disoriented and agitated, there is no recollection afterwards.

and not only is po care doable, it is mandatory-esp given the high risks of vap.

i would clearly share your concerns with your father's nurse.

best of everything.

leslie

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Specializes in Cardiac.

I am supposed to do a sedation vacation daily, but the timing is up to me and has nothing to do with the RT. We also have to have DVT/PUD prophalaxis, HOB >30, and oral care Q2hrs.

Sometimes, I just can't do a sedation vacation though. Some pts cannot tolerate it.

If the pt is on propofol, I will do the sed vacation when I change the tubing, seems like a perfect opportunity.

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I am sorry to hear about your father, and you are both in my prayers.

I just wanted to say that I was a patient who went into respiratory failure and was put on a ventilator in a coma for about a week. I was aware of much of what went on, could hear things, etc., but quite confused.

So PLEASE talk to your father and tell him what is going on. He hears you, and he is probably talking to you in his mind (I was, and couldn't understand later when they said they couldn't hear me.) If you explain some of the apparatus, it may help him relax. The more positive and loving the people are around him, the more he can relax and get better. Keep telling him you love him--he is telling you, too!

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Specializes in cardiac med-surg.

wishing your father a return to wellness

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Thanks guys for all your help. They are doing mouth care.. and they are backing down on the sedation acctually the nurse backed him down and before she could tell us what she did I had asked a question and she started to answer that and he started thrusting his head violently to get the tube out and I though I was gonna throw up lol and then she explained it. He calmed down when we told him to and he squeezed the nurses hand with his right hand and when she said with his left he didn't and when she asked if he could he shook his head no and then started real violent again and she turned the sedation up. I forget the name its milky white and they change the tubing really frequently. The vent is giving him 800cc and breathing 10 times a minute I don't know if thats really important but thats what they told us. the doctors said they think he is giving up but I don't know.. its not his nature to give up. Everything else is better its just he keeps retaining co2 his last blood gas prior to intubation and on cpap was a co2 level of 85.. I don't know... I guess its just a waiting game.. but I now know how families feel when they see their members laying so helpless like this.. I used to think itshelping them why are you so upset (I kinda understood but nothing like I do now) I don't know

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Specializes in Pediatrics (Burn ICU, CVICU).
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.

We also do not do sedation vacations for our vented pt's. We do however do vec holidays if they are on vecuronium. We do not use propofol for sedation either.

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Specializes in PICU, surgical post-op.
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

Do you work in the adult world or peds?

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I have a question for nurses who work with intubated patients. I realize that sedation is used, but I heard of having to "paralize" someone. What would typically be used and why?

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Specializes in ER, ICU, Infusion, peds, informatics.
i have a question for nurses who work with intubated patients. i realize that sedation is used, but i heard of having to "paralize" someone. what would typically be used and why?

this would mean to give a patient a chemical paralytic (such as norcuron, pavulon) to keep them from moving.

it is not a substitution for sedation, as the paralytic has absolutely no sedating properties. the patient is otherwise awake/alert, just unable to respond/move. of course, the patient is also mechanically ventilated since all muscles are paralyzed, including the respiratory ones.

it is commonly given with a sedative (diprivan, versed), and often a pain reliever (morphine).

there are a couple of good reasons to do this. sometimes, when a new trauma comes in but the patient cannot be controlled, they will be sedated/paralyzed/intubated, so they will be able to hold still for tests. it is imparative to find major traumatic injuries as quickly as possible, to treat and limit damage. if the patient won't hold still for xrays/ct scans, those tests can't be done. and sometimes, if a major spinal fracrue is found, the patient will be kept paralyzed until surgery is performed, to make sure the patient doesn't do more damage due to the inability to keep still.

i worked at one hospital where it was common to give a paralytic for bronchs, since the patients were always vented for them.

we would also sometimes paralyze patients with severe head injuries if we were having a hard time controlling icps. less frequently, we would every so often have to paralyze someone with severe chest/lung trauma in order to improve oxygenation.

took care of a patient once who had been in category #1. he had been in an mva, with +loc. came in through the er. wouldn't cooperate, so they give him norcuron to keep him still for xrays and ct. everything came out negative, but he came to icu because he was now ventilated. we got him extubated failry quickly. then he told us that he had been awake the whole time. they hadn't given him anything for sedation, just the paralytic. the whole time he was lying there, thinking he was permanatly paralyzed because he couldn't move. he said it had been terrifying. that happened several years ago, and it still sticks in my mind because it made such an impression. they always, always, always need something to sedate them when given a paralytic.

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critterlover

thanks for the info.

I appreciate it.

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Do you work in the adult world or peds?

adult

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Specializes in ICU, CM, Geriatrics, Management.

Elevation of the Head of the Bed

Daily "Sedation Vacations" and Assessment of Readiness to Extubate

Peptic Ulcer Disease Prophylaxis

Deep Venous Thrombosis Prophylaxis

T & P (small changes are OK) -- Lotion on back & all pressure points -- q 2 hrs

Mouth Care q 2 hrs

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