communicating w/ pts on ventilators

BellaInBlueScrubsRN · Aug 1, 2010

Writing if able. I'm horrible at reading lips and feel just as frustrated as they are. I feel so bad! I try to get them to mouth one word at a time, or the most important one. Prompt them by asking yes or no questions. Pointing. Make them really enunciate by using their lips. Alphabet board.

One of the best resources is family if someone is at the bedside. They might be better at figuring it out. And they have more time to be patient and figure it out.

tri-rn · Aug 1, 2010

Like the above poster said, writing. Pointing. Having the same patient a couple of days in a row helps...once you get to know each other you can devise signals for stuff. Much as I hate to say it, there have been plenty of times I've had to tell a patient "I'm sorry, I won't be able to understand you know matter how much we both try". At least then they don't keep frustrating themselves trying to communicate some complicated information that I won't ever get (one time, I vented patient was tryign to tell me his rent was due! I found out what he was saying after we extubated him). Luckily, the ones who are trying to communicate like that are often off thier sedation because we ARE about to extubate :)

sunnycalifRN · Aug 1, 2010

Yes, very difficult to communicate with awake patients on a vent. If stable, but vent dependent, you could talk to speech or RT about using an in-line Passy-Muir valve (depending on which departments is in charge of the Passy-Muir valves). The voice, even if intermittent, is the best mode of communication.

BellaInBlueScrubsRN · Aug 1, 2010

And if they are on the vent and they have any type of sedation still on or receiving narcs, it doesnt always mean they know what they are saying. I spent forever trying to figure out what this guy wanted (he had fent on). His wife finally had him point. He thought the window was broken. It was the blinds he saw.... :rolleyes:

aCRNAhopeful · Aug 1, 2010

I tell them not to try to mouth things since lip reading is nearly impossible when you have a plastic tube stuck between your teeth. Ask them if they are in pain, uncomfortable, need suctioned, need swabbed, want their family, want turned, want head up/head down, need to have a bm, etc etc. If they can write, which they almost always cant in my unit d/t swollen hands, then do so. Otherwise keep them sedated and comfortable and hopefully you can keep the anxiety to a minimum.

detroitdano · Aug 1, 2010

Lips, if they're good at it. Some people suck at enunciating and it's seriously impossible. Even the people good at reading lips on my unit can't understand people that suck at enunciating.

Alphabet board is your best bet, as long as they're suffering not from severe OA or asterixis.

The question game gets just as old as the lip reading. If they have some frequent complaints like repositioning, pain, wanting American Idol put on, brush dipped in ice chips, etc., those are okay questions to continually ask them. Just randomly guessing stuff is more work than it's worth.

TigerGalLE, BSN, RN · Aug 1, 2010

It really is humorous at times... One day I tried to figure out what my patient was saying all day. We finally were able to extubate him and I asked him... "so what did you want to tell me all day." He stated "Where is my underwear?" That was what was so important.... hahaha poor guy.

mskate · Aug 1, 2010

When I have an awake ICU patient that is vented I do a lot of education with them and a lot of talking to them to try to minimize their talking! HAHA :)

I will start off by fully reorienting - day, month, year, place, unit, floor, room #, my name and my role, the plan for the day. Then I go in depth and do my full assessment explaining everything - what i'm about to do, what i'm looking for, what I find, where their tubes are, what the purposes are and what the patient's vitals are. I make them follow basic commands, nods yes/no and update them on their family so they are not worrying about that as well as any tests, blood work, etc.. and the results of everything.

When they are trying to talk, I explain that/...

#1 - I am not a great lip reader and absolutely cannot read lips with a tube in your mouth, nor am I multi-lingual and if you keep trying to mouth words in another language - we are gonna keep hitting the same wall! :)

#2 - I will ask you yes/no questions and you can give me a nod yes or a shake of the head for no. Please do not try to mouth more words in response to a yes/no question.

#3 - Gesture and point at what you want. I do try to let them write sometimes but that is mostly not very practical - I either don't have time to hold the clipboard every few minutes when you think of something new or I can't read the writing! We tried little electronic boards that have pre programmed words and letters to push, but that never really worked very well.

Its really frustrating and after 12 hours, you can start to guess what they want because they will frequently ask for the same thing - turns, ice chips, tv channel, etc... and sometimes its just sheer anxiety from being in the ICU and being ventilated (who can blame them!?) - ativan is their friend.

dmc_rrt · Aug 1, 2010

I have one pt that uses his i-touch

sunnycalifRN · Aug 3, 2010

I have one pt that uses his i-touch

I never thought of that . . . even better would be to use an iPad!! It's bigger and easier to see the keys!! Some of our docs have iPads, but I don't think they'd let the patients use them!!

BellaInBlueScrubsRN · Aug 3, 2010

Only a few of our vent pt's are not sedated, or only sedated enough to be calm and awake, usually the ones that have been vented for a long period of time. And if they are awake then almost all are way too weak to write or point at letters. Someone suggested like fat white board markers since they might be easier to grip r/t size. iTouch is interesting.