nursing care of recently extubated patient

[RNbethy]

My patient is supposed to be extubated today, and I was looking for nursing research or review articles on how to best care for the extubated patient (I'm on night shift).

I haven't found any info on this topic and was wondering if anyone could give some insight on what the extubated patient might need -- both physically and psychologically. This might seem like a stupid question, but in nursing you never know... there seems to be important theory behind everything.

Thanks for the advice!

[hodgieRN]

Probably best to focus on cardio/pulmonary aspect , especially first 48-72 hrs. Promote mobilty/ I.S./ encourage turning, coughing, deep breathing (anything to halt atelectasis progression). If they get lethargic, they might be retaining CO2. Don't be afraid to order an ABG despite getting slack for it. Bi-pap or re-intubation is better than just keeping an eye on them. Get pt's out of bed ASAP and get them moving. Be careful of PO intake until sedatives are fully metabolized. Make sure the family isn't slipping them pizza 30 minutes after extubation. Just b/c they did well with CPAP trials doesn't mean they won't crap out 6 hrs later. Encourage them to use I.S themselves. Tell them coughing is good, good, good...get all that mucous up if they got it. Don't give them Ambien on night one. Don't hold their Duoneb treatments b/c they are sleeping. Hope this helps :)

[sapphire18]

Be on the lookout for delirium, esp if they've been intubated for more than like 3 days, lol. Watch the respiratory status VERY closely (duh). Do a full nursing swallow screen before leaving them alone with a glass of water or anything. Titrate O2 down as tolerated (and as ordered).