Respiratory assessment of older adults: Part II.
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Aged↗
Biomedical subjects
P B Weilitz
Publications and source records attributed to P B Weilitz.
Test your knowledge of tracheostomy tubes.
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Communication↗
A managed care system. Financial and clinical evaluation.
The ever-changing healthcare environment requires that nurse executives explore alternative ways to deliver quality patient care, manage resources, and reduce length of stay. Care paths provide one such alternative, incorporating multidisciplinary care planning, discharge planning, and documentation in a patient-centered design. This model includes a clinical and financial system for evaluating the impact of the care path on resource utilization, length of stay, and patient outcomes.
Academic Medical Centers↗
A protocol for initiation of nasal positive pressure ventilation.
BACKGROUND: Respiratory failure related to neuromuscular weakness has commonly been managed with long-term ventilation by tracheostomy. Currently, nasal positive pressure ventilation is being used with success in this patient population. It has been suggested that initiation of nasal positive pressure ventilation is best done in an intensive care setting. METHOD: Nine patients were placed on nasal ventilation during a brief admission to a medical floor staffed by nurses trained in respiratory care. This process was facilitated by use of a standardized protocol for nursing staff that identified treatment objectives. RESULTS: Following the initiation of nasal positive pressure ventilation, this group of patients experienced near normalization of daytime measurements of partial pressure of arterial carbon dioxide, reported increases in daytime energy levels, and relief of nighttime signs and symptoms. These objectives were accomplished with no significant complications. Use of this protocol may also decrease length and cost of hospitalization and improve patient acceptance of noninvasive ventilatory assistance.
Adult↗
Weaning a patient from mechanical ventilation.
The process of weaning a patient from mechanical ventilation is complex. Assessment of respiratory mechanics, oxygenation and ventilation, medical problems, nutrition, physical therapy and psychologic needs are important prior to developing the weaning plan. The weaning technique should be individualized to the patient and may be combined with other techniques for optimal outcome. Successful weaning depends on the nurse's attention to detail, careful assessment of patient responses to weaning trials, and coordination of and collaboration with other healthcare team members.
Adult↗
Weaning from mechanical ventilation: old and new strategies.
The strategies available for weaning patients from mechanical ventilation are many: T-piece mode, SIMV, PSV, and combinations of each. T-piece trials alternating with SIMV or AC provide periods of spontaneous breathing with rest on the ventilator. Decreasing SIMV rates gradually increases the patient's independence and spontaneous breathing; however, may result in an increased work of breathing with some systems. Alternatives such as flow-by and the addition of PSV may assist in the reduction of airway resistance. PSV weaning alone or in combination with SIMV or T-piece trials reduces work of breathing, promotes respiratory muscle training, and improves patient-ventilator interaction. Schuster states "the specific weaning technique employed is often less important than the care with which it is applied."
Clinical Protocols↗
New modes of mechanical ventilation.
The new modes and techniques of ventilation provide much needed alternative ventilatory support for the critically ill patient. Reduction of airway pressure, improved oxygenation, recruitment of alveoli, and redistribution of ventilation are the major advantages of these new modes. Continued research and clinical application will help develop a mechanical ventilation system that optimizes the patient respiratory status with minimal adverse effects.
Critical Care↗
Differences in pain perception associated with intravenous catheter insertion.
Seven intravenous catheter brands were compared for differences in pain perception associated with catheter insertion. A sample population included 210 healthy volunteers. Three key elements emerged from data analysis: 1) first insertions were viewed as less painful than second insertions; 2) thin-walled catheters were viewed as less painful than thick-walled catheters; 3) differences between brands exist. Catheters viewed as more painful were Travenol (Quik-Cath, Travenol Laboratories, Inc., Deerfield, Illinois) and Terumo (Surflo, Terumo Corporation, Tokyo, Japan). No catheter was viewed as less painful, but Insyte (Deseret Medical, Inc., Sandy, Utah) did approach statistical significance.
Adolescent↗