Randomized Controlled Study Essay

This paper will discuss the weaning of patients off of a mechanical ventilator. It will look at the problems associated with prolonged intubation vs. premature extubation, and what healthcare professionals can do to assess a patients readiness to begin the weaning process. A patient care scenario will be given and an explanation of how nursing practice can evolve with the knowledge from this study will be shown. The accountability of the nursing professional in regards to mechanical ventilation will be visited as well.

• Vigorous follow-up is recommended for patients with underlying chronic respiratory disease due to the high risk of recurrence

The no-show rate for our discharge clinic dropped from 50% to 35 % in 6 months. There was also reduced the length of time for the patients follow up which went from a 3-month interval between visits to 6 weeks. An unanticipated benefit of this was that it improved the working

Diagnosing COPD is multifactorial, as stated previously, an all-encompassing nursing assessment and patient history must be conducted. When these processes are finalized, and subjective evidence points towards COPD, it is necessary to confirm the diagnosis with objective data. The definitive way to do this is by conducting pulmonary function testing (PFT); specifically, spirometry. On top of diagnosing, spirometry, is also pertinent for staging the patients COPD (Corbridge,et al., 2012). In addition to these facets, there are several other radiologic and laboratory tests that are helpful in determining the severity of COPD; they are not so much diagnostic, as they are informative.

Do: We started by creating a fish bone diagram to get an understanding of the many different aspects that lead to a patient being discharged and re-admitted within 30 days. Then we deciding as a team on 2 aspects that we will focus on in implementing a small test of change.

Upon reading your presentation. There are many important things I learned about COPD. It is important that spirometry should be performed to know the values to determine the severity of obstruction. I’m glad that you mentioned the normal ranges of spirometry because I didn’t remember them correctly. Furthermore, there are symptoms that shouldn’t be neglected like cough, sputum production, dyspnea because there are millions of people in the united states that are left undiagnosed. I never had any idea that there are so many people being affected by COPD and has no idea about the disease process that I learned from my own research on DRIVE4COPD campaign. We all know that COPD affects activities of daily living, but your presentation was informative

Patients are struggling with their discharge plans, unable to manage their care as evidenced by complications reported after discharge (McBride & Andrews, 2013; Kangovi et al., 2012). Postoperative complications may be related to the nurse’s inability to assess a patient's comprehension of discharge instructions accurately (Ashbrook & Sehgal, 2012; Fredericks, 2010). Nurses as part of the healthcare team are responsible for effectively preparing patients for the transition to self-care in the home setting. Opportunities for practice improvement exist as nurses perform this important task. Teaching performed in the acute care setting generally consists of standardized content, rather than information based on the patient’s individual

Advanced practice nurses (APRN) at medical treatment facilities providing ECPR must coordinate the specialized education to the healthcare team in order to ensure rapid deployment of the ECPR circuit to these critically ill patients with severe cardio-respiratory dysfunction. APRNs often become certified as ECPR clinical specialists in order to assist with direct care of the patient, and at many facilities, APRNs act as the ECPR coordinator responsible for the training and supervision of the staff, collection of treatment data, and equipment maintenance (Extracorporeal Life Support Organization, 2015). The APRN plays a vital role in ensuring that quality patient care is provided by coordinating continuous educational opportunities based on current evidence-based practices (EBP) and by performing as a team leader to provide highly coordinated multidisciplinary

Two issues were to be addressed, length of stay (especially mechanically ventilated patients) and the failure of the medical staff to respond to nursing calls. This length of stay has improved. The medical staff response has improved but, remains an issue. Currently the program covers 7A - 7P. The over night cover is by a physician on call from home who may be called in. The I house coverage is provided by the hospitalist program. Some of these individuals are not proficient in airways or lines. The airway support is by a respiratory therapist or a nurse anesthetist ( a mid-level provider) when available. The coverage is haphazard, inconsistent, and at times unsafe. The goal of the proposed plan is to augment the 7P -7A at home physician with an in-house Midlevels who can reliably intubate, gain central access, and support the patient until assistance can

Respiratory therapists (RT) are an important part of the treatment team. They can obtain arterial blood gas samples and check oxygen saturation levels. RT’s administer nebulizer treatments, bronchodilators, and steroids. They monitor and adjust ventilator machines and bi-pap machines according to patient needs. These machines help rid the body of carbon dioxide and provide adequate oxygenation. RT’s can also help provide suctioning as needed and are usually very involved in cardiopulmonary resuscitation. Physical therapists (PT) also play a huge role in caring for COPD patients. They can teach them breathing and coughing techniques, and also teach them how to exercise for conditioning and pulmonary rehabilitation.

After a noninvasive respiratory testing the patient vital signs, lung sounds and Pso2 level need to be monitored. Also after an invasive respiratory testing the nurse need to monitor the patient vital signs per Dr. order or facility policy and listen for absent or reduced lung sounds. Assess for drainage, complications and infection. The nurse needs to report any change in condition to the patient

Many patients with COPD do not follow their recommended treatment by their health care provider, leading to hospital readmission and longer hospital stay. Poor medication management has been identified as one of the factors resulting in emergency hospitalization. Health care professionals should give more time for patients whose nonadherence is of concern. Patient concerns and disappointments about medication management should be address on an individual basis. These patients would likely not adhere to the treatment which in their experience efficacy. Inhaler technique assessments forms a key component of adherence assessment in COPD should be performed at times.

Note amount, color, and character of sputum. Monitor pulmonary function tests before initiating therapry and periodically during therapy. Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication and notify HCP immediately. Implementation: PO: Administer oral medication with meals to minimize gastric irritation. Do not break, crush, or chew ER tablets Inhaln: Shake inhaler well, and allow at least 1 min. between inhalations of aerosol medication. Prime the inhaler befoe first use by releasing 4 test sprays into the air away from face – ProAir Respiclick doesn’t require priming. Teaching: Instruct pt. to take albuterol as directed. If on a scheduled regimen, take missed dose as soon as remembered, spacing remaining doses or increase the dose at regular intervals. Caution pts to not exceed recommended dose or frequency of doses; may cause adverse effects (paradoxical bronchospasm, or loss of effectiveness of medication. Instruct pt to contact HCP immediately if SOB is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain. Instruct pt. to prime unit with 4 sprays before using and to discard canister after 200 sprays. Actuators should not be changed among products. Evaluation: Prevention or relief of

Rapid response teams are mobile teams that respond rapidly at any time of the day, seven days a week, to a bedside nurse’s request for assistance with a patient whose condition might be worsening (Leach & Mayo, 2013). Rapid response teams focus on patients’ emergent needs and manage critical situations to prevent avoidable deaths (Leach & Mayo, 2013). Rapid response teams are called to intervene on when patients who are experiencing signs and symptoms of compromise to prevent any further deterioration in the patients’ clinical condition, adverse outcomes, and preventable deaths (Leach & Mayo, 2013). Responsibilities of the team include developing a plan of action with the bedside nurse, the respiratory therapist, and the patient’s intern and/or

Helped to recognize and identify the patient who has no appointment at the time of discharge.