Mechanical ventilation is commonly used in the intensive care setting to artificially ventilate persons who are unable to breathe spontaneously at all or are unable to provide themselves with adequate spontaneous ventilation to guarantee satisfactory gas exchange (Boles et al.,…
To meet the competency standards of practice and to remain accountable in practice are very important aspects of nursing care. The main reason the patients on ventilator needs to be monitored and managed with dexterity is ventilator associated pneumonia (VAP), which adds to the morbidity and mortality statistics associated with ventilator management and hence this condition needs to be prevented. The current practice in the United States is to use the ventilator bundle as a nursing guideline for practice in the intensive care unit with focus remaining on the head of the bed elevation (Tolentino-DelosReyes et al., 2007). As has been indicated by Reeve and Cook (1999), VAP is the most serious complication of critical illness, and this occurs not due to the illness per se, but due to management of the patient. The magnitude of the problem will be more relevant from the fact that this accounts for almost half the intensive care unit infections in Europe (Vincent et al., 1995). A guideline for care in the current practice as a specialist nurse in a district hospital would be the best tool, and such tools can be accomplished through the evidence base. This would involve a way to improve current practice through the critical and thoughtful integration of best available evidence from research into clinical practice (Manthous et al., 1998). Research is a systematic enquiry on any subject, and therefore, research in the area of intensive care nursing relevant to people receiving ventilator breathing would mean a process to answer questions relevant to practice in this area (Cormack 2000).
This has an implication for the nurse involved in clinical practice, and it is required by the standards of practice that the nurse involved in practice expansion must ensure that the practice is evidence based and can be justified in the literature. Price (2001) states that a thorough literature review provides a foundation on which to base new knowledge and usually is conducted ...
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The most significant clinical and economic impact of ventilator related lung infection is that a very large percentage of the population will develop this type of infection after oral intubation. Evidence-based research has shown that with some very simple basic mouth care techniques along with additional protocols, the number of patients diagnosed with ventilator associated pneumonia can be drastically reduced; normally within the first 24 hours of mechanical ventilation.
The VAP bundle includes four components of care and they are: 1. Elevation of the head of the bed of the patient This is the most integral part of VAP bundle and has been strongly associated with decrease in the rate of VAP. The elevation level that is recommended is 30-45 degrees.
It is a disease of the lung tissue occurring forty eight hours after procedures like tracheostomy or placement of an endotracheal tube to the patient is done. These procedures impair the integrity of the respiratory tree (CDC, 2012). Various journals have been published on other various VAP issues affecting its severity and outcome.
Ventilator acquired pneumonia (VAP) is pneumonia that occurs in patients on endotracheal intubation or tracheostomy tube after 48 hours or more which was not originally present before the ventilation. It is the most common ICU infection and the most fatal of all.
Ventilator Associated Pneumonia (VAP) refers explicitly to nosocomial bacterial pneumonia that has developed in patients who are under mechanical ventilation. VAP can be segregated into two types – early onset pneumonia and late onset pneumonia. One that occurs within 48 to 72 hours after tracheal intubation and is mostly the result of aspiration is termed early onset VAP and the one that occurs after this period is termed late-onset pneumonia (Kollef, 2005).
The goal is geared towards the prevention of ventilator associated-pneumonia using ventilator bundle in long term care. The title of the project is Evidence-based Practice for the Prevention of Ventilator -associated Pneumonia using Ventilator Bundle in Long Term Care.
The reported incidences depend on mechanical ventilation exposure time, case mix, and finally the approach used to diagnose this infection. It is estimated that between 9% and 27 % of all mechanically ventilated patients are at risk of VAP infection, at a rate of about five cases per 1000 ventilations a day (Hunter, 2012).
Early onset of pneumonia is caused by infection of staphylococcus, haemophilus or streptococcus gram-positive bacteria. These strains of bacteria are antibiotic sensitive. The late onset of VAP occurs after 72hours of ventilation (Booker et al., 2013). Methicilin resistant staphylococcus, pseudomona and enterobactor bacteria normally cause it.
The main reason the patients on ventilator needs to be monitored and managed with dexterity is ventilator associated pneumonia (VAP), which adds to the morbidity and mortality statistics associated with ventilator management and hence this condition needs to be prevented (Fagon et al., 1996).
VAP can be segregated into two types – early onset pneumonia and late onset pneumonia. One that occurs within 48 to 72 hours after tracheal intubation and is mostly the result of aspiration is termed early onset VAP and the one
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