Advanced Nursing Task 4
This exercise requires you to submit 700 words critical analysis of an area of practice that has been developed to change patient outcomes and analyse the impact on patient homeostasis.
This could be any area from your practice, or an area you feel needs developing to ensure patient homeostasis is maintained.
If you want you can discuss this in the discussion area, however, the assessment task is an individual essay submission.
Remember it needs to be referenced.
One of the innovations that have been developed to promote homeostasis in healthcare is mechanical ventilators. Mechanical ventilators are developed to assist the patient in having normal breathing if their respiratory system organs have been damaged or they have suffered other injuries such as spinal cord or brain injuries that can affect the effectiveness of the respiratory system function. A mechanical ventilator is a machine used to deliver oxygen to the patients through tubes or artificial airways connected to the patient’s respiratory system. The ventilators can either be invasive or noninvasive. The invasive ventilators are connected directly to the major airways, that is, the trachea, while the noninvasive ventilators such as the gas mask or helmets are tightly placed on the face of the patient (Kaier et al., 2019).
The mechanical ventilators deliver high oxygen concentrations into the lungs, remove carbon dioxide, reduce the amount of energy a patient spends on breathing and instead use the energy for other purposes such as fighting infections. They are also used to promote breathing among unconscious patients due to drug overdose or the build-up of toxins in the blood. The use of mechanical ventilators is recommended to be initiated once the patient has a respiratory rate of > 30/minute, body fluid Ph is less than 7.25, if they are unable to maintain arterial oxygen saturation > 90%, if the fractional inspired oxygen is greater than 0.60 and the partial pressure of carbon dioxide is greater than 50 mm Hg. However, it is recommended that care providers assess each patient individually to determine if they need to be put on a mechanical ventilator even before the extreme levels are reached (Patel, 2020).
Naturally, the normal inspiration creates a negative intrapleural pressure resulting in a pressure gradient between alveoli and the atmosphere. This pressure gradient leads to the inflow of air into the lungs. Patients with a compromised respiratory system are unable to perform the lung movements required to produce the negative intrapleural pressure, and therefore they are unable to create the pressure gradient that can support the inspiration of air. Such patients are thus put on mechanical ventilators to assist the inspiration and expiration process. Unlike the normal inspiration process, mechanical ventilators rely on creating a positive pressure to support the inspiration of air by the patient (Goligher et al., 2018). The ventilators highly depend on the airway resistance and compliance to determine how much pressure must be generated by the ventilator to support a specific tidal volume. The positive pressure generated by the ventilators forces the air into the respiratory organs, including the smaller airways and the alveoli, leading to gaseous exchange (Hickey & Giwa, 2022).
The mechanical ventilation process involves four major phases, including the trigger phase; during this phase is the initiation process where the inhalation is initiated by the patient efforts or by the set parameters in the mechanical ventilation. The inspiratory phase is the second phase when air is forced into the patient’s lungs due to positive pressure from the ventilator. The cycling phase follows, and it is the period between inhalation of the air and expiration; during this phase, gaseous exchange take place where oxygen is dissolved into the blood and carbon dioxide is removed from the blood. The final phase is the expiratory phase, where the air is exhaled from the lungs (Hickey & Giwa, 2022). For the ventilators to work effectively, specific presets are required depending on the needs of the patients. Some of the presets, including respiratory rate, inspiratory flow rate, positive end-expiratory pressure, and the fraction of inspired oxygen, are the most important to ensure adequate oxygen supply. The respiratory rate is the number of breaths per minute; they are typically between 8-12 for most patients to prevent acidosis. Inspiratory flow rate determines how fast the inspirations are provided. Fraction of inspired oxygen is the estimated oxygen content inhaled by a patient and is regularly set to the lowest level to achieve SP02 of 92% to 96% to prevent hyperoxemia. Positive end-expiratory pressure is the pressure applied by the ventilator by the end of each complete breath cycle to prevent the collapse of the alveoli, leading to atelectatic trauma (Walter et al., 2018).
Mechanical ventilators have been extensively adopted and utilized in healthcare settings to save and improve the quality of life for the patients. Approximately 310 patients per 100000 adult population in the US require invasive ventilator procedures annually. Ventilators are also extensively used in intensive care units, where approximately all patients admitted in the ICUs use ventilators most of the time. Ventilators are associated with several benefits, including decreased mortality. It is possible to support patients with severe illnesses until they recover or receive a lung transplant with ventilators (Wu et al., 2019). Major surgeries such as cardiac surgeries have been improved since ventilators were invented. However, health risk factors have developed due to the prolonged use of ventilators. Ventilator-associated pneumonia is one of the significant disadvantages of using ventilators. About 40% of the patients in the ICU develop VAP, which increases the length of stay in the ICU and hospital in general and leads to higher mortality rates. While the ventilators have been effective in saving lives, interventions are required to prevent the associated disadvantages (Zisk-Rony et al., 2019).
Goligher, E. C., Dres, M., Fan, E., Rubenfeld, G. D., Scales, D. C., Herridge, M. S., … & Ferguson, N. D. (2018). Mechanical ventilation–induced diaphragm atrophy strongly impacts clinical outcomes. American journal of respiratory and critical care medicine, 197(2), 204-213. https://www.atsjournals.org/doi/full/10.1164/rccm.201703-0536OC
Hickey, S., & Giwa, A. (2022). Mechanical Ventilation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK539742/
Kaier, K., Heister, T., Motschall, E., Hehn, P., Bluhmki, T., & Wolkewitz, M. (2019). Impact of mechanical ventilation on the daily costs of ICU care: a systematic review and meta regression. Epidemiology & Infection, 147. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003623/
Patel B. K., (2020) Overview of Mechanical Ventilation Retrieved from: https://www.msdmanuals.com/professional/critical-care-medicine
Walter, J. M., Corbridge, T. C., & Singer, B. D. (2018). Invasive mechanical ventilation. Southern medical journal, 111(12), 746. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284234/
Wu, D., Wu, C., Zhang, S., & Zhong, Y. (2019). Risk factors of ventilator-associated pneumonia in critically III patients. Frontiers in pharmacology, 10, 482. https://www.frontiersin.org/articles/10.3389/fphar.2019.00482/full