Ventilator-associated pneumonia refers to the lung infection which affects patients who are on the mechanical ventilation breathing machines. These patients are already critically ill, and the new infection tends to increase their chances of death (Dodek et al., 2004). This infection affects the respiratory system of the patient, more specifically, the lower respiratory tract and lung parenchyma. The major route that a patient may acquire the infection is through oropharyngeal colonization by pathogens which are introduced exogenously from the intensive care unit (Dodek et al., 2004). This occurs through contaminated hands or apparel of the hospital personnel who access the unit, through contaminated medical equipment, the air, and even water. This is why the condition tends to occur after 48 hours of mechanical ventilation through the endotracheal tube or tracheostomy.
Nursing assessment is very important as it collects important information relating to the physiological, psychological, sociological, and spiritual status of the patient. Since most of the patients in the ICU on the ventilators are unconscious, it may be impossible to assess most of their status, other than the physiological aspect. The nurse should assess whether the patient has a fever and increased tracheobronchial secretions. These are quite common in patients with Ventilator Associated Pneumonia. The nurse may also hear crackles and see decreased respiratory efforts, and note decreased oxygenation. In case the patient is conscious, the nurse may inquire of any discomforts which the patient may experience. If the patient reports chest congestion, then the infection is suspected.
The diagnostic tests which should be conducted include; a chest radiograph, blood and pleural fluid cultures, nonquantitative and semiquantitative airway sampling, and also quantitative airway sampling. The issue of Ventilator Associated Pneumonia is relevant to geriatric patients mainly because they are at high risk of diseases such as heart attacks, which may lead to their hospitalization in the ICU environment. In addition, they are at a high risk of contracting the infection due to their compromised immune systems.
The nursing diagnosis for a patient with ventilator-associated diagnosis is impaired respiratory function, ineffective airway clearance, impaired gas exchange, and hyperthermia (Dodek et al., 2004). To help the patient with the symptoms, it is imperative that an evidenced based care is offered. In addition, the care needs to be individualized so as to fit the patient directly and effectively. The nursing intervention will feature practicing good hygiene, such as washing hands with soap and water before touching a patient, changing the oxygen masks more frequently, and immediately after it becomes soiled, and ensuring frequent mouth care for the patient (Dodek et al., 2004). Other interventions will help alleviate the patients discomfort and risk for more infections. These will include ensuring the ET-tube cuff pressure is maintained and elevating the head of the bed. In case the patient is unable to clear the airway effectively, then the nurse should employ the use of subglottic secretion drainage (Dodek et al., 2004).
The patient is treated with antibiotics for 15 days and given pain medication to manage the discomfort. The long period of consuming antibiotics is meant to prevent a recurrence of the same when the dose is complete. Unfortunately, it may be difficult to manage the infection once it starts due to the compromised immune system of the patients. A longer dosage also makes it difficult since the infection causing organisms may easily become resistant (Dodek et al., 2004).
Clinical practice change is very important as it will ensure a prevention of such infections in the ICU. Patient teaching is also vital for conscious patients as it will ensure they communicate any issues that they may have before the infection gets out of control. From the research article, it is recommended that topical antibiotics should not be used alone. This is because it tends to promote the emergence of antibiotic-resistant bacteria, hence causing more harm to the patient.
Dodek, P. et al. (2004). Evidence-Based Clinical Practice Guideline for the Prevention of Ventilator-Associated Pneumonia. Annals of Internal Medicine. 141(4), 305-310.
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