First,to maintain airway patency,In order to make better use of the cheap ventilator:we should remove timely the secretions and mucus in the resparitory tract and the mouth.If concious patient,we should urge them sputum;If weak patient,we should assist expectoration,treated with mechanical suction if necessary,to maintain aseptic suction,reduce lung infection and other unwanted bacterial infection.
Second,We should observe closely changes about vital signs and consciousness:an expression of its objective reflection of the body's activity,is a measure of the body's most reliable indicators of the state;it should be detected the disease shift,such as pulmonary encephalopathy,shock occurs,early to do emergency preparations for the patients and help their families to win precious time.
Third,the basic care:
1.eye care:prevent keratitis,conjunctival dryness,breakage and infection.
2.oral care:prevention of oral ulcers,clear secretions,keeping the mouth clean.
3.skin care:bedridden patients should prevent bedsores,timely removal of the patient's secretions and excretions,given the timing of the turning massage pressure.
4.psychological care:disease and environmental stress,psychological pressure will give the patient the trauma on the necessary explanations will reduce the negative emotions of patients,and get psychological solace.
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Fourth,Problems and Solutions
1.the patient is too small chest rise and fall,indicating lack of tidal volume,should be suitably adjusted tidal volume,tidal volume can be calculated according to patient body weight (10ml / kg),but taking into account the volume of the ventilator tube,so the practical application of tidal volume increase than the estimated value of 100 ~ 200m l.
Tracheal tube balloon can also cause insufficient gas leak,the gas must be injected enough,regularly check for leaks.Sputum more,blocking the airway,should be promptly removed and nose secretions.When using the ventilator,respiratory water loss increases cilia motility,secretions from the poor,prone to blockage that may cause secondary infection.
2.good airway humidification:
Ventilator wet bottle with distilled water and heated humidification its level is not too high,1/2 is preferably not more than 2/3,the temperature is generally 37 ~ 39 ℃;
Drug ultrasonic atomization;
pipe,using saline,chymotrypsin,gentamicin,slow trickle along the airway wall suction around 2 hours or 3 to 5 drops,such as airway infections every merger,should take secretions increase sensitivity for bacterial culture,and sensitive antibiotics based on airway infection bacteria,dubbed diluent injection airway.
3.self-breathing ventilator confrontation:appropriately adjusted ventilation,general frequency of 16 to 20 beats / min,inspiratory to expiratory ratio of 1/1 to 1:2,tidal volume 10ml / kg.Leak caused by inadequate ventilation,make spontaneous breathing to strengthen and accelerate the ventilator confrontation.Common duct convergence is not tight,the convergence process should be closely pipeline;casing outside the balloon inflated,the gas portion from the trachea slit or mouth to escape,treated as sufficient gas should be added.Convalescent patients eager weaning discharge or because of financial hardship rush weaning,they try to adjust breathing on his own,because of haste and confrontation,should tell the therapeutic implications and with treatment,eliminate the psychological barriers.When a patient respiratory muscle recovery,enhance spontaneous breathing strong,then prone to respiratory confrontation,you should consider switching to intermittent downtime or ventilation.Disable the ventilator should be the first day after the night,because at night the vagus nerve,prone to cause respiratory movement weakened,inhibition of respiration,the day before the general trial stop 15 to 30 minutes after the ventilator 30 minutes,if no breathing difficulties,stabilize blood gas analysis ,then gradually extended downtime,a gradual transition to full-day disabled while spontaneously breathing patient should be encouraged to strengthen,guide the patient reduce lip breathing,abdominal breathing and deep breathing to reduce the respiratory muscle fatigue.Away time,the use of nasal cannula oxygen,catheterization slightly darker,slightly higher traffic and close observation of changes after the shutdown and dealt with accordingly.From the ventilator a few hours before the sedative drugs should not be used in order to avoid respiratory depression occurs after the shutdown.
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