The purpose of ventilatory management

The purpose of ventilatory management in acute exacerbations of chronic obstructive pulmonary disease is to avert tissue hypoxia. Managing respiratory failure also provides control of acidosis and hypercapnia.

Non-invasive ventilation reduces the need for intubation among patients with COPD. It is necessary to monitor ph as the best marker of severity and the level of arterial carbon dioxide tension (PaCO2). In our case Mr. Bryant’s monitoring shown an improve – his ph increased from 7, 25 to 7, 42, there is a fall in PaCO2. These markers indicate a good prognosis. So Mr. Bryant’s condition did not deteriorate. Oxygen therapy, bronchodilator and antibiotic therapy worked effectively.

As to the further entilatory management it is possible to use non-invasive ventilation to reduce a need of hospitalization and future complications or respiratory failure. To avoid so called late failure it is necessary to continue monitoring the patient, have an intubation available and receive NIV in a place with trained staff of nurses. Taking into account the age, lifestyle and diagnosis of Mr. Bryant all the precautions must be followed.

As initial level of ph was 7, 25 it is possible to say that Mr. Bryant’s condition was unsatisfactory. Taking into consideration that patient had an acute exacerbation of COPD and a respiratory failure it was necessary to manage support ventilation by means of oxygen therapy. An effect of the therapy was positive, ph factor increased, so it is possible to say that treatment corresponded to the situation. It is also possible to use long term oxygen therapy during the time of hospitalization. Ventilatory management in cases of COPD and pneumonia is of a great importance. The survival of the patient and his further recovery depend upon appropriate managing respiratory failure.

In this very case it was necessary to use not only oxygen therapy, but bronchodilator and antibiotic therapy as well.Scientific and technological revolution provided a wide use of technology in different spheres of life. Medical care achieved a high level due to the technological innovations. The work of the medical men is speeded up and supported by means of technology. Thanks to the spread of progressive methods of work it is now possible to save patients’ lives; many former incurable diseases are successfully treated now.

Nurses have always used a great number of tools, instruments and devices to treat patients. X-ray laboratory equipment, thermometers, cardiac monitors and many other appliances of the health care realization took their place.

Electronic medical records have an intense impact on nursing today. All the information about patient is available for the nurse and physician due to this device. It also helps to avoid errors in treatment, reminds about necessary procedures, helps to control time, dosage of medicine and keeps all the necessary parameters of the patient’s condition.

Since we deal with pulmonary it will be important to pay attention to such technical devices as ventilators, Venturi masks, intubational equipment, incentive spirometers that are widely used and provide an effective diagnosis , prevention and successive treatment of pulmonary diseases, particularly pneumonia and chronic obstructive pulmonary disease, cases of respiratory failure syndrome.

Ventilatory management during COPD treatment requires a variety of specialized equipment for such strategies as oxygen therapy, non-invasive ventilation and invasive mechanical ventilation. The latter is the most complicated procedure and it makes a provision of use technology. Nursing directly undergoes the impact of technology. Nurses have to operate all the devices, machines and instruments applied for the treatment process. It goes without saying that technology simplifies the work of nurses and makes it much more effective. Now it is possible to make faithful diagnosis and prevent an after-effect of an illness.

Technology in health care caused a differentiation in nursing practice. There are telephone nurses, operating room nurses, nurse equipment specialist etc. Now nurses deal both with patient and certain technical device. The development of technology does not lead to the era when machines will substitute nursing in the process of treatment and rehabilitation. Technology helps to escape mistakes in diagnosis; it minimizes the chance of mistreatment but is not able to operate the whole process. The purpose of technology in health care is to rationalize and speed up the work of the medical staff, to make it effective and provide comfort for both patients and physicians. Nurses serve as the main users of technical equipment while physicians are at the head of the process of treatment.

One of the most significant goals of technology use is monitoring of the patient. Different diseases refer to different criteria of the patient’s condition. There are factors that indicate a danger for life and health. To be aware of these factors means to make an accurate diagnosis and prevent complications. All this is of great importance because the contemporary tendency of health care is to save health and provide prophylaxis, instead of treating disease.

Nurses work with different patients including children and old people, who demand care and support. The role of nurse is psychologically motivated; nurse gives necessary emotional comfort to the patient and fulfils the duties of mediator between patient and technology, physician and patient.

References

Ambrosino N, Foglio K, Rubini F, ET AL. Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive airways disease: correlates for success. Thorax 1995

Cambell Ej.The management of acute respiratory failure in chronic bronchitis and emphysema. The J Burns Amberson lecture. Am Rev Respir Dis, 1967

Chronic obstructive pulmonary disease. London: Chapman & Hall, 1995: 461-94

Jeffrey A, Warren P, Acute hypercapnic respiratory failure in patients with COPD.Thorax, 1992

Mador M, Tobin M, Acute respiratory failure. In: Calvarley P, Pride NB, Eds, 1998

Plant P, Owen j, Elliot M, Non-invasive ventilation in acute exacerbations of COPD.Thorax, 2001

Warren P, Flenley D, Respiratory failure revisited: acute exacerbation of chronic bronchitis. Lancet, 1980

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