ppt课件-initial assessmentofthe mechanically ventilated patient（初始assessmentofthe机械通风病人）.pptVIP

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2017-01-25 发布于四川
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ppt课件-initial assessmentofthe mechanically ventilated patient（初始assessmentofthe机械通风病人）.ppt

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Initial Assessment of the Mechanically Ventilated Patient Chapter 9 What do you do first? Look at your patient Color RR Breathing pattern Use of accessory muscles Chest movement Easily audible breath sounds Work of breathing Check your orders Verify that the ventilator has passed the operational verification procedure (OVP) Patient-Ventilator Systems Check Checks are performed according to hospital policy (usually every 1-4hrs) or before: ABG’s New orders or vent changes Hemodynamic or PFT measurements Acute changes in patient condition Questionable ventilator performance Evaluation of the ventilators function and the patient’s response to ventilatory support Documentation contains Data relevant to the patient’s condition Patient’s information and observations of ventilator settings Physician’s orders for settings Brief narrative of the clinical observations PART OF THE MEDICAL RECORD! Clinical Rounds 9-1 p. 153Reasons for Documentation A 38year old woman is intubated for respiratory failure secondary to severe pneumonia. After 24 hrs her status improves. The ETT is kept in place to allow suctioning, because she has large amounts of secretions. On the third day after intubation her respiratory status declines. She has a cardiac arrest and is resuscitated but suffers brain injury as a result. She dies several weeks later. The family hires an attorney. At issue is the fact that in the medical record, the respiratory therapist’s notes with the ventilator flow sheet indicate that the patient had been suctioned about q2hrs for large amount of thick yellow secretions. However during the 8 hrs before the arrest, nowhere did the notes state that the patient had been suctioned. The therapist states that he had suctioned the patient but had not recorded it in the chart. Was the therapist negligent and did his actions lead to the wrongful death of the patient? The legal inference is that if treatment is not documented, it is not done. The therapist must prove th