Mr. Nguyen is a 58-year-old patient that had septic shock and developed Acute Respiratory Distress Syndrome. He is orally intubated and on a mechanical ventilator. He is paralyzed and sedated.

• What manifestations might you observe for a patient with ARDS?
• What complications can Mr. Nguyen develop from being mechanically ventilated?
• List priority nursing interventions to prevent complications associated with ventilatory support.
• What interventions can be implemented specifically to prevent the development of Ventilator Acquired Pneumonia (VAP)?
• You are orienting in the ICU, the nurse you are working with is not implementing the VAP interventions. What would you do?

Initial Post 1:(A.T)

 Severe respiratory distress and low oxygenation are characterizations of ARDS. Manifestations of ARDS include severe dyspnea (difficulty breathing), shallow, rapid breathing, Low oxygen concentrations or hypoxemia, cyanosis (bluish lips or skin as a result of low oxygen levels), reduced lung compliance, increased effort of breathing, bilateral infiltrates seen on the X-ray of the chest, altered mental state as a result of hypoxia. A number of complications can develop for Mr. Nguyen from being on mechanical ventilation, such as ventilator-associated pneumonia (VAP), oxygen toxicity, ventilator-induced lung injury (VILI), barotrauma (high airway pressure-induced lung damage), and ventilator-associated events (VAEs). Priority nursing interventions to prevent complications with ventilatory support include regular evaluation of Mr. Nguyen’s respiratory condition, to avoid self-extubation and lessen agitation continue to administer appropriate sedation and analgesics, keep an eye on and maintain the proper ventilator alarm settings, changing positions frequently to avoid pressure sores and atelectasis, oral hygiene to stop VAP, ensure appropriate ventilation circuit and endotracheal tube hygiene, trials of weaning to evaluate preparedness for extraction. The following are some interventions to avoid ventilator-associated pneumonia (VAP): To lessen the chance of aspiration, raise the bed’s head to a position between 30 and 45 degrees. using chlorhexidine for oral hygiene to stop the growth of microorganisms, routine evaluation of endotracheal tube (ETT) suctioning requirements, To reduce contamination, use a closed suctioning system. To avoid microaspiration, the ETT cuff pressure should be regularly assessed. Reduce the amount of time that patients need mechanical ventilation by using a sedative strategy. Sedation vacations are interrupted every day to evaluate preparation for extubation. It would be imperative to take immediate action if I saw an ICU nurse failing to apply VAP preventative treatments. I would document the circumstance and your activities for my charge nurse or unit manager and If the problem persists, I would talk to my nurse manager or supervisor to make sure that best practices and procedures are followed and maybe consider reeducation for the nurse. In the ICU, patient safety is the top priority. 

Initial Post 2:(B.M.)

Acute Respiratory Distress Syndrome, or ARDS, is a dangerous lung condition that can develop in people who are critically ill and necessitates frequent mechanical ventilation to maintain breathing. One of the symptoms of ARDS identified in Mr. Nguyen was a cluster of respiratory and systemic symptoms. The underlying lung tissue injury and inflammation that obstruct the lungs’ ability to exchange oxygen and carbon dioxide are reflected in these signs and symptoms. Extreme shortness of breath, rapid breathing (tachypnea), cyanosis (bluish skin color), restlessness, fatigue, decreased urine output, tachycardia, low blood pressure (hypotension), and altered mental status are a few of the main symptoms.

When caring for critically ill patients, nurses must consider the potential difficulties of mechanical ventilation, as in Mr. Nguyen’s case. The process of mechanical ventilation requires placing a tube in the patient’s airway in order to deliver oxygen and remove carbon dioxide. Even while treatment can save lives, there are risks and a chance of problems. Ventilator-associated pneumonia (VAP), barotrauma (high air pressure lung damage), ventilator-associated lung injury (VALI), ventilator-associated events (VAE), pressure ulcers, cuff-related tracheal injury, sedation-related complications (such as excessive sedation or inadequate pain management), and infection at the site of the endotracheal tube insertion are a few potential side effects of mechanical ventilation.

Priority nursing interventions include regular evaluations of the patient’s vital signs, oxygen saturation, and respiratory status to gauge how they are responding to mechanical ventilation. Maintaining proper ventilation settings and keeping an eye out for signs of high or low airway pressures are necessary to prevent lung injury and maximize respiratory assistance. The patient must be moved frequently to lessen the chance of pressure sores and to improve lung expansion, which may be compromised in ARDS patients. Regular sedation intervals and assessments of extubating readiness are necessary to avoid prolonged artificial breathing and reduce the risk of sedation-related issues.

In order to prevent the emergence of Ventilator-associated Pneumonia (VAP), nurses should implement specific measures. Among them are regular suctioning of the endotracheal tube to remove secretions and reduce the risk of aspiration, maintaining proper positioning of the endotracheal tube to prevent micro aspiration of gastric contents, and routine oral hygiene using antiseptics to lessen bacterial colonization in the oropharynx. Raising the head of the bed by at least 30 degrees can prevent aspiration, and closely following infection control protocols such hand hygiene and sterile procedures lowers the risk of infection.

While orienting in the ICU, if I see a nurse not using VAP treatments, I would do the following:

I would speak to the nurse politely and respectfully to express my worries on the lack of VAP interventions. I want to underline how important VAP prevention is for patient safety and outcomes, and how it is our responsibility to adhere to best practices in the ICU.I would share my knowledge and understanding of the importance of VAP prevention, emphasizing how it may significantly impact patient recovery and minimize the likelihood of issues. I would give the nurse the tools and knowledge she needs to carry out the VAP interventions, or I would volunteer to help her. Accurate documentation is essential for maintaining a culture of cooperation and stability in our healthcare system and delivering high-quality care to our patients.

Gender stereotyping is common in American culture. It all starts with “Pink is for Girls and Blue is for Boys”.  Define the term gender stereotyping and Watch the video clips on Gender stereotyping and discuss your reaction to the videos. Are there certain costumes or toys that should be limited to only boys or only girls? Why?

Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use research literature to explore ideas, guide your thinking, and gain new insights. As you search the research literature, it is important to use resources that are peer-reviewed and from scholarly journals. You may already have some favorite online resources and databases that you use or have found useful in the past. For this Discussion, you explore databases available through the Walden Library.

Discussion post ( question to answer)

Using proper APA formatting, cite the peer-reviewed article you selected that pertains to your practice( PHMNP) area and is of particular interest to you and identify the database that you used to search for the article. Explain any difficulties you experienced while searching for this article. Would this database be useful to your colleagues? Explain why or why not. Would you recommend this database? Explain why or why not.

250 words. APA format

3 references

Two in text citation 

No plagiarism please. 

You have been promoted to nurse manager of your unit. You realize that to function effectively, you must have a better understanding of your organization’s structure and, specifically, the chain of command.

Find and analyze the organizational chart of the healthcare organization you are currently working for or for one that you have encountered in your nursing experience.

• Give a brief description of the organization of the healthcare structure used in your facility.
• Describe the chain of command used in your organization and identify the people you report to and those who report to you.
• Consider the following and discuss how the chain of command is used to implement change.
  • Based on the organization chart, what leadership structure is used in the organization—hierarchical or flat?  How does this affect implementing change?
  • Does this organization use a shared governance model for nursing?
  • When nurses have an idea for changing a process and they make a decision as a group, where do they go with their suggestions? (the director? the unit manager?)
• Explain why understanding this information is important to your success.

APA format.

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