Routine Oral Care Positioning to Term Paper

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(Schleder, 2003)

Elevating heads of beds for patients on mechanical ventilation

Along with the recommendations for removal of plaque, there is also a guideline made by CDC that for proper treatment to "elevate at an angle of 30 to 45 degrees the head of the bed of a patient at high risk for aspiration." The benefits elevation of the head of the bed is on the theory that then gravity will reduce the possibilities of regurgitation that exists in an overly distended stomach. The recommendation by CDC also clearly states that the patients should not be lying flat unless there is some clinical need for that. At the same time, some medical authorities feel that this is likely to make the patients uncomfortable, though the recommendation is from CDC. This makes them reduce the angle of laying the patients bed at a lower angle than the angle specified by CDC. (Breathing easy)

For patients likely to be infected with VAR there are two main factors - colonization of the oropharynx and the aspiration of bacteria. When the patients are on mechanical ventilation then if the head of the bed is elevated by 30 degrees to 45 degrees, then there is a significant decrease in gastroesophageal reflux and aspiration. According to the experience of some hospitals, this practice should be taken up in all hospitals and all such patients unless there are signs of clear contraindications. These may be cases like cervical fracture or large bore femoral catheters. This is clearly an easy method to adopt. The practice also should not add to the costs of caring for patients, and the method to be adopted can be taken up directly by the nursing personnel and does not require an approval from the physician before implementation. The simple method of raising the head of the bed can reduce the chance of the patient getting VAR. (Preventing Ventilator associated Pneumonia)

Other precautions

We know that the occurrence of pneumonia is quite high and there are also some very simple methods that can be used to reduce the chances of patients getting the disease.

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Another simple care that can be taken is to stop all visitors who show some symptoms of any respiratory infection to visit the wards of cardiac patients or immuno-suppressed patients. Another method is to ensure that all hospital personnel in these areas are also given inactivated influenza vaccine during October of every year. This includes the night and weekend staff. The benefit is likely to be less chances of infection coming from that area. During the entire season when influenza occurs, it should be ensured that vaccination be readily available to all staff, including those who are newly hired. Though the injection should be given to all staff, in case enough vaccination is not available, give the first priority to staff that are to handle patients who are at the greatest risk from these diseases. Records should also be maintained of all the vaccination that has been given so that it can be ensured that the correct staff has been vaccinated. It is also important to review the laboratory diagnostic tests of patients for both required - culture of correct respiratory specimen and urine antigen. The tests should be for legionellosis and the important persons to be checked those who have received HSCT or solid organ transplants, patients receiving systemic steroids, patients above the age of 65, or patients who have some chronic diseases like diabetes mellitus, congestive heart failure and COPD. The results of these tests should also be readily available. (Tablan; Anderson; Besser; Bridges; Hajjeh, 2003).....

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