Discussion: Chronic obstructive pulmonary disease

You are a staff nurse working in an intensive care unit and assigned to care for a 75-year-old man who had coronary artery bypass graft surgery four days ago. The patient has a history of chronic obstructive pulmonary disease exacerbated by heavy smoking. His postoperative course has been difficult, and he has suffered a number of setbacks.

Staff members, despite their diligent efforts, have not been able to wean him off the ventilator since the surgery. He has required frequent suctioning throughout the shift, and he is being evaluated for the development of ventilator-associated pneumonia.

Today, when returning from lunch, you observed an experienced nurse suctioning your patient. His secretions were thick, and you observed that the nurse was instilling saline into the patient’s endotracheal tube as she was suctioning him.

The patient turned red and began coughing, and it was obvious he was in distress. You asked the nurse why she was instilling saline into his endotracheal tube. She replied this was being done to loosen the secretions.

You told her this was no longer an acceptable practice. She stated that she has many years of critical care experience and she did not care what anyone said, that the only way you could loosen the patient’s secretions would be to instill saline. She also said that would be the last time she would do something for one of your patients while you were at lunch.

Outline/Describe the strategies/process you use to search for evidence related to best practices (including databases used, search phrases, number of articles located) for suctioning and whether the instillation of saline while suctioning is an acceptable technique.

Search for evidence related to best practices, and provide a summary of all evidence.

Cite at least two scholarly (peer-reviewed) articles to support the data presented in the paper

Develop a PICO question for the instillation of saline during endotracheal suctioning.

Consider/Describe how you could apply PICO to problems in your workplace in order to influence things in clinical practice. Develop a PICO to represent your work setting.

Submit your search strategies, search results, and PICO question and application to clinical practice as an:

· 880-word APA formatted paper(title and reference page are not included in the 880 words count)

PICO is a mnemonic used to describe the four elements of a good clinical foreground question:

P = Population/Patient/Problem – How would I describe the problem or a group of patients similar to mine?

I = Intervention – What main intervention, prognostic factor or exposure am I considering?

C = Comparison – Is there an alternative to compare with the intervention?

O = Outcome – What do I hope to accomplish, measure, improve or affect?

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