NURSING PRACTICE: Respiratory Complications Prevention Report

This report focuses on the prevention of respiratory complications, particularly in patients with spinal cord injuries (SCI). It examines the impact of SCI on respiratory function and the associated risks. The report details the procedure of tracheostomy as a key intervention to mitigate these risks, comparing it with previous practices and highlighting evidence-based practices that support its use. It emphasizes the importance of early intervention and intensive physiotherapy. The report also discusses the significance of lesion level and completeness in determining the need for tracheostomy. It concludes by summarizing the importance of interventions like intubation and tracheostomy in promoting effective breathing, preventing complications, and improving patient outcomes. The report references several studies to support its claims and provides a comprehensive overview of the topic, making it a valuable resource for nursing students. The report is prepared as part of an assignment on nursing practice and care plan development for medical-surgical clients.

Running Head: NURSING PRACTICE: RESPIRATORY COMPLICATIONS PREVENTION
NURSING PRACTICE: RESPIRATORY COMPLICATIONS PREVENTION
Name of the Student:
Name of the University:
Author Note:

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PART A:
Introduction:
Spinal cord damage (Sweis & Biller, 2017) (SCI) is comparatively an unusual condition
but is considered as one that has significant personal and societal impacts. Physical injury is
usually severe, with substantial decreases in group engagement, education and quality of life
(QOL). Post the occurrence of SCI, respiratory problems are the most frequent cause of death.
The paper below determines the procedure that might help in impacting the patient and prevent
the occurrence of any of such complications.
Discussion:
Description of the procedure:
Patterns and degree of movement, sensory, and autonomic neurological dysfunction are
the most significant indicators of the magnitude of respiratory vulnerability after SCI. As in other
professional experience, knowledge of biological, pathophysiological, and illness histories
support patient professional evaluation. In SCI, most can be diagnosed from close examination
of the patient's breathing rhythm to detect paradoxical or uneven activity in the chest wall.
Tracheostomy (Gundogdu, Ozturk, Umay, Karaahmet, Unlu & Cakci, 2017) may be done as
early as day 4 after anterior cervical surgery with little rise in the occurrence of wound or device
infection, with less days on the ventilator and a reduced hospital stay in chosen cases.

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Comparison of the procedure with previous practice:
Early extubation and intense physiotherapy can minimize the duration of stay in intensive
care in appropriate patients. Circumstances where the intubation is not performed in a timely
manner in the presence of tetraplegia, may result in the need for intervention of emergency
airway or devastating failure and death of airways. In a generalist unit not acquainted with SCI-
specific treatment, intubation and intrusive ventilation accompanied by the use of a tracheostomy
(McCully, Fabricant, Geraci, Greenbaum, Schreiber & Gordy, 2014) to promote ventilation
weaning may provide the patient with a more secure alternative.
Evidence based practice that promotes tracheostomy to prevent complications:
Surveys conducted by (Berlowitz, Wadsworth & Ross, 2016) show that patients are more
likely to develop tracheostomy if they encounter pulmonary health issues or if they have a
comprehensive SCI motor or AIS motor score of approximately 22. Level of lesion, and
completeness, are significant. Changes in C3-level magnetic resonance imaging forecast the need
for tracheostomy. Overall occurrence of tracheostomy in tetraplegia is stated to be between 10%
and 60% [116, 117] with FVC being a major indicator of the need for tracheostomy, with cut-of
< 830 mL and < 500 ml.
Promoting tracheostomy to improve patient health:
Studies (Auchincloss & Wright, 2016) show that for most of the patients with acute
traumatic cervical SCI, mechanical ventilation with or without a tracheostomy is normal. Patients
are most likely to proceed to tracheostomy whether they encounter disorders in the respiratory
system or have a full SCI motor or an AIS motor score of about 22. Level of lesion, and
completeness, are significant. Changes in magnetic resonance imaging at stage C3 are indicative
of tracheostomy requirements.

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Conclusion:
Flaccid paralysis of the intercostal muscles produces an unstable chest wall that induces
paradoxical internal compression of the ribs during inspiration. Such technical mismatch and
drawback results in less effective breathing, decreased pulmonary function and micro atelectasis
of the distal airways. Airway secretions may build up in the lungs by either enhanced
development or reduced secondary clearance causing impaired cough. The paper states that
intubation and intrusive ventilation accompanied by a tracheostomy to promote ventilation
weaning, may provide a safer alternative for the patient to avoid pulmonary complications.

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References:
Auchincloss, H. G., & Wright, C. D. (2016). Complications after tracheal resection and
reconstruction: prevention and treatment. Journal of thoracic disease, 8(Suppl 2), S160.
Berlowitz, D. J., Wadsworth, B., & Ross, J. (2016). Respiratory problems and management in
people with spinal cord injury. Breathe, 12(4), 328-340.
Gundogdu, I., Ozturk, E. A., Umay, E., Karaahmet, O. Z., Unlu, E., & Cakci, A. (2017).
Implementation of a respiratory rehabilitation protocol: weaning from the ventilator and
tracheostomy in difficult-to-wean patients with spinal cord injury. Disability and
rehabilitation, 39(12), 1162-1170.
McCully, B. H., Fabricant, L., Geraci, T., Greenbaum, A., Schreiber, M. A., & Gordy, S. D.
(2014). Complete cervical spinal cord injury above C6 predicts the need for
tracheostomy. The American Journal of Surgery, 207(5), 664-669.
Ruscic, K. J., Grabitz, S. D., Rudolph, M. I., & Eikermann, M. (2017). Prevention of respiratory
complications of the surgical patient: actionable plan for continued process
improvement. Current opinion in anaesthesiology, 30(3), 399.
Sweis, R., & Biller, J. (2017). Systemic complications of spinal cord injury. Current neurology
and neuroscience reports, 17(1), 8.