Talking to intubated patients make a difference

I’ve taken care of my fair share of intubated patients. But over the last 2 nights, I encountered something different. They went from calm to wild in just a few minutes. If the sedation was down, then I increased that. Normally it works pretty fast.

But it wasn’t so in this case. Both patients were ‘bucking the vent.’ One didn’t have a PRN order ready so for one I had my coworker help me get an order and prepare ativan. But in the meantime, I remember reading critical care nursing journals about the experiences of previously intubated patients. They said to always assume that the patient can hear you. They said that when the nurse talked to them about where they were, what’s going on, and what to do, in a strong confident voice, that the patients felt comforted by that. So that’s exactly what I did.

This patient kept biting down on the tube (which is a big no no because we don’t want a punctured tube!!). “You’re in the hospital and you’re very sick. I’m Jessica, your nurse. Right now you’re having trouble breathing so you have a breathing tube. I know it’s uncomfortable but you need this. Try to calm down and take slow breaths. Open your mouth. Your face is very red but calming down will allow you to breathe better.”

Once I said this, the patient did calm down and opened her mouth.

“Good, your face is looking better and you’re oxygenating better. We are going to turn you to the side to clean you because you had a little accident, ok?”

She was able to cooperate much more at this point. And this happened before giving the ativan. My coworker then came in, administered it (“we’re going to give you something to help you relax now”), and she was at peace again.

Even though she couldn’t focus her eyes and couldn’t follow simple commands, it seems as though what I said did make a difference.

 

Posted in Evidence Based Practice, ICU Nursing, Journal, Nursing.
  • I had a similar experience with my husband. He would fight the vent, so I got right in his face and said the same thing you did, reassuring him I was right there. He would settle down, then I would ask if he hurt, which he usually did. Later, he didn’t remember these events, but I did. After extubation, he felt like his while world was the width of the bed. If I talked to him from “outside” the bed, I was not where he could hear me. Not until I leaned over the bed. I use this information as I deal with ding patients, or very confused ones. I try to get very close to their ear to calm them down, to reassure them.
    Good job.

    • Thank you for your story. I’m glad to hear it from a loved ones perspective. Sometimes people feel so helpless but this helps empower them.