Neuromuscular Compromise and Respiratory Failure — Core Patient Assessment and Planning — Clinical Pathway: Inpatient and PICU

Neuromuscular Compromise and Respiratory Failure Clinical Pathway — Inpatient and PICU

Core Patient Assessment and Planning: Consults, Nursing Considerations, Nutrition, Postoperative Care, Initial Respiratory Assessment

Upon arrival to the patient care area, an assessment should be made of the patient’s respiratory status. This assessment will inform the nutrition plan. Encourage the family to bring in home equipment — particularly seating devices such as wheelchairs.

For the Post-operative Patient

Provide treatments within one hour after returning from surgery.

Continue Q4 hours until the following morning (postoperative day #1) and reassess for treatment schedule to return to baseline.

Nursing and Respiratory Considerations

Domain Recommendations Rationale
Respiratory – Noninvasive Ventilation (NIV) Assessment
  • Rotate interface per policy
  • Notify clinical team if unable to rotate interfaces
  • If patient requires an increase in FiO2, notify respiratory therapist to assess the need for secretion clearance
  • If traveling to any diagnostic or therapeutic procedure, a respiratory therapist should stay with the patient to monitor NIV synchrony and respiratory status during the procedure
  • Avoid full face (unless home interface) and oral interfaces to facilitate suctioning of oral secretions
  • The patient should be monitored closely during procedures that require removal of NIV interfaces
Skin and Positioning
  • Patients are unable to reposition themselves, increasing the risk for skin breakdown
  • Bulbar and swallowing dysfunction increase the risk for secretion pooling
Consults
  • Physical Therapy (PT)
  • Occupational Therapy (OT)
  

Nutrition

See PICU/PCU Nutrition Pathway

After admission, a full nutritional assessment and plan should be established to include:

  1. Weight upon admission, then every Monday, Wednesday, and Friday
  2. Consult Clinical Nutrition if concerns with poor PO, weight loss, or on enteral feedings. Indicate if Dietician needs to evaluate patient within 24-72 hours in the consult
  3. Assess home nutritional regimen (PO feeds versus G-tube)
  4. Nutrition is vitally important for these patients. Evaluate NPO time and if projected > 6 hours:
    1. Consider  NG, ND, or NJ placement for continuous feeds (if G-tube/fundoplication not in place). See ND Placement Policy.
      Or
    2. Consider central venous line (CVL) for TPN
  5. Limit NPO time for peri-procedure to no greater than 6 hours
    See NPO Guidelines — Enteral Intake Timing Before Procedures
  6. While NPO, consider gastric decompression (Salem sump or G-tube to chimney/vent)
  7. Initiate bowel regimen (restart home if possible):
    1. When starting enteral feeds to diminish gastric slowing due to sedatives and minimize abdominal competition
    2. Consider increased dosing as needed