Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR5926 > - MECHANICAL VENTILATION (CLINICAL) - > Flashcards

- MECHANICAL VENTILATION (CLINICAL) - Flashcards

1
Q

Discuss Synchronised Intermittent Mandatory

Ventilation (SIMV)

A
  • pre-set number of breaths to a pre-set TV
  • pt can initiate spontaneous breaths
  • volume is dependant on pt effort, will not top up breaths
  • manditory breaths are synchronised with spontaneous breaths (therefore controls RR and MV)
  • less likely to have resp alkalosis
  • not filling as much which reduces cardiac comprimise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Discuss assist / control (A/C)

A
  • pt able to trigger spontaneous breaths but manditory breaths are not synchronised
  • will top-up breaths to a pre-set volume
  • increases RR and MV massively and thus resp alkalosis
  • PEEP and FRC increase and thus decrease in CO2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Discuss Controlled Mandatory Ventilation (CMV)

A
  • ventilator doing all the WOB (no spontaneous breaths (pt heavily sedated and paralysed)
  • pre-set RR and TV
  • lets respiratory muscles rest (can have muscle atrophy when weaned)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Discuss Volume cycling

A
  • constant inspiratory flow that gradually increases in pressure with inspiration
  • works up to a pre-set TV and inspiratory time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Discuss Pressure cycling

A

. - constant inspiratory pressure that gradually increases

- works up to a pre-set inspiratory pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define pressure support (PS), and identify when PS is an appropriate intervention

A
  • breath-by-breath ventilatory support by means of a positive pressure
    wave synchronized with the inspiratory effort of the patient, both
    patient-initiated and patient-terminated
  • to a limited pressure
  • usually used to weane patients from ventilator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define positive end expiratory pressure (PEEP), and identify when it is appropriate to use PEEP

A
  • Positive end-expiratory pressure (PEEP) is the pressure in the lungs above atmospheric pressure that exists at the end of expiration. It works to recruit alveoli, reduce WOB and increase FRC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define Tidal Volume and discuss how it is determined

A

Volume of gas moving in and out of the lungs during inspiration and expiration
- Normal = 6-8mls/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define Minute volume and discuss how it is determined

A

Volume of gas inhaled or exhaled

- RR X TV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define rate/frequency and discuss how it is determined

A
  • Vitals
  • Blood gas
  • Physiological cause for intubation
  • Co-morbid conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define inspiratory flow rate/pattern and discuss how it is determined

A
  • Vitals
  • Blood gas
  • Physiological cause for intubation
  • Co-morbid conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define pressure/flow sensitivity and discuss how it is determined

A
  • Physiological cause for intubation
  • Co-morbid conditions
  • trouble shooting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define FiO2 and discuss how it is determined

A

The concentration of oxygen in the air/gas that a person inhales.

RA: 0.21

NP:
1 - 0.24
2 - 0.28
3 - 0.32
4 - 0.36
5 - 0.40
6 - 0.44

HM:
5-10 - 0.4-0.6

Non-rebreather:
5-10 - 0.4-1.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define inspiratory/expiratory ratio and discuss how it is determined

A

Duration of inspiration : duration of expiration in seconds (usually 1:2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Discuss the physiological effects of mechanical ventilation

A

CNS: increased ICP
CVS: impaired cardiac function due to increased ITP, reduced RV preload and afterload
RESP: Resp alkalosis, barotrauma
GIT: Gastric distention
RENAL/HEPATIC: elevation in ADH and aldosterone, reduction in renal funtion and renal blood flow,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Outline the possible complications related mechanical ventilation

A

Airway:
- Aspiration
- Ventilator-acquired pneumonia (VAP)
Breathing:
- Lung injury (barotrauma)
- Atelectasis (from hypoventilation)
- Hypocapnia and Resp Alkalosis (resulting in hypervent)
- Hypercapnia and resp acidosid (hypoventilation)
Systemic:
- Hyperthermia (from overheated inspired air)
- Decrease CO and BP
- Fluid over load
- Resp muscle weakness and atrophy
- Complications of immobility (e.g. PIs)
- GIT issues (paralytic illeus, stress ulcers, distention)

17
Q

Discuss the alarm settings for peak inspiratory pressure and how to troubleshoot it

A
  • Normal PIP ~ 10-20cmH2O
  • High PIP indicates airway resistance
  • Caused by:
    - Secretions, coughing, gagging
    - Kinked or compressed tubing
    - Condensate in tubing
    - Increased resistance from pt (bronchospasm)
    - ETT displacement
    - obstruction of foreign material
    - Decreased compliance
    - Lung collapse, APO, coughing
18
Q

Discuss the alarm settings for low minute volume and how to troubleshoot it

A 
- Low MV alarm: 10-15% below average MV
Check for cause:
 - Patient disconnected
 - Leak in circuit
 - Cuff Leak
 - Chest tube leak
 - Flow sensor malfunctioning
 - Inappropriately set alarm
19
Q

Discuss the alarm settings for high minute volume and how to troubleshoot it

A 
- 10-15% above average MV
Check for cause
 - pt demmand increased
 - Ventilator auto triggering (too sensitive)
 - External nebuliser
 - flow sensor malfunctioning
 - inappropriate alarm settings
20
Q

Discuss the alarm settings for apnoea and how to troubleshoot it

A
  • ?? 10 sec
  • Is it an actual apnoeic episode
  • alarm setting inappropriate
  • ventilator insensitive to pt effort
  • leak
  • flow or pressure sensor faulty
21
Q

Demonstrate the ability to accurately interpret arterial blood gases and make appropriate changes to ventilation to optimize gas exchange

A

Resp acidosis or high PaCO2:

  • increase IPAP/PS
  • increase RR
  • reduce FiO2 in COPD
  • ensure EPAP>4

Low PaO2:

  • increase EPAP/PEEP
  • Adjust FiO2
  • increase inspiratory time (?inverse I:E ratio)
22
Q

Discuss considerations when ventilating obstructive lung disorders. e.g. Asthma/COAD

A

Asthma + COPD —-> Obstructive

  • Increase expiratiory time
  • decrease RR
  • fast flow
  • no unecessary inspiratory pauses
  • decrease tidal volumes if plateau pressure is rising
  • Permissive hypercapnia
  • Aim for MV approx 6L/min
23
Q

Discuss considerations when ventilating infective lung disorders e.g. pneumonia

A

Pneumonia —-> Restrictive

  • increase inspiratory time
  • look at pts position
  • Reduce peak inspiratory pressures
  • change to pressure control
  • work with PEEP to recruit alveoli
  • Permissive hypercapnia
24
Q

Discuss considerations when ventilating Raised ICP e.g. head injury

A
  • PC-CMV and PEEP can increase ICP (only have if necessary to reduce hypoxaemia)
  • cautious of hypoxaemia
  • suctioning and coughing can increase ICP , but essential
25
Q

Discuss considerations when ventilating paediatric patients

A
  • Small diameter airway
  • Large tongue
  • Relatively large occiput
  • Infants are nose breathers
  • Ensure correct positioning to open airway
  • Trachea more cartilaginous and soft
  • Larynx higher and more anterior
  • Glotis narrowest part airway
  • Huge implications for intubation

NUR5926 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions