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Critical Care and Emergency Nursing > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

ventilation/perfusion (v/q)

A

air going in and out of lung/ blood circulating to area of lung

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2
Q

V/Q in top areas of lung

A

higher ratios because there is more ventilation in the upper portions of the lung and less perfusion –> higher oxygenation

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3
Q

V/Q in lower areas of lung

A

lower ratios because more perfusion but less ventilation (can’t saturate area of perfusion) –> less oxygenation

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4
Q

V/Q mismatch

A

certain areas of the lung have high v/q ratios and some have low v/q ratios; most common cause of hypoxemia; will respond to 100% O2 and has an increased Aa gradient

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5
Q

possible causes of V/Q mismatch

A

pneumonia, PE, COPD, asthma, pulmonary HTN, fibrosis

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6
Q

pulmonary shunting

A

does not respond to 100% O2; increased Aa gradient

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7
Q

O2-Hgb Dissociation curve

A

relationship b/t PaO2 and % saturation of Hgb

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8
Q

shift of curve to the right

A

more difficult to pick up at lung but easier to drop off at tissues; causes: decreased pH, increased pCO2, hyperthermia, chronic hypoexemia

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9
Q

shift of curve to the left

A

easier to pick up at lung but more difficult to drop off at tissues; causes: increased pH, decreased pCO2, hypothermia, banked blood

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10
Q

normal pH

A

(acd.) 7.35 - 7.45 (alk.)

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11
Q

normal PaO2

A

80-100%

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12
Q

normal PaCO2

A

(alk.) 35-45 (acd.)

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13
Q

normal HCO3

A

(acd.) 22-26 (alk.)

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14
Q

SLOPE for intubation: S

A

Suction, syringe, stethoscope, sedation, stylet

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15
Q

SLOPE for intubation: L

A

lubricant, laryngoscope

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16
Q

SLOPE for intubation: O

A

oxygen

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17
Q

SLOPE for intubation: P

A

patient positioning, pressure

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18
Q

SLOPE for intubation: E

A

ETT, end-tidal CO2

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19
Q

cuff pressure

A

20-25 mmHg; want the cuff inflated enough to prevent aspiration but not too inflated where it could lead to tracheal necrosis; check Q6-8hr

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20
Q

ETT care

A

verify placement by auscultation, EtCO2 and x-ray, secure the tube, monitor position (cm marking), suction only PRN, monitor for skin breakdown, prevent dislodgement, monitor cuff pressure (q 6-8hr), ambu bag at bedside

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21
Q

ETT suctioning

A

make sure pt is stable first, no more than 10 seconds, no more than 3 attempts; no difference b/t intermittent and continuous suctioning on closed system like this, nurses will probably continually suction upon withdrawal; no more than 120 mm of suction

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22
Q

ETT complications on insertion

A

nasal, oral, pharyngeal, or hypopharyngeal trauma, vomiting with aspiration, cardiac arrest

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23
Q

ETT complications while in place

A

nasal/oral inflammation and ulceration, sinusitis/otitis, larygneal and tracheal injuries, tube obstruction and displacement

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24
Q

oral hygiene importance

A

very vulnerable to develop VAP, more bacteria in mouth

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25
Q

VENTS: V

A

View, monitor ABGs, airway, and resp. status

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26
Q

VENTS: E

A

Elevate HOB 30 degrees, Equipment at bedside (ambu bag and suction)

27
Q

VENTS: N

A

Notice GI complications (stress ulcers), Nutritional needs

28
Q

VENTS: T

A

Take note of settings and alarms

29
Q

VENTS: S

A

Suction tracheal tube, Secretions, Self-protection, Soft wrist restraints

30
Q

ETT obstruction

A

bite block, sedation, suction, humidify, replace

31
Q

ETT displacement

A

secure, restrain, sedate, support tubing, replace

32
Q

ETT fistula/stenosis

A

cuff inflation, monitor cuff pressure, tracheostomy

33
Q

ETT skin breakdown

A

loosen tube holder at least q24hr and change sides, inspect skin

34
Q

ETT related infection

A

use sterile technique

35
Q

reasons for mechanical ventilation

A

acute respiratory distress, surgery, post-surgery, OD, sedation, head trauma

36
Q

negative pressure ventilators

A

not seen often, might be on someone with muscular dystrophy; applied externally to pt and decreases the atmospheric pressure surrounding the thorax to initiate inspiration

37
Q

positive pressure ventilators

A

uses a mechanical drive mechanism to force air into the pt’s lungs through an ETT or tracheostomy

38
Q

assist-control mode

A

all breaths are mandatory, triggered from either the pt or the machine; if pt initiates breath, the full volume set on vent will be given

39
Q

synchronized intermittent mandatory ventilation (SIMV) mode

A

set minimum rate and tidal volume, pt able to breathe spontaneously b/t mandatory breaths; the breaths initiated by the patient would be whatever volume they can do - not the set amount from the vent

40
Q

Spontaneous mode

A

(CPAP or PSV) all breathing is determined by the patient, there is no “trigger mode” offered by machine

41
Q

controlled breath

A

ventilator does all the work, pt does nothing

42
Q

assisted breath

A

pt initiates breath and the ventilator takes over

43
Q

supported breath

A

pt able to do some or most of the work but the ventilator assists to finish (like pressure support)

44
Q

pressure control

A

preset pressure limit, delivered volume variable depends on pt’s compliance

45
Q

benefits to pressure control

A

airway pressure limited, and prevents damage to alveoli

46
Q

cons to pressure control

A

if resistance rises or compliance falls in the pt’s airway or chest wall, the set pressure limit remains the same, but the delivered tidal volume fails

47
Q

Pressure regulated volume control (PRVC)

A

volume and pressure control, delivered over a set time; constant pressure applied throughout inspiration regardless of whether breath is control or assist breath; vent will adjust pressure as needed r/t airway resistance and compliance changes

48
Q

CPAP

A

spontaneously breathing pt; gives continuous positive airway pressure to keep alveoli open to maximize oxygenation

49
Q

BIPAP

A

2 levels of positive airway pressure; inspiratory pressure (IPAP) would be a higher level and the pt would be given lower pressure during expiration (EPAP)

50
Q

normal vent rate

A

12-20

51
Q

normal tidal volume

A

5-7ml/kg

52
Q

normal FiO2

A

40-100%

53
Q

normal PEEP

A

5-10

54
Q

high pressure alarm causes

A

anything causing vent to have to work harder to give the set volume; decreased lung compliance, increased secretions, bronchoconstriction, kinked circuit

55
Q

low pressure alarm causes

A

something making it easier to give set volume than it should be; disconnection, significant airleak, extubation

56
Q

minute ventilation

A

RR x TV

57
Q

weaning off vent parameters

A

VC 10-15ml/kg
TV 7-9ml/kg
PaO2 greater than 60 on an FiO2 of less than 40%

58
Q

extubation

A

HOB 75 degrees, hyperoxygenate, suction oral cavity, deflate and remove cuff, encourage to cough, suction PRN, monitor closely and encourage vocal rest, monitor ability to cough and swallow

59
Q

vent recommendation with respiratory acidosis

A

increase respiratory rate to blow off the excess CO2

60
Q

complications of mechanical ventilation

A

infection, positive fluid balance, pt discomfort, and psychosocial

61
Q

benefits of sedation

A

decrease anxiety, amnesia, reduce tissue O2 consumption, improve vent synchrony

62
Q

preventing VAP

A

hand hygiene, oral care, HOB 30-40 degrees, suction only PRN, cover yankauer cath when not used, adequate ETT cuff pressure, d/c NGT asap, subglottic suctioining prior to repositioning or deflating cuff

63
Q

when to hold tube feedings

A

if residual more than 150cc

Critical Care and Emergency Nursing (4 decks)

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