Exam 1 - Mechanical ventilation

Question 1

Complications that can occur with mechanical ventilation

Answer 1

• Decreased cardiac output
• Sodium and water balance
• GI bleeding
• VAP
• Alveolar hyperventilation/hypoventilation
• Inability to wean from vent
• Tracheal necrosis
• Pneumothorax

Question 2

• Positive end-expiratory pressure – extra pressure is added at exhalation that keeps the alveoli open a little bit longer for gas exchange
• Started at 5 cm

Answer 2

PEEP

Question 3

• Continuous positive airway pressure

* Use on vent or just a mask– tight mask forcing O2 continuously

Answer 3

CPAP

Question 4

• Bi-level positive airway pressure
• Continuous O2 fluctuates between high and low pressure
• Good for weaning

Answer 4

BiPAP

Question 5

Best measure of ventilation

Answer 5

PaCO2

Question 6

If PaCO2 is elevated, what does it indicate?

Answer 6

Poor ventilation and respiratory effort

Question 7

If PaCO2 is low, what does it indicate?

Answer 7

Hyperventilation

Question 8

What does a low exhaled volume alarm mean?

Answer 8

No pressure - free flowing

Loss of tidal volume - could be due to an air leak, dislodged tubing

Question 9

What does a high pressure alarm mean?

Answer 9

Hard time getting air in d/t resistance
Increased airway resistance - could be d/t mucus plug, tension pneumothorax, pt fighting vent by coughing
Can occur when weaning

Question 10

Interventions for vent management

Answer 10

o Monitor pt and vent settings and lungs q2h
o Offer forms of communication and stress reduction techniques
o Monitor for signs of bleeding
o Maintain adequate nutrition
o Mouth care q2h
o Correct cuff pressure (minimal leak technique)
o Suction PRN
o Tube placement – check at lip
o Monitor fluid balance
o ABGs – usually done q4h
o Position – turning q2h, HOB 30 degrees, ROM

Question 11

Nutrition concerns for pt on vent

Answer 11

Carbohydrate load is a concern because metabolism of carbs results in increased CO2 production

Question 12

Enteral feeding Pulmocare

Answer 12

High in fat and protein, low in carbs
Keep HOB up when receiving tube feedings
Check gastric residuals

Question 13

Criteria for weaning off vent

Answer 13

• Must be capable of maintaining spontaneous respirations
• Must have a vital capacity of 10/15 mL/kg
• Minute ventilation of 6 mL/min
• No hypotension
• No tachycardia
• Hemodynamically stable

Question 14

Education for vent

Answer 14

Stress reduction techniques

Teach about vent to family