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Critical Care > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

(68 cards)

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1
Q

Mechanical Ventilation purpose

A

support respiratory system until underlying cause of RF is corrected

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2
Q

Mechanical Ventilation indication

A
  1. pt cannot maintain ventilation
  2. pt with acute respiratory failure based off ABGs
  3. life saving therapy while tx plan is put in place
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3
Q

respiratory failure definition

A
  1. PaO2 < 60 mmHg with FiO2 on 0.5
  2. PaCO2 50 mmHg with pH < 7.25
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4
Q

Nurse role

A
  1. provide continuous monitoring
  2. prevent complications
  3. monitor equipment
  4. provide emotional support
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5
Q

Negative pressure ventilation

A

created the thoracic cavity expands , provides pulling on external chest wall

**can be done outpatient

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6
Q

Positive Pressure ventilation

A

pushes air into lungs causing alveoli to participate in gas exchange

**ET tube and tracheostomy

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7
Q

Exhalation remains passive…

A

in pressure cycled ventilators , delivers air into lungs until preset air pressure is reached

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8
Q

supraglottic airway

A

laryngeal mask airway

**used temporary
**quick intubations

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9
Q

CO2 detector

A

used after intubation , turns purple to yellow

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10
Q

volume cycled ventilators

A

deliver air into lungs until preset volume is reached , volume remains constant

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11
Q

FiO2

A

amount of oxygen patient receives from the vent

-can be started at 100% then decreased

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12
Q

FiO2 range

A

21-100%

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13
Q

FiO2 goal

A

maintain PaO2 > 60 mmHg and SaO2 90-92%

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14
Q

Rate (f)

A

number of respirations pt receives per minute

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15
Q

rate range

A

8-12 breaths

-can gradually decrease when pt spontaneously breaths

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16
Q

breathing documentation

A

need to document both ventilator breaths and spontaneous breaths

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17
Q

Tidal Volume (Vt)

A

amount of preset volume delivered with each breath

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18
Q

Tidal volume range

A

4-10 mL / kg

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19
Q

based on patients ideal body weight

A

tidal volume

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20
Q

lower tidal volume…..

A

used with ARDS to avoid barotrauma

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21
Q

PEEP

A

holds alveoli open , positive pressure applied at end of expiration

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22
Q

PEEP range

A

5-20 cm H2O

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23
Q

PEEP modes

A

AC and SIMV or Pressure Controlled vent

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24
Q

PEEP adverse effects

A

increase intrathoracic pressure –> decrease CO –> decrease venous return , volutrauma , barotrauma , increase ICP

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25
Pressure Support
extra push of air during spontaneous breathing -pt initiates breath , more PS applied larger the breath
26
pressure support range
5-20 cm H2O
27
Flow
velocity of gas flow per min
28
PIP
maximum pressure that occurs during inspiration
29
PIP range
should remain < 35
30
PIP DANGER LEVEL
should never be above 40
31
PIP increasing
1. secretions 2. bronchospasm 3. biting ETT 4. pulmonary edema 5. ARDS 6. pleural disease
32
minute ventilation (Ve)
amount of air delivered / min
33
minute ventilation formula
Ve = Vt x f
34
Assist Control Ventilation ( AC )
used for weak respiratory muscles and pts cannot maintain adequate ventilation -NO PRESSURE SUPPORT -pt does not initiate breath -allows workers to take complete control of breathing
35
AC complication
respiratory alkalosis -increased CO2 delivery -hyperventilation
36
AC modes
PEEP Vt rate FiO2
37
SIMV
used for patients being weaned from the vent and who need some assistance to maintain ventilation -HAS PRESSURE SUPPORT -synchronizes with patient breath
38
SIMV modes
rate Vt FiO2 PEEP PS!!!
39
Pressure Support
mode is used for weaning or Spontaneous breathing trials
40
pressure support used with....
CPAP and SIMV
41
PS modes
FiO2 PEEP PS
42
Mechanical Ventilation complications
1. Hypotension 2. Infection 3. Barotrauma 4. Aspiration 5. Ventilator assisted pneumonia
43
Hypotension w/ vent
increased intrathoracic pressure decreasing venous return to R side of heart --> decreased CO **SEDATIVES CAN CONTRIBUTE
44
Ventilator infection
defense systems of respiratory tract are bypassed , ETT is direct source to the lungs
45
Ventilation Barotrauma
lung injury , due to overdistension of alveoli --> tension pneumothorax
46
tension pneumothorax
prepare for chest tube insertion to release trapped air
47
Ventilator aspiration
keep HOB 30-45 degrees
48
ventilator assisted pneumonia
typically develops 48 hours after intubation -result from aspiration / gastric contents
49
high pressure alarms
mucous plug / secretions patient biting ETT pneumothorax pt anxiety kink in tubing water collected in vent tubing
50
low pressure alarms
cuff leak deflated cuff (leak in vent circuit) pt stops breathing OR decreased breathing
51
weaning mechanical ventilation
patient should demonstrate cause of RF is reversed
52
indications for weaning
1. breathe spontaneously 2. adequate oxygenation 3. hemodynamic stability
53
criteria for weaning
1. RF cause reversed 2. pH > or = 7.25 3. PEEP < or = 5-8 cm H2O 4. FiO2 < or = 0.4 - 0.5 5. PaO2 / FiO2 > 150 -200 : really MUCH greater 6. hemodynamic stability
54
pH level for weaning
> or equal to 7.25
55
PEEP for weaning
5-8 cm H2O
56
FiO2 / PaO2 for weaning
> 150 - 200 really need MUCH HIGHER
57
FiO2 for weaning
0.4 - 0.5 %
58
FiO2 / PaO2 ratio
need to divide PaO2 by FiO2
59
modes for weaning
1. Pressure support 2. T-piece 3. CPAP
60
pressure support weaning
gradual reduction in 2-5 cm H2O , gradually lengthen time intervals -discontinue when pt is stable for 2 hours or longer at 5cm H2O
61
t-piece weaning
provide humidified oxygen attached to ET tube start as short as 5 minutes REST PERIOD 6-8 hours -discontinue when pt stable for 2 hours
62
CPAP weaning
patient performs all WOB CPAP of 5cm H2O start with trial for 5 min REST PERIOD 6-8 hours -discontinue when patient for 2 hours
63
last option before ventilation
BiPAP
64
extubation complications
1. reintubation 2. aspiration 3. airway obstruction s/s
65
reintubation
have intubation tray at bedside
66
aspiration
COUGH W/ TUBE REMOVAL
67
airway obstruction
stridor dyspnea cyanosis coughing dyspnea laryngospasm swelling
68
ventilation care
suction HOB 35-45 degrees sedation vacation DVT prevention oral care clorahexadine peptic ulcer prevention

Critical Care (15 decks)

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