Mechanical Ventilation

Question 1

What is the FIO2

Answer 1

Fraction of inspired oxygen (concentration of O2 the pt is to receive)

Question 2

Tidal volume

Answer 2

Amount of air the ventilator has been set to deliver to the pt with each ventilator breath

Question 3

Respiratory rate

Answer 3

Number of positive pressure breaths the ventilator delivers per minute

Question 4

Continuous mechanical ventilation (CMV)

Answer 4

Standard mode of mechanical ventilation

Ventilator delivers preset tidal volume and RR.
No allowance for spontaneous breaths.
Ventilator not responsive to client (can lead to agitation and asynchrony)

Question 5

Assist/control ventilation (A/C)

Answer 5

Standard mode of mechanical ventilation

Spontaneous inspiratory effort of client triggers ventilator to deliver preset today volume.
If client does not trigger an assisted breath, ventilator delivers breaths at preset RR.

Question 6

Intermittent mandatory ventilation (IMV)

Answer 6

Standard mode of mechanical ventilation

Ventilator delivers preset tidal volume and RR
Client can take unassisted spontaneous breaths between preset breaths.
“Stacking” can occur when voluntary and preset breaths occur simultaneously

Question 7

Synchronized intermittent mandatory ventilation (IMV)

Answer 7

Standard mode of mechanical ventilation

Similar to IMV except preset ventilator breaths are synchronized with client’s spontaneous breaths to avoid “stacking”.
Can develop “stacking” of breaths and asynchrony

Question 8

PEEP

Answer 8

Positive end-expiratory pressure

Preset amount of pressure stays in lungs at *end of exhalation, keeping alveoli open.

Used in conjunction with a standard mode of ventilation

Question 9

Continuous positive airway pressure (CPAP)

Answer 9

Similar to PEEP but for clients who breathe entirely on own
*Keeps airway open all the time

Question 10

Pressure support ventilation (PSV)

Answer 10

Client breathes spontaneously, but ventilator provides a preset level of pressure assistance with each spontaneous breath on *inspiration only

Question 11

NI for increased secretions in airways or mucous plug

Answer 11

Suction as needed

Question 12

NI for client coughing, gagging, or biting oral ET tube

Answer 12

Insert oral airway to prevent biting on the ET tube

Question 13

NI for anxious client who is fighting the ventilator

Answer 13

Provide emotional support to decrease anxiety
Increase flow rate
Explain all procedures
Provide sedation or paralyzing agent as ordered

Question 14

NI for airway size decreases related to wheezing or bronchospasm

Answer 14

Auscultate breath sounds
Consult with physician for management of bronchospasm

Question 15

NI for pneumothorax

Answer 15

Auscultate breath sounds
Consult with physician about a new onset of decreased breath sounds or unequal chest excursion, which may be due to pneumothorax

Question 16

NI for artificial airway is displaced (ET tube may have slipped into right mainstream bronchus)

Answer 16

Assess chest for unequal breath sounds and chest excursion
Obtain chest X-ray film as ordered to evaluate position of ET tube
After proper position if verified, tape the tube securely in place

Question 17

NI for obstruction in tubing because client is lying on tubing or there is water or a kink in tubing

Answer 17

Assess the system, moving from the artificial airway toward the ventilator
Empty water from the ventilator tubing and remove any kinks

Question 18

NI for increased PIP associated with deliverance of a sigh

Answer 18

Consult with respiratory therapist or physical to adjust the pressure alarm

Question 19

NI for decreased compliance of the lung is noted or a trend of gradually increasing PIP noted over several hours or a day

Answer 19

Evaluate the reasons for the decreased compliance of the lungs
(Increase in PIP occurs in ARDS, pneumonia, or any worsening of pulmonary disease)

Question 20

NI for a leak in ventilator circuit which prevents breath from being delivered

Answer 20

Assess all connections and all ventilator tubings for disconnection

Question 21

NI for client stops spontaneous breathing in the SIMV or CPAP mode or on pressure support ventilation

Answer 21

Evaluate the client’s tolerance of the mode

Question 22

NI for a cuff leak occurs in th ET or tracheostomy tube

Answer 22

Evaluate the client for a cuff leak (suspected when the client is able to talk b/c air escapes from mouth or when the pilot balloon on the artificial airway is flat)