Mechanical Ventilation Flashcards

1
Q

What is mechanical ventilation?and what does it do?

A

type of therapy that helps you breathe or breathes for you. It improves gas exchange and decreases the work of breathing until the cause is identified and corrected.

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2
Q

What is tidal volume?

What is the normal range?

Risks of tidal volume?

A

volume of air delivered during a ventilator supplemented breath. (amount of air in/out of the lungs during each respiratory cycle.)

normal range = 6-12 ml/kg

high TV = Barotrauma
low TV = Atelectasis

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3
Q

What is FI02?
(fraction of inspired oxygen)

A

the concentration or percentage of oxygen in the air we inhale.
ex. room air is 21%

-FI02 greater than 50% increases the risk of oxygen toxicity.

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4
Q

What is the rate of ventilation?

A

the breaths per minute that is administered to the patient.

  • between 4-20 breaths/min
  • follows the normal respiratory rate of 12-20, anything as low as 4 are going to be extra breaths the patient may need.
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5
Q

What is PEEP?
(positive end-expiratory pressure)

A

the pressure applied to the airway during ventilator exhalation to keep the lungs partially expanded.

  • decreases the amount of FI02 needed.
  • most common is PEEP 5
  • use caution in COPD & ARDS
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6
Q

What is SIMV mode?
(synchronized intermittent mechanical ventilation)

A

preset tidal volume, preset minimum ventilator rate (minimum breaths) in coordination with patient breaths.

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7
Q

What does a high pressure alarm indicate?

A

High Blockage!

(2 PB sandwiches make you SCK)
Pneumothorax
Pulmonary Edema
Biting
Secretions
Coughing
Kinking

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8
Q

What does a low pressure alarm indicate?

A

Loss of connection!
Leaking air!

Cuff leak
ETT displacement
disconnection

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9
Q

What is a normal arterial 02?

A

60-80

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10
Q

What are the two types of NON invasion positive pressure ventilators ?

A
  1. CPAP delivers continuous positive airway pressure to keep the airways open.
  2. BIPAP delivers bilateral positive airway pressure to help patients breath during inspiration and expiration. (first step before intibation)
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11
Q

What is terminal weaning?

A

withdrawing mechanical ventilation when survival of the patient is not expected. It requires a gradual decrease in ventilator settings to do less for the patient.

  • family should be educated on what it will look and sounds like, how they may feel and what is to be expected before the wean begins.
  • the patient should be sedated and comfortable.
  • Life Quest should be called for organ donation several hours prior to weaning.
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12
Q

What are the complications of mechanical ventilation?

A

ventilator associated pneumonia, barotrauma, pneumothorax, pneumomediastinum, cardiovascular and GI complications.

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13
Q

What are the preventions for ventilator associated pneumonia (VAP) ?

A
  • HOB 30 degrees of higher
  • ETT w/ subglotic suction
  • RASS; how awake/how drowsy
  • daily weaning assessments w/ daily sedation weaning (not on paralyzed or unstable pts)
  • daily delirium checks
  • frequent oral care (Q2 hours)
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14
Q

VAP Signs & Symptoms

A

fevers, sudden respiratory distress, increase in WBC, purulent tracheal drainage/secretions, new infiltrates on chest xray.

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15
Q

What is barotrauma and the symptoms?

A

“over inflated lungs” from positive pressure ventilation rupturing the alveolar sacs.
- those with ARDS & COPD are at greater risk.

S/S: SOB, chest pain, increase heart rate, blood pressure and respirations, with a decrease in blood oxygen levels.

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16
Q

What is pneumothorax and the symptoms?

A

abnormal collections of air in the space between the lungs and the chest wall that constricts chest expansion.

S/S: unequal chest expansion, decreased/absent breath sounds, reduced arterial oxygenation, difficulty breathing.

  • decrease tidal volume and insertion of chest tube.
17
Q

What is pneumomediastinum and the symptoms?

A

presence of air in the mediastinum (center on the chest) due to air escaping some where in the body.

S/S: severe chest pain, SOB, subcutaneous emphysema (rice crispy sounds) and a crunching sounds during cardiac cycle.

  • requires a chest tube
18
Q

What are the cardiovascular complications?

A
  • increase in thoracic pressure
  • decrease in venous return (collapsed veins)
  • decreases in cardiac output
19
Q

What are the GI complications?

A
  • stress ulcers
  • opioid constipation
  • decreased nutrition
  • decreased fluids
20
Q

How do we care for a patient on mechanical ventilation?

A
  • frequent oral care
  • pain assessment
  • sedation assessment
  • frequent turning but make sure to group your care and promote rest.
  • monitor vitals and oxygenation status
21
Q

What are signs of distress in a ventilated patient? and what to look for during weaning?

A
  • nasal flaring, increase WOB
  • groaning or LOC
  • pale or sweating
  • restlessness/anxiety
  • abnormal lung sounds
  • wheezing
  • accessory muscle use
  • increased HR, BP, RR
  • decreased SP02
22
Q

Maintaining patent airway:

A
  • lung sounds every 2-4 hours
  • repositioning every 2 hours, bad lung side down is the best.
  • cooled humidification
  • hydration
  • secretion management
  • SP02 trend monitoring
23
Q

Promoting spontaneous ventilation:

A
  • HOB 30 or higher
  • Q2 turning w/ suctioning first
  • ABGs & SP02 monitoring
  • Improve rest and conserve energy
  • supplemental oxygen
24
Q

Enhancing cardiac output:

A
  • maintain SBP >90, MAP >60, and urine output >30
  • Q4 neuro checks
  • Q4 lung auscultation
  • monitor cardiac rhythm
  • I&O, weigh ALL fluid thats leaves the body. (stool, urine, sweat, weeping sounds etc.)
  • daily weights
  • pain assessments
25
Q

Relieving anxiety:

A
  • use informed consent and make sure the patient knows whats going on and understands whats happening at all times, and explain everything you do before you do it.
  • communication tools
  • stay calm and be supportive
  • encourage family visits (unless pt declines)
  • address the pt need ASAP.