Mechanical Ventilation Flashcards
(64 cards)
1
Q
Desired Outcomes for patients on Mechanical Ventilators
A
- Client will reestablish/ maintain effective respiratory pattern via ventilator with absence of accessory muscle use
- Arterial blood gases are within normal range
- Breath sounds are CLEAR.
2
Q
2 types of INVASIVE application of mechanical ventilation support
A
- Tracheostomy
- Endotracheal intubation
3
Q
3 Modes of Ventilation
(how breaths are delivered)
A
- Controlled ventilatory support
- Assisted ventilatory support
- CPAP
4
Q
Ventillator does ALL work of breathing
A
Controlled ventilatory support
5
Q
Controlled Ventilatory Support:
Pt’s usually need to be ___.
A
sedated
6
Q
Ventilator & patient SHARE work of breathing
A
Assisted Ventilatory Support
(ie. SIMV)
7
Q
Which ventilator support is used to WEEN patients off.
A
Assisted Ventilatory Support
8
Q
- Patient breathing on their own
- positive pressure maintained
A
CPAP
for test, CPAP is ONLY used for sleep apnea
9
Q
Ventilator Settings:
Rate setting is set to
(breaths per min)
A
10-12
10
Q
What is Tidal Volume (Vt)
A
Amount of air moved in & out of the lungs with each breath during normal, RELAXED breathing.
11
Q
Normal range of Tidal Volume (Vt)
A
6-10 mL/kg
12
Q
What is FiO2?
A
Percentage (%) of O2 a person breathes in
- tells us how much oxygen is in the air someone is breathing. Normal room air has about 21% oxygen, but if someone needs extra oxygen, like with a mask, the FiO2 can be higher. It’s important in healthcare to know how much oxygen is being given to help a patient breathe better.
13
Q
Room air FiO2
A
21%
14
Q
FiO2 usual setting on Ventilators
A
50-65%
(ventilator is always more than room air)
15
Q
Whats the highest % of FiO2 can be given?
A
- Up to 100% may be given- if needed!
16
Q
With ventilated patient, what is the PaO2 goal?
A
PaO2 > 60
- Norm PaO2: 80-100 mmHG
17
Q
With ventilated patient, what is the SpO2 goal?
A
SpO2 > 92%
(pulse ox)
18
Q
Why are Ventilator goals lower than ABGs?
A
- Prevent O2 toxicity
- Ventilator pts are at higher risk of O2 toxicity
19
Q
What is PEEP (Positive End-Expiratory Pressure)
A
- A setting on the ventilator
- Used to keep alveoli open at the end of expiration to prevent atelectasis
20
Q
Common setting of PEEP
A
5cm H2O
21
Q
Setting of PEEP for patients with ARDS
(Acute Respiratory Distress Syndrome)
A
40cm H2O
22
Q
Is Oxygen a drug?
A
YES
23
Q
Overexposure of O2 leads to
A
O2 toxicity
24
Q
High risk patients for O2 toxicity
A
- Mechanically ventilated patients receiving high levels of FIO2 for prolonged periods of time are at increased risk.
- Specifically those on 50% FIO2 for >24 hours
25
*FiO2 levels*:
**Goal level** for **SpO2**
SpO2 > 92%
26
*FiO2 levels*:
**Goal** level for **PaO2**
PaO2 **between** 60 and 90 mm Hg.
27
What is an **important nursing action** when managing patients on high levels of oxygen?
**Regularly** assess arterial blood gases (ABGs) for signs of excess O2.
* Main ones: PaO2 & FiO2
-FiO2 not an ABG
28
S/S of **O2 toxicity**
* **Substernal discomfort**- *pain behind sternum*
* Restlessness
* Fatigue
* Malaise
* **Progressive respiratory difficulty**
* **Refractory hypoxemia**- *low O2 despite receiving O2*
29
6 Nursing Managements for Artificial Airway
1. Maintain Correct Tube Placement
2. Maintain Proper trach cuff Inflation
3. Monitor O2 and Ventilation
4. Maintain Tube Patency: *clear secretions **as needed***
5. **Provide Oral Care and Skin Care**
6. Foster Comfort and Communication
30
Oral care should be performed every __.
2-4 hrs
31
15 **Daily care** steps to be performed for ventilated patients
* Continuous Monitoring of Pulse Oximetry
* Check Settings against physician’s orders.
* Alarm Functionality- *NEVER turn off alarms; they must be audible at the nurse’s station*
* Assess endotracheal tube (ETT) Placement
* Auscultate Breath Sounds Q2 hrs & if distressed
* Ensure Secure Placement of ETT
* Maintain NG Tube if present
* Ensure Adequate Nutrition
* **Suction as Needed ONLY**!!!
* Assess for Pressure Ulcers on Lips and Tongue
* Rotate Tube Placement
* Provide Oral and Lip Care
* Sedate as needed
* Monitor Condensation in Tubing
* Monitor Intake and Output (I & O)
32
What is an important guideline regarding **suctioning** patients on ventilators?
* Do not routinely suction patients
* Assess the need first.
33
What **signs** will let you know patient needs suctioning?
List 7
* Visible Secretions in ET Tube
* Sudden onset of Respiratory Distress
* Suspected Aspiration of Secretions
* Increased Respiratory Rate: *with or without sustained coughing.*
* Sudden Decrease in SPO2
* Increased Peak Airway Pressure in Ventilator
* Adventitious Breath Sounds
34
When the ventilator alarm sounds what is the **1st thing you do**?
Assess the patient
35
**2nd thing to assess** when ventilator alarm sounds and **patient is okay**.
Check connections. Usually the #1 issue
36
**First connection** you will check.
pulse oximetry (SpO2) reading.
37
What should you do if a patient’s **SpO2 decreases significantly**?
Connect to a **bag-valve mask (BVM)** and **ventilate manually.**
-*technique used in CRITICAL emergencies when pt is not breathing ADEQUATELY or AT ALL.*
-*provides HIGH concentration of O2*
38
*Ventilators alarms*:
* If unable to resolve the situation...
call for immediate assistance.
39
**4 Types** of **Ventilator Alarms**
1. High-Pressure Alarms
2. Low-Pressure Alarms
3. High Respiratory Rate
4. Apnea Alarm
40
What causes **High-pressure Alarms** to go off?
indicates machine is encountering resistance when trying to deliver air to the patients lungs.
* **secretion buildup**
* **kinked tubing**
* **bronchospasm**: *sudden tightening of the muscles around airway- causing narrowing*
* **coughing**
* **decreased lung compliance**: *pulmonary edema, atelectasis, ARDS*
* **biting on ET tube**
* **condensation**: *can block airway*
41
What causes **Low-pressure Alarms** to go off?
Pressure needed to deliver air to the pt’s lungs is below expected level. Common causes include:
* disconnection
* loose fittings
* a leaking airway
* loss of airway (*partial/complete **dislodgement** from trachea*
42
Causes of **High RR alarms**
* anxiety
* pain
* hypoxia
* fever
43
What does an **apnea alarm indicate**
alerts clinicians that the patient is **not initiating breaths**. Due to :
* oversedation
* airway loss (extubation)
44
What is this called?
Endotracheal intubation
45
What should be monitored during **patient movements** in those with **endotracheal tubes (ETT)**?
The **exit mark** on the ETT should **remain consistent** during any movements to ensure proper tube placement.
46
*Endoctracheal Tubes*:
What 2 assessmnts confirm **proper ventilation** of patients?
1. **chest symmestric** in **movement** during ventilation
(*confirms that both lungs are receiving air evenly*)
2. bilateral **breath** sounds
(*indicate that air is reaching both lungs*)
47
*Endoctracheal Tubes*:
**How long** should you wait **AFTER** making changes in ventilator settings BEFORE reassessing?
Wait 20-30 minutes
* *gives the body time to adjust to new settings or interventions.*
48
**4 most important settings** that need to be **reassessed AFTER ventilator changes**.
1. **Blood pressure!!!**: *mechanical ventilation increases intrathoracic pressure which affects BP and CO* **
2. Arterial Blood Gas Analysis (ABGs)
2. SpO2 Measurement
3. End-Tidal Carbon Dioxide Readings (*proper CO2 eliminations*)
49
What is the **most common and serious complication** of mechanical ventilation?
**know**
**Ventilator-Associated Pneumonia** (VAP)
* *bacteria enter the lungs via the ventilator, leading to infection*.
50
What 3 factors **increase the risk** of developing Ventilator-Associated Pneumonia (VAP)
* Prolonged time spent on a ventilator
* extended length of ICU stay
* extended stay in hospital AFTER ICU.
51
**How long AFTER ET intubation** does the risk or **VAP** occur?
48 hours or more
52
5 **S/S** of Ventilator-Associated Pneumonia (VAP)
**know**
* Fever
* Elevated WBC count
* Purulent/odorous sputum
* Crackles or rhonchi
* **Pulmonary infiltrates on CXR**
53
What is a **key strategy** for preventing **Ventilator-Associated Pneumonia (VAP)**?
Follow a **Ventilator Care Bundle**.
* *evidence-based practices designed to reduce the risk of VAP*
54
What are the **steps** of the **ventilator care bundle**?
6 steps
* **Elevate head of the bed 30-45 degrees**.
* **Practice daily sedation vacations and assess readiness to wean from the ventilator**.
* **Perform regular oral care with chlorhexidine 0.12%**
* **Hand hygiene**
* **DVT propylaxis**: *enoxaparin (prevent the formation of blood clots), Q12 hrs, SCV's*
* **Peptic ulcer prophylaxis**:*reduces GERD -> reduces acid -> reduces aspiration*
**know**
55
What are the **STRICT infection control measures** to **prevent VAP**?
List 5
1. Strict hand washing
2. **Use of sterile technique during endotracheal (ET) suctioning.**
3. Frequent oral hygiene.
4. **Change** ALL **oral and suction equipment tubing every 24 hours**.
5. After each use, **rinse** **non-disposable** oral suction tools **with sterile normal saline** and place them on a dry paper towel.
56
Do we encourage ventilated patients to move?
yes, patients should move early to help with breathing.
57
What feature do most endotracaheal tubes have to fascilitate **suctioning** & help prevent VAP in ventilated patients?
Subglottic drainage ports
* included in certain types of endotracheal tubing
* removes secretion that accumulate ABOVE the cuff of tube.
58
If endotrach tube has no subglottic drainage port, we will manually suction what 2 sites?
1. oral cavity
2. pharynx (throat)
(suction only as needed)
59
When do we change the ventilators tubing?
Don’t change ventilator tubing **unless necessary** to reduce infection risk.
* *Changing ventilator tubing frequently can introduce bacteria and increase the risk of infections, such as Ventilator-Associated Pneumonia (VAP)*
60
Drain water in ventilation tubing ___ from patient.
away
- prevent aspiration
61
What are the **criteria for determining readiness for weaning** from mechanical ventilation?
List 4
* Resolving the underlying condition.
* Stable hemodynamics
-*no myocardial ischemia (low blood flow to heart) or hypotension*
* Adequate oxygenation
* Patient ability to initiate **breathing on their own** (inspiratory effort)
62
Signs of intolerance to weaning:
**know**
* RR <8
* tachypnea: *rapid breathing*
* dyspnea: *SOB*
* agitation
* desaturation (SpO2 <90%)
* tachycardia (syst >20bpm)
* changes in mentation.
63
Extubation Process/Steps
* **Hyperoxygenate 100%**: before & after suctioning **
* Suction airway
* **Have pt deep breath and at peak deflate cuff and remove ETT in one motion**.
* Encourage coughing & deep breathing
* Provide supplemental oxygen
* Oral care
64
What are the respiratory considerations for geriatric patients on mechanical ventilation?
* **Barotrauma**: *damage to the lung tissue due to excessive pressure*
* **Loss of alveolar elasticity**: *due to age*
* **Difficulty weaning from ventilation due to thoracic rigidity and chronic obstructive pulmonary disease (COPD)**.
