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Critical Care and Emergency Nursing > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

(63 cards)

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1
Q

ventilation/perfusion (v/q)

A

air going in and out of lung/ blood circulating to area of lung

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2
Q

V/Q in top areas of lung

A

higher ratios because there is more ventilation in the upper portions of the lung and less perfusion –> higher oxygenation

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3
Q

V/Q in lower areas of lung

A

lower ratios because more perfusion but less ventilation (can’t saturate area of perfusion) –> less oxygenation

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4
Q

V/Q mismatch

A

certain areas of the lung have high v/q ratios and some have low v/q ratios; most common cause of hypoxemia; will respond to 100% O2 and has an increased Aa gradient

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5
Q

possible causes of V/Q mismatch

A

pneumonia, PE, COPD, asthma, pulmonary HTN, fibrosis

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6
Q

pulmonary shunting

A

does not respond to 100% O2; increased Aa gradient

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7
Q

O2-Hgb Dissociation curve

A

relationship b/t PaO2 and % saturation of Hgb

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8
Q

shift of curve to the right

A

more difficult to pick up at lung but easier to drop off at tissues; causes: decreased pH, increased pCO2, hyperthermia, chronic hypoexemia

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9
Q

shift of curve to the left

A

easier to pick up at lung but more difficult to drop off at tissues; causes: increased pH, decreased pCO2, hypothermia, banked blood

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10
Q

normal pH

A

(acd.) 7.35 - 7.45 (alk.)

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11
Q

normal PaO2

A

80-100%

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12
Q

normal PaCO2

A

(alk.) 35-45 (acd.)

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13
Q

normal HCO3

A

(acd.) 22-26 (alk.)

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14
Q

SLOPE for intubation: S

A

Suction, syringe, stethoscope, sedation, stylet

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15
Q

SLOPE for intubation: L

A

lubricant, laryngoscope

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16
Q

SLOPE for intubation: O

A

oxygen

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17
Q

SLOPE for intubation: P

A

patient positioning, pressure

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18
Q

SLOPE for intubation: E

A

ETT, end-tidal CO2

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19
Q

cuff pressure

A

20-25 mmHg; want the cuff inflated enough to prevent aspiration but not too inflated where it could lead to tracheal necrosis; check Q6-8hr

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20
Q

ETT care

A

verify placement by auscultation, EtCO2 and x-ray, secure the tube, monitor position (cm marking), suction only PRN, monitor for skin breakdown, prevent dislodgement, monitor cuff pressure (q 6-8hr), ambu bag at bedside

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21
Q

ETT suctioning

A

make sure pt is stable first, no more than 10 seconds, no more than 3 attempts; no difference b/t intermittent and continuous suctioning on closed system like this, nurses will probably continually suction upon withdrawal; no more than 120 mm of suction

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22
Q

ETT complications on insertion

A

nasal, oral, pharyngeal, or hypopharyngeal trauma, vomiting with aspiration, cardiac arrest

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23
Q

ETT complications while in place

A

nasal/oral inflammation and ulceration, sinusitis/otitis, larygneal and tracheal injuries, tube obstruction and displacement

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24
Q

oral hygiene importance

A

very vulnerable to develop VAP, more bacteria in mouth

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25
VENTS: V
View, monitor ABGs, airway, and resp. status
26
VENTS: E
Elevate HOB 30 degrees, Equipment at bedside (ambu bag and suction)
27
VENTS: N
Notice GI complications (stress ulcers), Nutritional needs
28
VENTS: T
Take note of settings and alarms
29
VENTS: S
Suction tracheal tube, Secretions, Self-protection, Soft wrist restraints
30
ETT obstruction
bite block, sedation, suction, humidify, replace
31
ETT displacement
secure, restrain, sedate, support tubing, replace
32
ETT fistula/stenosis
cuff inflation, monitor cuff pressure, tracheostomy
33
ETT skin breakdown
loosen tube holder at least q24hr and change sides, inspect skin
34
ETT related infection
use sterile technique
35
reasons for mechanical ventilation
acute respiratory distress, surgery, post-surgery, OD, sedation, head trauma
36
negative pressure ventilators
not seen often, might be on someone with muscular dystrophy; applied externally to pt and decreases the atmospheric pressure surrounding the thorax to initiate inspiration
37
positive pressure ventilators
uses a mechanical drive mechanism to force air into the pt's lungs through an ETT or tracheostomy
38
assist-control mode
all breaths are mandatory, triggered from either the pt or the machine; if pt initiates breath, the full volume set on vent will be given
39
synchronized intermittent mandatory ventilation (SIMV) mode
set minimum rate and tidal volume, pt able to breathe spontaneously b/t mandatory breaths; the breaths initiated by the patient would be whatever volume they can do - not the set amount from the vent
40
Spontaneous mode
(CPAP or PSV) all breathing is determined by the patient, there is no "trigger mode" offered by machine
41
controlled breath
ventilator does all the work, pt does nothing
42
assisted breath
pt initiates breath and the ventilator takes over
43
supported breath
pt able to do some or most of the work but the ventilator assists to finish (like pressure support)
44
pressure control
preset pressure limit, delivered volume variable depends on pt's compliance
45
benefits to pressure control
airway pressure limited, and prevents damage to alveoli
46
cons to pressure control
if resistance rises or compliance falls in the pt's airway or chest wall, the set pressure limit remains the same, but the delivered tidal volume fails
47
Pressure regulated volume control (PRVC)
volume and pressure control, delivered over a set time; constant pressure applied throughout inspiration regardless of whether breath is control or assist breath; vent will adjust pressure as needed r/t airway resistance and compliance changes
48
CPAP
spontaneously breathing pt; gives continuous positive airway pressure to keep alveoli open to maximize oxygenation
49
BIPAP
2 levels of positive airway pressure; inspiratory pressure (IPAP) would be a higher level and the pt would be given lower pressure during expiration (EPAP)
50
normal vent rate
12-20
51
normal tidal volume
5-7ml/kg
52
normal FiO2
40-100%
53
normal PEEP
5-10
54
high pressure alarm causes
anything causing vent to have to work harder to give the set volume; decreased lung compliance, increased secretions, bronchoconstriction, kinked circuit
55
low pressure alarm causes
something making it easier to give set volume than it should be; disconnection, significant airleak, extubation
56
minute ventilation
RR x TV
57
weaning off vent parameters
VC 10-15ml/kg TV 7-9ml/kg PaO2 greater than 60 on an FiO2 of less than 40%
58
extubation
HOB 75 degrees, hyperoxygenate, suction oral cavity, deflate and remove cuff, encourage to cough, suction PRN, monitor closely and encourage vocal rest, monitor ability to cough and swallow
59
vent recommendation with respiratory acidosis
increase respiratory rate to blow off the excess CO2
60
complications of mechanical ventilation
infection, positive fluid balance, pt discomfort, and psychosocial
61
benefits of sedation
decrease anxiety, amnesia, reduce tissue O2 consumption, improve vent synchrony
62
preventing VAP
hand hygiene, oral care, HOB 30-40 degrees, suction only PRN, cover yankauer cath when not used, adequate ETT cuff pressure, d/c NGT asap, subglottic suctioining prior to repositioning or deflating cuff
63
when to hold tube feedings
if residual more than 150cc

Critical Care and Emergency Nursing (4 decks)

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