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Flashcards in Oxygen and Ventilator Management Deck (38):
1

principles of rehab w/ oxygen and ventilator management

early mobilization of the patient
mobilization can occur with ventilator weaning
a patient who gains overall strength will be more likely to wean off the ventilator and be less likely to develop side effects of bed rest
progress is guided by vital signs, not by the volume (size) of the apparatus
"if there's nothing wrong with their legs, have them walk"

2

some of the challenges of mobilization with vent

trachs
A lines
IVs
telemetry
ventilators
pulse oximetry
BP monitors
Dobhoff/G tubes

3

causes of respiratory failure

drugs - narcotics
metabolism - hyponatremia, hypercapnia
neoplasm
infections - meningitis, WNV, polio
trama - flail chest, contusion of lung
other - ALS, MS, OSA, GB, obesity, COPD, CF, ILD, atelectasis, PE

4

measuring respiratory function
-normal blood gases

PaO2
-80-100 mmHg
PaCO2
-35-45 mmHg
pH
-7.35-7.45
HCO3
-22-26 (base)

5

measuring respiratory function
-pulse ox tells you...
-what to observe of the patient
-patients may not have

pulse oximetry gives a measure of the % O2 in the blood. it does not tell you the pCO2 level
observe the patient. are they more combative or confused (could be a sign of climbing pCO2). have they turned pale, labored breathing
patients may not have labored breathing with respiratory failure - look for other signs

6

types of lines and tubes for respiratory support

nasal cannula
non-rebreather mask
face mask
Bipap/Cpap: noninvasive ventilation
heated hi-flow

7

nasal cannula
-flow range

1 to 6 L/min

8

if more than 6 L/min is needed, what oxygen delivery systems can you use

pendant oxymizer
high flow tubing
-has its own color
simple mask
non-rebreather mask

9

Bipap
-stands for

bilevel positive airway pressure

10

Bipap
-when would you use it
-can be used as a temporary way to...

patient has to be able to breathe independently
positive airway pressure during inspiration and exhalation
can be used as a temporary way to "blow out" residual CO2 to reduce confusion and improve oxygenation

11

how does a Bipap work?

"the inspiratory positive airway pressure is higher and supports a breath as it is taken in
conversely, the expiratory positive airway pressure is a lower pressure that allows you to breathe out.
these pressures are preset and alternate just like your breathing pattern

12

BiPAP/CPAP
-what type of ventilation
-used for...
-what does CPAP stand for?

non-invasive ventilation (NIV)
used for sleep apnea
temporary artificual ventilation
CPAP
-continuous positive airway pressure

13

CPAP
-non-invasive form of...
-can be provided thorugh...
-provides...
-used with what condition

non-invasive form of Positive End Expiratory Pressure (PEEP)
can be provided through a ventilator or via an independent machine
provides constant end-expiratory pressure that keeps the airway open
used with OSA (obstructive sleep apnea)

14

characteristics of volume control ventilators
-what is set
-what varies

set tidal volume
set rate
set PEEP
set FiO2 (fraction of inspired O2)
peak inspiratory pressure varies

15

characteristics of pressure control
-what is set
-what varies

set inspiratory pressure
set rate
set PEEP
set FiO2
tidal volume varies

16

modes of ventilation

full support
intermittent ventilation
continuous positive airway pressure

17

full support ventilator
-what does it do
-disadvantage

set number of breaths
gives additional full breath once patient initiates breath
disadvantage
-barotrauma: you're pushing too much air into the lungs and the muscles become weak (like putting a brace on someone)

18

intermittent ventilation
-what type of patient would you use it with

use with a patient who can spontaneously breathe in between breaths given by machine

19

continuous positive airway pressure
-3 descriptors

ventilator mode
nasal mask
also used for sleep apnea as a unit separate form a ventilator

20

common abbreviations
-CMV
-SIMV
-CPAP

CMV
-controlled mandatory ventilation
SIMV
-synchronized intermittent mandatory ventilation
CPAP
-continuous positive airway pressure

21

common abbreviations
-PS
-PEEP
-ETT

PS
-pressure support
PEEP
-positive end expiratory pressure
ETT
-endotracheal tube

22

principles behind weaning

resting settings alternate with weaning settings/time off the ventilator
time off the ventilator increases by 2-4 hours per day
tidal volume, RR, HR, O2 sat and blood gases indicate tolerance for vent weaning

23

reasons for a tracheostomy

need for artificial/mechanical ventilation greater than 2 weeks
inability to swallow
blockage of the airway (such as laryngectomy)
obstructive sleep apnea
frequent suctioning needed due to ineffective cough

24

inability to swallow often due to...

stroke or other neuromuscular disease

25

types of tracheostomies

cuffed
uncuffed
fenestrated

26

cuffed tracheostomy
-what does it do?

holds the trach in place and prevents air flow to nose and mouth

27

uncuffed trach
-what does it do

allows air flow over vocal cords - patient can talk

28

fenestrated trach
-what does it do

allows patient to talk

29

trach brands

bivona
shiley
jackson

30

trach position
-does not interfere with...
-below...
-cuff holds...
-cuff prevents...

does not interfere with the passage of food
below the vocal cords
holds the trach in place
prevents air passing up through the vocal cords

31

aerosol collar (trach collar)
-what do they do?

deliver humidified O2

32

portable circuits
-wide end connects to...
-narrow end connects to...

wide end connects to the T collar
narrow end connects to the portable tank

33

oxygen settings
-add about _____ of O2 for each extra liter of O2 up to _____ L/min

3% up to 6 L/min

34

6 L/min O2 is considered a FiO2 of ____ or ____

0.4 or 40%

35

can patients with trachs shower?
-if so, what are precautions?

yes
avoid water entering the trach with a light dressing to cover

36

4 myths of oxygen and ventilation

you can never work with a patient with SaO2 lower than 90%
ventilated patients need sedation
ventilated patients can't walk
ventilated patients can't eat

37

Passy Muir valves for speaking
-joint decision between...
-trach must be...
-patient must be...

joint decision bewteen MD, SLP, and RT
trach must be cuffless or the cuff must be deflated
patient must be able to swallow

38

eating and talking with a trach
-coordinate with...
-most patients...

speech therapy
most patients want to eat and talk