T2 - Airway, Oxygen, Mechanical Ventilation (Josh) Flashcards
(93 cards)
1
Q
Difference between Hypoxemia and Hypoxia?
A
Hypoxemia = low levels of O2 in blood
Hypoxia = decreased tissue oxygenation
2
Q
What is the goal of O2 Therapy?
A
use lowest fraction of inspired oxygen for acceptable blood oxygen level without causing harmful side effects (O2 is a drug)
3
Q
ABGs
Normal pH
A
7.35 - 7.45
less than 7.35 = acidic
greater than 7.45 = alkaline
4
Q
ABGs:
Normal PaCO2
A
35 - 45
5
Q
ABGs:
Normal PO2
A
90 - 100
6
Q
ABGs:
Normal HCO3
A
22 - 26
7
Q
What can happen with Oxygen-Induced Hypoventilation?
A
Hypercarbia = retention of CO2
CO2 Narcosis = loss of sensitivity to high levels of CO2
8
Q
What is the amount that can be given via BNC?
A
1 - 6 L
9
Q
O2 Devices:
What is the amount that can be given with a Simple Rebreather Mask?
A
6 - 10
- *minimum of 5 L / min
- if less, go to BNC
10
Q
O2 Devices:
What is the amount that can be given with a Non-rebreather Mask?
A
12-15 L/min
11
Q
BNC:
What rates?
What O2 Concentration?
A
Rate = 1-6 L/min
O2 Concentration = 24 - 44%
12
Q
Simple Facesmask:
What rates?
What O2 Concentration?
A
Rate = min of 5 L/min
O2 Concentration = 40-60%
13
Q
Partial Rebreather:
What rates?
What O2 Concentration?
A
Rate = 6-11 L/min
O2 Concentration = 60-75%
14
Q
With a Partial Rebreather, how much of the Tidal Volume is exhaled with each breath?
A
1/3
15
Q
Which mask delivers the highest level of O2?
A
Non-rebreather Mask
rates of 12-15 L/min
16
Q
A Non-Rebreather Mask can deliver what levels of FiO2?
A
greater than 90%
rates of 12-15 L/min
17
Q
What would happen if the oxygen source should fail or both flaps of a Non-Rebreather Mask are in place?
A
Patient would not be able to inhale air, leading to CO2 buildup
18
Q
What are the High-Flow delivery systems and what rates and concentation can they deliver?
A
Venturi Mask Face Tent Aerosol Maks Tracheostomy Collar T-piece
can deliver 24-100% at 8-15 L/min
19
Q
Which delivery device is best for Chronic Lung Disease?
Why?
A
Venturi Mask
provides precise O2 concentration delivery
***switch to BNC during meals
20
Q
What is a T-Piece used for?
A
Trachs
- provides humidified air
***Mist should be seen during inspiration and expiration
21
Q
What is NPPV?
A
Noninvasive Positive-Pressure Ventilation
- *uses positive pressure to keep alveoli open
- *improves gas exchange without airway intubation
22
Q
What are examples of NPPV?
A
BiPAP
CPAP (Continuous Positive Airway Pressure)
23
Q
What are CPAPs used for?
A
Atelectasis after surgery
Cardiac-induced PE
Sleep Apnea
24
Q
What is TTO?
A
Transtracheal Oxygen Delivery
**small flexible catheter is passed into trachea through small incision
**long-term
**avoids irritation that nasal prongs can cause
25
What are the two ways we can reposition client to maintain patent airway?
Head Tilt-Chin Lift Method
Jaw Thrust Method
***for people in any accident where possible trauma to spinal cord or neck
26
What is the benefit of the Oropharyngeal Airway?
prevents airway obstruction from tongue
***gotta be unconcious b/c gag reflex will be stimulated
27
Measuring appropriates size for Oropharyngeal Airway
Place the oropharyngeal airway along the outside of the jaw with one end of the airway at the bottom tip of the ear.
Close the mouth and bring the other tip of the airway toward the corner of the mouth.
The airway should reach from the bottom tip of the ear to the corner of the mouth.
Proper placement: the tip of the airway lies above the epiglottis at the base of the tongue
Can cause obstruction if incorrect size
28
When are Oropharyngeal Airways used?
to ease breathing in ICU for a dying patient
29
How do you measure correct size for Nasopharyngeal Airway?
Hold the airway against the side of the face and ensuring it extends from the tip of the nose to the earlobe
Proper placement: the tip of the airway lies above the epiglottis at the base of the tongue
Lubricate prior to placement
30
When do we want to use a long-term Trach?
if they need it for longer than 21 days
***If less, use Oral or Nasal
31
When inserting an Endotracheal Tube (ETT), what do we use to confirm placement?
CO2 Detector
Xray for confirmation
32
ETT:
Why do we measure placement by the teeth/gums and not the lips?
lips can swell and give false impression of dislodgement or movement
33
ETT:
How is Correct Placement confirmed?
Auscultate x 5
Inspect Chest Expansion
End-Tidal CO2 Detector
CXR
34
ETT:
Why do we ausculatate 5 x's for confirmatin of placement?
to make sure we are in airway and not lungs
***listen in epigastric area first to make sure not in esophagus
***then listen abdomen, anterior and laterally on each side
35
ETT:
Why do you want to inspect chest expansion to confirm placement?
make sure you're inflating both lungs and not just one
36
ETT:
With CXR, what depth are we looking for in placement of the tube?
3-4 cm above carina (where trachea bifurcates into right and left bronchus)
***we don't want it into one of the bronchi
37
ETT:
What cuff pressure are we looking for?
14-20 mmHg
38
ETT:
Should we be able to hear coughing or gagging if tube places properly and pressure is correct?
No
Air should not be able to leak around the sides of the tube and through the vocal cords
if they make sounds, then we know that air is leaking around the pressure cuff
39
ETT:
Don't use --- in the ETT if suctioning?
saline
***will cause more damage to trachea
40
Suctioning:
What should we do before suctioning?
hyperoxygenate patient
**turn FiO2 machine up to 100% for a few mins
41
What are some complications from suctioning?
Hypoxia
Tissue (Mucosal) Trauma
Infection
Vagal Stimulation and Bronchospasm
Cardiac Dysrhythmias (PVCs) from Hypoxia
42
Which cardiac rhythm is associated with hypoxia?
PVC
43
Extubation Process
Hyperoxygenate Patient
Sucntion ET and Oral Cavity
Rapidly deflate ET cuff
Remove tube at PEAK INSPIRATION
Instruct patient to cough
Monitor patient q 5 mins and assess for resp. distress
44
--- is a surgical incision into trachea for purpose of establishing an airway
--- is the stoma (opening) that results from tracheotomy.
Tracheotomy
Tracheostomy
45
Where is the incision for the Tracheotomy done?
2nd, 3rd, and 4th Tracheal Rings
46
What will laryngeal stenosis look like?
hoarse voice
47
Why must tracheostomy air be humidified and warmed?
it bypasses the nose, which normally does these things
48
What is one way to keep secretions thin with an trach patient?
keep them adequately hydrated
49
Tracheostomy:
What are some causes of hypoxia?
Ineffective oxygenation before, during, and after suctioning
Use of catheter that is too large for the artificial airway
Prolonged suctioning time
Excessive suction pressure
Too frequent suctioning
50
Tracheostomy:
What should we do to prevent aspiration?
elevate HOB for at least 30 mins after eating
51
Tracheostomy:
What can be done to promote Bronchial and Oral Hygiene?
Turn/Reposition every 1-2 hrs
Encourage early ambulation
Coughing and Deep Breathin
Avoid alcohol wipes for oral care (use chlorhexidine instead)
52
Tracheostomy:
How and when is weaning accomplished?
cuff is deflated when patient can manage secretions and does not need assisted ventilation
weaning involves a gradual decrease in tube size leading to ultimate removal of tube
53
Types of Ventilators
Negative Pressure
Positive Pressure
- Pressure-cycled
- Time-cycled
- Volume-cycled
54
Mechanical Ventilator:
What are the Modes of Ventilation?
Assist-control Ventilation (AC)
Synchronized Inermittend Mandatory Ventilation (SIMV)
Bi-level Positive Airway Pressure (BiPAP)
Others
55
Mechanical Ventilator:
What are the ventilator controls and settings?
Tidal Volume (Vt)
Rate (breaths/min)
Fraction of Inspired Oxygen (FiO2)
PIP
CPAP
PEEP
Flow and other settings
56
Modes of Ventilation:
What is AC (Assist Control) or CMV (Continuous Mandatory Ventilation)?
Delivers preset number of breaths at tidal volume
If pt. initiates breath, machine delivers a preset tidal volume for every breath
* **It Vt is set at 600, they will get 600 for every breath
* **Number set is minimum (ex: if 10, he will get 600 Vt 10 tims a minute if he breathes less than that....if he breathes more (say 20 x's) then he gets 600 Vt 20 x's
57
Modes of Ventilation:
What is PRVC (Pressure-Regulated Volume Control)?
combo of volume and pressure features
- Delivers a preset Vt using the lowest possible airway pressure
- Airway pressure will NOT exceed preset maximum pressure limit
* ***prevents injury to lungs
* ***used with ARDS because lungs become stiff and non-compliant
58
Modes of Ventilation:
What is BiPAP (Bi-level Positive Airway Pressure)?
Pre-set inspiratory pressure
Expiratory pressure
- two levels
- a range for Positive End Expiratory Pressure (PEEP)
* **from HIgh PEEP to Low PEEP
59
Modes of Ventilation:
What is SIMV (Synchronous Intermittent Mandatory Ventilation)?
Delivers preset number of breaths at preset tidal volume
***if patient initiates breath, machine allows patient to breath in OWN TIDAL VOLUME
***your own breaths are the Vt
***requires you to work harder than Assist Control
60
Modes of Ventilation:
What is CPAP (Continous Positive Airway Pressure)?
Patient initiates own breath
Machine delivers constant positive pressure
61
Ventilator Settings:
What is Pressure Support?
a set amount of pressure delivered when patient initiates own breath
assists mvmt of air through ventilator tubing in order to AUGMENT PATIENTS OWN TIDAL VOLUME
****WORKS AT BEGINNING OF INSPIRATION
62
Ventilator Settings:
What is PEEP?
Positive End Expiratory Pressure
** positive airway pressure appled at end of expiration to KEEP ALVEOLI OPEN and facilitate O2 transport
WORKS AT END OF EXPIRATION
63
PEEP vs. Pressure Support
Which one works at beginning of inspiratoin?
Pressure Support
***PEEP works at end of EXPIRATION
64
When would PEEP be used?
used in atelectasis (when you need more alveoli participating in exchange)
65
Ventilator Settings:
What is Tidal Volume?
amount of air it takes to inflate lungs with each breath
takes approximately 10-15 mL/kg
66
Ventilator Settings:
What is Minute Ventilation?
amount of gas moved in or out of lungs per minute
RR x TV = MV
ex: 12 bpm x .600 TV = 7.2 L/min
Normal is 5-8 L/min
67
Why is Minute Ventilation Important?
it is the assessment of the work of breathing
normal is 5-8 L/min
RR x TV = MV
68
Ventilator Settings:
What is I:E Ratio?
Inspiration to Expiration Ratio
1:2 is normal
69
What would we set the I:E Ratio for COPD patient?
Longer (1:4) to prevent 'Breath Stacking'
70
Ventilator Settings:
What is PIP?
Peak Inspiratory Pressure (PIP)
**amount of pressure it takes for ventilator to deliver TV or breath
***changes from breath to breath
71
What does an increased PIP indicate?
there is not a clean airway
**suction or check to see if kink or patient biting it
**Mucous plug number one cause
72
Ventilator Settings:
What is FiO2?
Fraction of Inspired O2
- percentage or fraction of oxygen delivered by the ventilator
***shows us how much of the work the ventilator is doing
73
Troubleshooting Alarms:
What can cause a High Pressure Limit?
Circuit tubing kinked
Water collecting in dependent tubing
Fighting vent (breath stacking)
Airway secretions, coughing
ETT in Right Bronchus (too far down)
Decreased Lung Compliance
* *ARDS
* *Tension Pneumothorax
* *Pumonary HTN
74
Troubleshooting Alarms:
What can cause Low Pressure Limit?
Tubing disconnected
Circuit leak
Cuff deflated
75
Troubleshooting Alarms:
What can cause Low Exhaled Tidal Volume?
Leak in system
Poor cuff inflation
Leak through chest tube
76
Troubleshoot Alarms:
What can cause Temperature Alarm?
Sensor malfunction
Sensor pickup up outside airflow
77
Troubleshooting Alarms:
What can cause Apnea Alarm?
Sedation
Neurologic
Metabolic
78
Troubleshooting Alarms:
What can cause High Respiratory Rate Alarm?
Not tolerating weaning
Neurologic / Metabolic
Anxiety
Pain
79
Troubleshooting Alarms:
What can cause Mechanical Ventilator Failure?
Check outlet (red outlet goes to backup generator)
Bad machine
80
What can we do to prevent complications from Mechanical Ventilation?
Plateau pressure kept greater than 32 cm H2O
PEEP should be used
Vt set at 6-10 mL/kg (as low as possible to prevent injury)
81
Ventilator Induced Lung Injury:
What is Barotrauma?
excessive pressure in the alveoli
82
Ventilator Induced Lung Injury:
What is Volutrauma?
excessive volume in the alveoli
83
Ventilator Induces Lung Injury:
What is Atelectrauma?
shearing due to repeated opening and closing of the alveoli
84
Ventilator Induced Lung Injury:
What is Biotrauma?
Inflammatory immune response to ventilator
85
What are some Cardiovascular complications from Ventilator?
Cardiovascular Compromise:
- Increased intrathoracic pressure
- decreases venous return, decreasing preload, decreasing CO and BP
- Tachycardia to compensate
- Hepatic and Renal dysfunction
- Impairment of cerebral venous return -- increasing ICP
86
What are some GI Distrurbances from Ventilator?
Gastric Distenstion
Hypomotility
Constipation
87
How can PEEP cause a pneumothorax?
too much pressure causing the lungs to collapse
88
Nosocomial Pneumonias account for --- of all hospital infections and --- of all MICU infections.
15%
27%
***risk factor is 6-21 x's more for ventilated patient than non-ventilated
89
Nosocomial Pneumonias:
Within 48 hrs of intubation, which bacteria commonly colonizes in the URT?
Gram Negative bacilli
90
What can we do to prevent Ventilator Associated Pneumonia (VAP)?
HOB 30-45 degrees
ETT with a dorsal lumen provides continuous suction above the cuff
Oral care
Handwashing
****first 24 hrs is most critical
91
Proper oral care to prevent VAP?
use BRUSH instead of the soft swab once a shift with chlorahexadine solution
***use soft swab q 2 hrs for oral airway
92
What are Ventilator Bundles?
bundle of orders for nursing and resp. therapy for a patient on ventilator to prevent complications
93
What are some of the things we do in Ventilator Bundel orders?
VAP precautions
DVT precautions
Gastric Reflux prevention
Sedation vacations
Evaluations of readiness to wean from ventilator
