Unit 4 Chapter 29 Mechanical Ventilation

Question 1

Why is mechanical ventilation needed?
A.decrease gas exchange
Increase perfusion and ventilation
C. increase rate if alveoli collapse
D. to increases the narrowing of the bronchioles

Answer 1

B.increase perfusion and ventilation

The patient cannot breathe on their own and they need support

-improves gas exchange
-decreases workload of breathing

With mechanical ventilation, the patient who has severe problems of gas exchange may be supported until the underlying problem improves or resolves.

Question 2

Which of the following individuals can intubate a client?
A. Nurse anesthetist
B. Registered Nurse
C. Dietician
D. Medical Student

Answer 2

-anesthesiologist,
-nurse anesthetist, or
-The respiratory therapist usually performs the intubation.

Question 3

Is mechanically ventilation used as a temporary life-support?
A. Yes
B.No

Answer 3

A. Yes

Usually, mechanical ventilation is a temporary life-support technique.

The need for this support may be lifelong for those with severe restrictive lung disease or chronic progressive neuromuscular disease that reduces ventilation.

Mechanical ventilation is most often used for patients with hypoxemia and progressive alveolar hypoventilation with respiratory acidosis.

. Mechanical ventilation may be used for patients
who need temporary ventilatory support after surgery, those who expend too much energy with breathing and barely maintain adequate gas exchange , or those who receive general anesthesia or heavy sedation

Question 4

Does a patient requiring mechanical ventilation require an artificial airway? Which one is most type for short duration?

Answer 4

The patient who needs mechanical ventilation must have an artificial airway.

The most common type of airway for a short-term basis is the endotracheal (ET) tube.

Question 5

Which of the following intubation types is used for long-term ventilation?
A. Endotracheal tube
B.Tracheostomy
C. Nasogratric tube
D. Central Line

Answer 5

B.Tracheostomy

Although there is no exact time frame,
A tracheostomy is considered if an artificial airway is needed for longer than 10 to 14 days in order to reduce tracheal and vocal cord damage

Question 6

What are the expectations of Intubation?

Answer 6

Intubation expects to..
maintain a patent airway,
provide a means to remove secretions,
Provide ventilation and oxygen.

Question 7

What is the Anesthesiologist next action after the endotracheal tube is inserted to confirm or verify placement?
A. Suction fluid and place fluid on litmus
B. Order an X-ray
C. Vigorously shake patient
D. turn client on side

Answer 7

Immediately after an ET tube is inserted, placement is verified by checking end-tidal carbon dioxide levels and by chest X-ray

Assess for breath sounds bilaterally, sounds over the gastric area, symmetric chest movement, and air emerging from the ET tube. If breath sounds and chest wall movement are absent on the left side, the tube may be in the right mainstem bronchus. The respiratory health care provider intubating the patient should be able to reposition the tube without repeating the entire intubation procedure.

Question 8

How long should it take for intubation attempt to take place?
A. 2 minutes
B. 15-30 sec
C. 1 minute
D. 20-45 sec

Answer 8

B. 15-30 sec

Ensure that each intubation a ttempt lasts no longer than 30 seconds, preferably less than 15 seconds.

After 30 seconds, provide oxygen by means of a mask and manual resuscitation bag to prevent hypoxia and cardiac arrest. Suction as necessary.

Question 9

During the mechanical ventilation therapy your patient exhibits nasal flaring and use of accessory muscles to breathe. What is your next priority action?
A. Continue the intubation attemt
B. Prepare client for tracheostomy
C. Apply soft wrist restraints on the client
D. Remove the ventilator and provide ventilation with a manual resuscitation bag.

Answer 9

D. Remove the ventilator and provide ventilation with a manual rescusitation bag

If the patient develops resp.
distress during mechanical ventilation remove the ventilator and provide ventilation with a bag valve mask.

Question 10

After Intubation what should you suspect the health care provider to provide to assess if mechanical ventilation is therapeutic?
A. Continous pulse oximetry monitoring.
B. Post-intubation Arterial Blood Gases.
C. Neutropenic precaution
D. Airborne precautions

Answer 10

B. Post-intubation Arterial Blood Gases.

Question 11

Can a patient talk when the cuff is inflated in the endotracheal tube?
A. Yes
B. No

Answer 11

B. No

The patient cannot talk when the cuff is inflated.

Question 12

What is the function of an inflated cuff

Answer 12

The cuff at the distal end of the tube is inflated after placement and creates a seal between the trachea and the tube.

The seal ensures delivery of a set tidal volume when mechanical ventilation is used.

The cuff is inflated using a minimal-leak technique; when the cuff is inflated to an adequate sealing volume, a minimal amount of air can pass around it to the vocal cords, nose, or mouth.

Question 13

Which of the following should you keep at the bedside for the patient with a scheduled endotracheal tube?
A. Manual resuscitation bag
B. Pupilometer
C. Dopper
D. Padded tongue blade

Answer 13

A. Manual resuscitation bag

Basic life-support measures, such as obtaining a patent airway and delivering 100% oxygen by a manual resuscitation bag with a facemask, are crucial to survival until help arrives.REINTUBATION KIT

Question 14

Critical Rescue- Occluded airway

Answer 14

Maintain a patent airway through positioning (head-tilt, chin-lift) and the insertion of an oral or nasopharyngeal airway until the patient is intubated. Delivering manual breaths with a bag-valve-mask may also be required.

Question 15

Nursing Responsibility for during Intubation attempt

Answer 15

1. During intubation, the nurse coordinates the rescue response and continuously monitors the patient for changes in vital signs, signs of hypoxia or hypoxemia, dysrhythmias, and aspiration.

2.Ensure that each intubation a ttempt lasts no longer than 30 seconds, preferably less than 15 seconds.

3.After 30 seconds, provide oxygen by means of a mask and manual resuscitation bag to prevent hypoxia and cardiac arrest. Suction as necessary.

Question 16

What should occur if the Endotracheal tube location is stomach instead of the trachea?
A. Repositioning of tube
B. Reintubation attempt
C. Placing patient in trensdelenburg position
D. Place patient on side lying posistion.

Answer 16

B. Reintubation attempting

If the tube is in the stomach or esophagus, the abdomen may be distended and end-tidal carbon dioxide (EtCO 2) monitoring would
indicate the absence of carbon dioxide.

In such a case, reintubation is necessary and the stomach must be decompressed with a nasogastric (NG) tube after the ET tube is properly placed.

^Monitor chest wall movement and breath sounds until tube placement is verified by chest x-ray.

Question 17

PEEP

Answer 17

PEEP–application of positive pressure to the airways
at the end of expiration to distend the alveoli and prevent collapse.

Question 18

What are patients at risk for with intubation with mechanical ventilation?

Answer 18

INFECTION
intubation and ventilation allow us to bypass natural
defenses in nose and upper airway–increases the
chance of infection

Common complications include tube obstruction, tube dislodgment, pneumothorax, tracheal tears, bleeding, and infection.

Question 19

What is a common infection with Mechanical ventilation?

Answer 19

Ventilated Associated Pneumonia

Question 20

How to prevent Ventilated Associated Pneumonia

Answer 20

• Remove water from circuits(MILK THE LINE)
• HOB up 30 degrees
• Turn Q2H
• Suction
• Oral Care
• Lip moisturizer
• Percussion

Question 21

Nursing Care for ET

Answer 21

The priority nursing action when caring for an intubated patient is maintaining a patent airway. Assess tube placement, cuff leak, breath sounds, indications of adequate gas exchange and oxygenation, and chest wall movement regularly.

Prevent the patient from pulling or tugging on the tube to avoid tube dislodgment, and check the pilot balloon to ensure that the cuff is inflated.

Question 22

What is the purpose of repositioning the endotracheal tube every 2 hours?

Answer 22

to prevent skin breakdown and pressure ulcers

Question 23

Why is it important to have your patient sedated on a vent?

Answer 23

The most common causes of unplanned extubation in adults are confusion and agitation
^to prevent extubationon

Question 24

What is the recommended cuff pressure?
A. 10-20cm
B. 20-30cm
C. 40-50cm
D. 100-120 cm

Answer 24

Monitor the pressure within the cuff to ensure that it is maintained between 20 to 30 cm H2O to stabilize the tube without causing tracheal injury.

Question 25

What can cause dislodgement of Et

Answer 25

Suctioning, coughing, and speaking can cause dislodgment. Neck flexion, neck extension, and rotation of the head also can cause the tube to move. Tongue movement also can change the tube’s position

Question 26

Your patient who is placed mechanical ventilator has become agitated and disoriented and noticed he is attempting to remove the endotracheal tube. You ask the patient to stop and they continue to attempt to extubate? What is your next priority action?
A. Obtain a prescription for soft wrist restraints
B. Attempt to use therapeutic communication.
C. Obtain a prescription Methyphenidate
D. Instruct the client to bite on the tube instead.

Answer 26

A. Obtain a prescription for soft wrist restraints

When other measures fail, obtain a prescription for soft wrist restraints and apply these for the patient who is pulling on the tube. Restraints are used only as a last resort to prevent accidental extubation.

Question 27

Care for client of Mechanical ventilation

Answer 27

• Resp. assessment/VS Q4h and as needed
• Elevate HOB at least 30 degrees
• Check ventilator/ET tube status Q2h
• Check for need to suction Q2h but only suction when needed–pre-oxygenate with 100% O2
• Turn Q2h side to side and semi-prone(MOBILIZE SECRETIONS)
  *Provide oral care Q2h-inspect for pressure ulcers
  (evidence based)
• Tooth brushing Q12h (Evidence based)
• Vigilant hand washing (Evidence based)
• Provide pt. with alternate communication method
  when awake
  *GI prophylaxis

Question 28

Suction Nursing Care

Answer 28

STERILE TECHNIQUE

Assess lung sounds first

Pre-oxygenate with 100% oxygen for 30 seconds - 3 minutes prior to suctioning

Suction intermediately withdrawing the catheter for a maximum amount of time of 10-12 second each pass

Hyperoxygenate client

Assess lung sounds
(Repeat)

Question 29

Which of the following patients should the nurse assess first
A. The client with chronic asthma and is experiencing wheezing
B. The client is becoming unconscious and has left absent lung sounds.
C. The patient with cystic fibrosis is coughing up thick secretions.
D. The patient with Hepatic Encapaltholpy that exhibits asterixis

Answer 29

B. The client is becoming unconscious and has left absent lung sounds.

^YOUR PRIORITY PATIENT

Question 30

Cause of Low Pressure Alarms

Answer 30

• Not getting enough air (in or out) Air leak in the cuff
• Disconnected tubing
  **Patient not breathing
  EXTUBATION

Question 31

Cause of High Pressure Alarm

Answer 31

INCREASE IN PRESSURE OR BLOCKAGE

• Blocked airway (Suctioning)
• Biting tube
• Kinks in tubing
• Coughing
• Tension Pneumothorax(CAUSED BY PEEP)
• Pulmonary Edema
• Psychomotor Agitation
• Pain

Question 32

You suspect a cuff leak which of the following would certain you suspect?
A. The patient is biting on the tube
B. The patient has pulmonary edema
C. the patient is the talking
D. The patient has 400ml/hr urine output

Answer 32

C. the patient is the talking

Question 33

Suction continued

Answer 33

.Determine the need for suctioning by observing secretions for type, color, and amount. The most common indicator of the need for suctioning is the presence of coarse crackles over the trachea. Assess the area around the ET tube or tracheostomy site at least every 4 hours for color, tenderness, skin irritation, and drainage, and document the findings.

Question 34

Complications of Mechanical Ventilation

Answer 34

• Tube obstruction or dislodgment/pneumonthorax
• GI & nutrition problems, electrolytes
• Several types of trauma
• Ventilator Associated Pneumonia (VAP)

Question 35

Several types of trauma of Mechanical Ventilation

Answer 35

• Barotrauma (damage to the lungs by positive pressure)
• Volutrauma (damage to the lung by excess volume delivered to
  one lung over the other)
• Atelectrauma (shear injury to alveoli from opening and closing)
• Biotrauma (inflammatory response–mediated damage to alveoli) * Ventilator-associated lung injury/ventilator-induced lung injury
  (VALI/VILI) (damage from prolonged ventilation causing loss of surfactant, increased inflammation, fluid leakage, and noncardiac pulmonary edema)
• Acid-base imbalance

Question 36

GI problems with mechanical ventilation

Answer 36

Stress ulcers occur in many patients receiving mechanical ventilation.
These ulcers complicate the nutrition status and, because the mucosa is not intact, increase the risk for systemic infection. Antacids and histamine blockers such as cimetidine or proton pump inhibitors such as esomeprazole may be prescribed as soon as the patient is intubated.
Because many other acute or life-threatening events occur at the same time, nutrition is often neglected.

Malnutrition is an extreme problem for these patients and is a cause of failing to wean from the ventilator. In malnutrition, the respiratory muscles lose mass and strength. The diaphragm, the major muscle of inspiration, is affected early. When it and other respiratory muscles are weak, ineffective breathing results, fatigue occurs, and the patient cannot be weaned.
use of PPantaprozole

Question 37

How to prevent Vap

Answer 37

Remove water from circuits-MILK THE LINE
* HOB up 30 degrees
* Turn Q2H
* Suction
* Oral Care
* Lip moisturizer
* Percussion

Question 38

Weaning

Answer 38

Weaning
Weaning is the process of going from ventilatory dependence to spontaneous breathing. The process is prolonged by complications. Many problems can be avoided with appropriate nursing care. For example, turning and positioning the patient not only promote comfort and prevent skin breakdown but also

Question 39

Extubation

Answer 39

Extubation
Extubation is the removal of the endotracheal (ET) tube. The tube is removed when the need for intubation has been resolved. Before removal, explain the procedure. Set up the prescribed oxygen delivery system at the bedside and bring in the equipment for emergency reintubation. Hyperoxygenate

Monitor vital signs after extubation every 5 minutes at first and assess the
ventilatory pa ttern for signs of respiratory distress. It is common for patients to be hoarse and have a sore throat for a few days after extubation. Teach the patient to sit in a semi-Fowler position, take deep breaths every half-hour, use an incentive spirometer every 2 hours, and limit speaking. These measures help improve gas exchange , decrease laryngeal edema, and reduce vocal cord irritation. Observe closely for respiratory fatigue and airway obstruction.

Question 40

Obstruction and stridor intervention

Answer 40

emergency tracheostomy

Early symptoms of obstruction are mild dyspnea, coughing, and the inability to expectorate secretions. Stridor is a high-pitched, crowing noise during inspiration caused by laryngospasm or edema around the glott is. It is a late sign of a narrowed airway