Ventilation Flashcards
(47 cards)
1
Q
Types of mechanical vents?
A
- Volume vent - mostly used (ARDs)
- Pressure vent
- High-frequency vent - neonate
2
Q
Vent Modes?
A
- AC - vent does the work - Pr can trigger it but the machine does the work for them
- SIMV- weaning - Pt does the work
3
Q
CPAP?
A
Increases end-expiratory only
4
Q
BiPAP?
A
Inspiratory and Expiratory
5
Q
The purpose of Artifical airways?
A
- Establish Airway
- Protect airway w/ cuff
- Vent assistance
- Airway clearance
6
Q
Nursing care with vent?
A
- 30 degrees semi-fowlers
- Suction
- Oral hygiene
- Sedatives, Analgestics
7
Q
Have to be unconscious to get?
A
oropharyngeal airway intubated
8
Q
Vt - Tidal Volume
A
Volume of gas delivered during each breath (one cycle)
5-8 ml/kg
9
Q
RR - Respiratory Rate
A
BPM
10
Q
Peak Flow
A
the velocity of the gas flow
11
Q
IPL - Inspiratory Pressure Limit
A
Controls the Limit - High pressure is reached - inspiratory is terminated
“high pressure ALARM”
12
Q
PEEP - Positive End-Expiratory Pres
A
Maintains End of Expiratory
Starts around 3, no higher 10
ARDS is 5
Prevents Atelectasis
13
Q
High Alarm means what?
A
Coughing, Needs Suctioning, Kinked Tube, Pneumothorax
14
Q
Low Alarm means what?
A
15
Q
How to read Vent?
A
16
Q
Goals for Vent patient?
A
- Patent Airway
- Optimal Gas Exchange
- Free of Infection
- Neuro - Glasco Scale
- ROM - Mobility - Positioning
- Comfort and Nonverbal Communication
- Complications - MODS, CO, Fluid blance
17
Q
Complications on vent?
A
- Aspiration
- VAP
- Pneumothorax
- Decreased CO
- Decreased Fluid balance
- Immobility
- GI
18
Q
Aspiration can cause?
A
VAP - nosocomial pneumonia
19
Q
VAP is a ?
A
Never should occur event
20
Q
VAP is when patient has?
A
been on vent for at lest 48hrs and has acquired pneumonia
21
Q
2nd most common HAI is?
A
VAP and Intubation is 10 x’s a greater risk
22
Q
How to prevent VAP?
A
- Washing hands and gloves
2.Oral care q8hrs - Suction/ Drain
- Elevate HOB 30
- Avoid or Shorten Intubation
23
Q
Risk factors of VAP?
A
- Mechanical Ventilation
- Reintubated or Self-extubated
- NG tube (high glucose)
- Antacids or H2 Blocker - decreases acidity
- Trauma
24
Q
What is subglottic suctioning?
A
25
Nursing Interventions for Vent Pt?
1. HOB 30
2. Oral care
3. Sedation Vacation
4. GI - give PPI or Pantoprazole
5. DVT - lovenox
26
ET Tube care
1. Anchor tube with tape
2. Move tube to prevent skin breakdown - change when soiled
3. Cuff pressure q8hrs - pressure 20-25mm - use manometer - if leak is found call HCP - auscultate for AIR 1st
27
Nursing Interventions for Gas Exchange?
1. Assess Pain and Admin Meds
2. Frequent Re-positing q2hrs - helps with blood flow and skin break down
3. Monitor Fluid balance - strict I&O, daily wgt, assess peripheral edema
28
Nursing Interventions for Airway clearance?
1. Assess Lung sounds
2. Clear Airway - Suctioning, Position changes, Increase mobility, Chest therapy
3. Humidification
4. Admin Meds
29
Other interventions?
1. ROM
2. Communication
3. Reduce stress and Promote coping
4. Family teaching and coping
30
Weaning off Vent - 3 stages?
1st gradually remove vent "Machine"
2nd remove ET ot Trach "Tube " - will need supplemental O2
3rd Finally "Oxygen"
31
Around what day will doctor look at a Tracheostomy instead of ET tube?
Day 10, no longer than 14 and make sure to get consent signed for Trach
32
What is hallmark sign of tension pneumothorax?
Trachea deviated
33
Signs of tension pneumonthorax?
Extreme Dyspnea
hypoxemia
Decreased or Absent breath sounds
Sudden develop of SQ emphysema
Ominous signs: hypotension, Bradycardia and Cardia arrest
34
Chest tude dressing assessment?
1. Do NOT change the dressing
2. Make sure dry, intact, no bleeding
3. Palpate for SQ air, redness or swelling
35
Chest tude does what?
1. Removes air, fluid, blood from pleural space
2. Restores negative pressure
3. Prevents reflux of drainage back into the chest
36
3 Chamber Chest tube has?
1. Water seal
2. Collection of suction
3. Suction source
37
Water seal is filled to?
2 cm
38
Suction control is around what level?
20 cm
39
What should you see in the suction part of chest tube?
gentle bubbling and movement
40
Chest tube Assessment?
1. Maintain patency and proper functioning of tube
2. Assess Cardiopulmonary VS q2hr
3. Check tube patency, color, and amount of drainage q2hr
4. Mark drainage amount on the collection chamber hourly and document
5. Prevent loops from forming and make sure patient doesn't lie on it or kink it.
6. Refill water system w/ sterile water
7. Assess for "tidaling" in water seal chamber with respiration or vent
8. Assess for location of air leaks, if constant bubbling. Turn off suction.
9. Check all tubing connections are securely sealed and taped
10. Assess Patient for Pain, Admin meds
11. Assess tube insertion site for infection, SQ emphysema, or soiled dressing
41
Only Clamp tube for 2 reasons
1. Locate source of leak
2. Replace chest tube - use padded hemostat
42
Nurse does not do if chest tube gets clogged?
Strip it or milk it - Call HCP
43
Continuously monitor chest tube when patient is?
Transported
44
Chest tube should never be above the?
Chest
45
What is a serious complication of any obstruction in a chest tube?
pneumothorax
46
What does Nurse do if chest tube comes out?
Place 4x4 gauze over the site, tape it around 3 corners, and call HCP
47
Suctioning technique
1. Admin meds, assemble equipment, explain procedure, adjust bed, prepare suction pressure, WASH HANDS and put GLOVES on
2. HYPEROXYGENATE w/ 100% oxygen - if vent is used at least 2 mins
3. Quickly but gently insert catheter as far as possible without applying suction
4. Withdrawal the catheter 1-2 cm and apply intermittent suction while rotating and removing catheter - Sucion pressure 80-120mm. Aspiration should not exceed 10-15 secs
5. Hyperoxygenate before and after each pass of the catheter for 30 secs
6. Monitor HR and Rhythm, Pulse Oximetry during and after
7. Discontinue is patient does not tolerate w/ dysrhythmias, bradycardia, or SaO2 drops
8. Remove equipment, Clean suction tube, Wash HANDS and Document
