109: U5: Management of Mechanical Ventilation

Question 1

Respiratory assessment

Answer 1

Auscultate breath sounds bilaterally.
Assess for symmetry in chest wall movement
Assess respiratory effort and signs of decreased ventilation.
Assess for signs of hypoxemia

Question 2

Monitor

Answer 2

Serial ABGs and Pulse Ox
Ventilator settings and alarms (Q1 hour)
Maintain cuff pressure 20-25

Question 3

Administer

Answer 3

Sedatives, paralytics and analgesics per protocol.

Question 4

Provide oral care

Answer 4

Suction as needed

Question 5

ETT

Answer 5

Keep secured and without pressure to patient’s face

Question 6

Provide teaching

Answer 6

To patient and family

Question 7

Monitor for and prevent ventilator associated problems such as:

Answer 7

Barotraumas: increased pressure distends the lungs and ruptures alveoli and blebs, may cause pneumothorax.
Volutrauma: alveolar fractures causing fluids and proteins into alveolar spaces - use low volume ventilation to prevent.
Alveolar hypoventilation: caused by inappropriate vent settings, leakage of air from the vent tubing or around the ETT or trach.
Hyperventilation and respiratory alkalosis.
Decreased cardiac output and hypotension - increased throacic pressure compresses throacic vessels and decreases venous return

Question 8

Pneumonia prevention

Answer 8

.

Question 9

Assess

Answer 9

Neurologic system
Prevent stress ulcers
Decompression of the stomach

Question 10

Ensure

Answer 10

Maintain muscle strength with ROM

Ensure adequate nutrition