2 Ventilatory Assistance Part 2 Flashcards
Reasons pulse ox may read wrong
Cold fingers
Vasopressors
Fake nails
Burns
End tidal CO2 (ETCO2)
Measures what
Attaches to what
What is the reading?
Used for what
Measures expired CO2
Attach to ETT
2-5mmHg less than PaCO2
Used to:
-assess pt response to ventilation
(how well their being vented)
Colorimetric CO2 detector
Used when
Attach to what
What is it used for? How we know it good
After intubation to verify tub placement
-observe color change (yellow to purple)
Attach to ETT
How much O2 can be given:
NC
High flow NC
Simple mask
NC:
-1-6L
-use humidification if 4L+
High flow NC:
-15-60L/min (60-90% O2)
Simple mask:
-5-12L/min (30-60% O2)
-short term only
How much O2 can be given:
Face mask w/reservoir
Venturi (type of patients)
Face mask w/reservoir:
-35-90%
-reservoir increases amt of O2 available w/inspiration
Venturi:
-a fixed FIO2
-COPD patients
CPAP
Indications
What is does
Location
Increases what? Caution
Risk
Indications:
-obstructive sleep apnea
Keeps airway pressure from falling to 0
(Similar to PEEP)
-face or nasal mask
Increases WOB:
-pt must forcibly exhale on own
-caution with cardiac pt (tires easy)
Risk (aspiration)
BIPAP
What it does
Risk
No what on patients
Indications
2levels:
High inspiratory
Low expiratory pressures
Risk: aspiration
No restraints on pt
Indication:
-COPD, HF, ARF
-after extubation to prevent reintubation
Indications for mechanical ventilation
3
Assess what 3 things
PaO2 under 60 with FIO2 over 50%
PaCO2 over 50 with pH under 7.25
Procedures/sx
Assess (WOB, dyspnea, breathing patterns)
Normal ETT size
Size of syringe needed
7.5-8
10ml syringe for cuff
Intubation procedure:
-give what meds
-do what prior
-how long to intubate
-always assess what 1st after intubation
-assess what second to double confirm
Sedation and paralytics
Hyperoxygenate w/ambu bag prior
30 secs to intubate
Ausculate bilateral lung sounds 1st
CXR second
Complications from intubation
Pneumothorax
Dental damage
Esophageal intubation
Vent settings
(RR, Vt, FIO2, PEEP, PS)
What 3 settings can pt show on own breaths with certain settings?
respirations
tidal volume
FIO2: oxygen were delivering to pt
PEEP (positive end expiratory pressure)
PS (pressure support=pressure vent is delivering to pt)
Patient info:
Vt
PIP (peak pressures)
RR
PEEP
What is it
What does it improve
Normal PEEP
Above what is considered high and can cause what?
Pressure left in alveoli at end of expiration
(Improves ability for gas exchange)
Normal 5-20
Above 10 is high (risk of barotrauma)
Vent modes
Volume modes vs pressure modes
Volume:
-AC (assist control)
-IMV/SIMV (synchronized intermittent mandatory ventilation)
Pressure:
-CPAP
Ventilator volume modes
AC vs IMV/SIMV
AC (assist control)
-all breaths are machine breaths
(Even when pt takes their own breath the vent assist them)
IMV/SIMV:
Pt can take own breaths (get own tV as well as assistance)
-machine and spontaneous breaths
Vent pressure ventilation mode
-CPAP
AKA
-used for what
-keeps pts what 2 things
All spontaneous (weaning mode)
-trying to extubate pt
(Provides support but keeps own tV & RR)
Other vent modes
-high frequency oscillatory ventilations
Size of Vt
RR rate
What it does
Meds needed
Small Vt (fast RR 300-420)
-need sedation/paralyzed to not fight
Stabilizes alveoli
(good for unhealthy lungs needing to heal)
Other vent modes
Nitric oxide
-does what
Indication
Regulates pulmonary vascular tone
—pulmonary vasodilation
Indication:
-pulmonary HTN
-improve oxygenation
Prone positioning:
-indication
-names of machines
Other name for proning
Risks
Meds
ARDS, covid
Rotorest/rotoprone/manual
Kinetic therapy
Risk:
-atelectasis
-skin breakdown
-edema
-connections secured
Meds: sedated/paralyzed
ECMO (extracorporeal membrane oxygenation)
What its used for
-a modified what?
What is does
Meds needed
Pulm support for resp failure
Modified cardiac bypass
Infuses O2 and removes CO2:
-via large catheters in artery/veins via a pump
-then returns it to pt
Meds: anticoagulation required
Nurses responsibility with vent pts
Assess what
Verify what
Synchrony w/ vent meaning
Review what
How to prevent VAP
Assess ability to wean
Position/verify settings
Synchrony w/ vent (keeps honking may need more sedation)
Review ABG
VAP bundles
ALARMS
High peak pressure and high exhaled volume/high minute volume
Assess what
Check what
Assess what else and why
Assess increased what
Assess for:
-obstruction/kinks/coughing/anxiety/biting tube
Check water in circuit tubing
Assess lung sounds:
May need suction (mucus obstruction)
Assess increased:
RR, TV, pain, hypoxemia
ALARMS
Low pressure/PEEP/CPAP
Low exhaled volume/low minute volume
Assess what
Disconnection and cuff/tubing leak
Assess pt fatigue or over sedated
(For pt on SIMV or CPAP)
ALARMS
Apnea
Check what
Assess for what
Do what to pt
When all else fails do what? Dont do what?
Check:
-Pt, RR, effort
Assess:
-oversedation, resp arrest
When all else fails:
-bag the pt
DO NOT IGNORE THE ALARM
Vent complications:
ETT out of place
-assess
-do what
Unplanned extubation
-assess what
-provide what
-grab what
ETT out of place:
-assess lung sounds, tube position at lip
-call provider
-deflate cuff reposition
-then recheck lung sounds
Unplanned extubation:
-assess oxygenation and provide O2
-get stuff to reintubate
Vent complications:
Laryngeal or tracheal injury
-prevent by assessing what (who measures that)
-assess for what if they self extubated
Damage to oral or nasal mucosa
-look for what
Laryngeal or tracheal injury:
-assessing cuff pressure to prevent
-RT measures this pressure
-assess for stridor if self extubated
Damage to the oral or nasal mucosa:
-skin breakdown / infection
Vent complications:
Baro trauma:
Whats the issue?
Lead to what?
S/s
Prepare for what?
Too high PEEP or tidal volume
-alveoli rupture
(subcutaneous emphysema/pneumothorax)
S/s:
-high PIP
-decreased breath sounds
-tracheal shift
-hypoxemia
Prepare for chest tube insertion
Vent complications:
Volutrauma
-what causes
-leads to what
Hypoventilation
-leads to what
Hyperventilation:
-leads to what
Volutrauma:
-too high of tidal volume
Lead to: pulmonary edema (similar to ARDS)
Hypoventilation: ateletasis/resp acidosis
Hyperventilation: resp alkalosis
Vent complications
Oxygen toxicity:
-what to do
-mimics what?
-can cause what?
Aspiration and dysphagia:
-what to do post extubation to prevent?
Oxygen toxicity:
-wean FIO2 as tolerated:
-mimics ARDS
-cause atelectasis
Aspiration/dyspagia:
-swallow study
Vent complications
Infection
-what we do
-examples of it (5)
VAP bundle:
-30 degree HOB
-DVT prophylaxis
-oral care
-hand hygiene
-suction
Vent complications
Cardiovascular
-increased PEEP leads to what?
-tx
GI system:
-issues
-how to prevent
CV:
-increased PEEP = decreased CO / HOTN
Tx:
-inotropic agents
-vasopressors
-fluids if preload issue
GI:
-stress ulcers/GI bleeding
Prevent:
-SUP (stress ulcer prophylaxis)
-enteral nutrition
Nursing interventions for pt on vent:
Communication
Keep airway patent (suction)
Meds (analgesics/sedation)
Weaning pt off vent:
-assess readiness to wean by what?
Whats a must?
-hemodynamically stable
-disease process resolved/stable
-airway patent (leak test)
-SBT/Tpiece
-decrease sedation (need to be off first)
Amust:
-pt initiating inspiratory effort
(adequate oxygenation)
What is a leak test
What is a tpiece
Leak test:
-RT deflates cuff and listen for air around tube
-this is a passes leaked test
Tpiece:
Connect to pt see how well theyll breath without help
Weaning parameters for VENT (4)
NIF >(greater) than 20
(Measures resp muscle strength and reserve)
Spontaneous tidal volume (5ml/kg)
Normal RR
Adequate O2
When to discontinue weaning
(pt cant be extubated) 12
-changes in HR or BP from baseline
-ST segment elevation
-RR <8 or >35
-abnormal breath patterns
-dysrhythmias
-diaphoresis
-agitation/anxiety
-decreased LOC
-labored RR
-O2 sats <90
-Low Vt
-accessory muscles use
Extubation
-what syringe size needed
-set up what (3 things)
-is sedation off?
10ml syringe
Set up:
-O2, suction, ambu bag
Sedation OFF
After extubation assess for what?
3 to assess
3 to implement
Assess:
—Lung sounds
—SATs
—Hemodynamic stable
Implement:
—HOB 30degrees
—Suction
—Turn CDB
