2 Ventilatory Assistance Part 2 Flashcards by Brendon Allen

Reasons pulse ox may read wrong

Cold fingers
Vasopressors
Fake nails
Burns

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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)

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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

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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

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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

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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)

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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

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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)

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Normal ETT size
Size of syringe needed

7.5-8

10ml syringe for cuff

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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

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Complications from intubation

Pneumothorax
Dental damage
Esophageal intubation

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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

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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)

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Vent modes

Volume modes vs pressure modes

Volume:
-AC (assist control)
-IMV/SIMV (synchronized intermittent mandatory ventilation)

Pressure:
-CPAP

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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

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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