6.3 Intubation and Ventilation Flashcards
Flash Pulmonary Edema
- Dramatic presentation of acute decompensated HF which can cause acute respiratory distress
- Rapid accumulation of fluid in the lungs causes elevated cardiac filling pressure which results in severe dyspnea and hypoxia
Risk Factors
- Hypertension, Coronary Ischemia, Valvular Heart Disease, Diastolic Dysfunction
Treatment
- CPAP/Bi-PAP
- High Dose NTG
Nurses Role in Endotracheal Tubes
- Know the proper equipment and its use
- Verify equipment is available and functional
- Anticipate Health Providers Needs
- Position Patient
- Preoxygenate patient
- Provide suction
- Monitor patient
- Provide information
Endotracheal Tube
- Temporary artificial airway to create open pathway to improve ventilation and gas delivery.
- Also protects trachea and lungs from aspiration in patients who have lost protective reflexes (gag reflex)
- Patients are unable to vocalize because tube passes through vocal cords
- Can be inserted nasally or oral but oral is most frequent in emergencies.
- Cuff sites below vocal cords
- STABILIZATION OF ET TUBE IS IMPORTANT
DOPE
- Displacement
- Obstruction
- Pneumothorax
- Equipment failure
(Most common cause of hypoxia/deterioration of intubated patients)
Documentation for ET Tubes
- Size of ET tube
- Location of ET tube in the airway
- Medications administered
- Patients tolerance of procedure
- Cuff pressure should be maintained at 20-25 mmHg and checked on q8h
Mechanical Ventilation
Ventilation - Movement of air in and out of airways
Mechanical Ventilation
- Used to control patients respirations during surgery/treatment, oxygenate blood when patients ventilatory efforts are inadequate, and to rest respiratory muscles.
- Patients can breathe spontaneously but effort needed to do so may be exhausting
Failing Mechanical Ventilation
- Decreased O2, Increased CO2, Persistent Acidosis
Ventilators
- Positive/Negative pressure machines that maintain ventilation and oxygen delivery for a client
- Negative pressure systems are no longer used because lungs are naturally negative pressure breathing systems.
How Ventilators Work
- Monitors RR, Pressure, Volume
- Delivers Specified Volume, Pressure, Or Both
- Controls concentration of oxygen
- Mixes compressed air with oxygen to reach desired FIO2
Volume Cycled Ventilator
- Volume is constant in inspiration but variable on expiration depending on the client
Complications
- Barotrauma due to client requiring a lot of force to inspire
Pressure Cycled
- Pressure is constant but volume depends on airway resistance and compliance
Complications
- Compromised ventilation because of inadequate tidal volume
High Frequency Oscillatory Support (HFOS)
- Very high respiratory rate but low tidal volume and high pressure. Pulses oxygen into airways to help expand alveoli so oxygenation can occur
Complications
- Decrease cardiac output, decreased venous return, intraventricular hemorrhage, increased intrathoracic pressure
Non-invasive CPAP and BiPAP
CPAP
- Continuous positive airway pressure all the way through breathing cycle
Problems
- Client must be able to breath on their own (can be used in adjunct to mechanical ventilation support)
BiPAP
- Bilevel positive airway pressure for independent control of inspiration/expiration depending on how machine is set. Prompt for client to breath on their own
Problems
- Motivated Clients Only
Ventilators
- Ventilators deliver gas to lungs on positive pressure limited at a certain rate
- The amount of gas delivered is limited by time, pressure, or volume
- Duration can be cycled by time, pressure, flow.
VOLUME LIMITED
- Preset Tidal Volume
PRESSURE LIMITED
- Preset PIP or PAP
Ventilator Modes
Continuous Mandatory Ventilation
- Preset volume and rate, clients can’t take spontaneous breaths
Assist-Control Ventilation (IMV)
- Combination of preset and spontaneous but preset intervals and volumes so that client can try but machine still uses its presets
Synchronized Intermittent Mandatory Ventilation (SIMV)
- Preset volume and rate but if client initiates breaths, ventilator will adjust so there is no “fighting”
Pressure Support Ventilation (PSV)
- Client breathes on their own and the machine applies pressure to the airway
- Nurse needs to assess and adjust rates/tidal volumes
PEEP
- Positive End Expiratory Pressure
- NOT A SETTING IT IS A MODE
- Provides resistance at the end of exhalation
- Prevents alveoli from collapsing (at least 5cm of H2O required to prevent alveolar collapse)
- Greater than 5cm of H2O can cause decreased cardiac output
- Pneumothorax at higher levels of PEEP (barotrauma)
Nursing Process
Assess everything because client cannot talk to you while intubated.
- All body systems, in depth respiratory assessment including all indicators of oxygenation status, comfort or rest, coping, communication needs
- Vent Assessment (ASSESS CLIENT BEFORE MACHINE)
- ETT (bends, patient biting, dislodged)
VENT ALARMS
- High Pressure (Biting or Kink in Tube)
- Low Pressure (Disconnected Tube)
- Apnea
- Circuit Disconnect
- High Exhaled Volume
GOALS
- Optimal gas exchange, patent airways, no trauma, no infection, effective communication, good coping skills
Complications
- Vent issues, barotrauma, pneumothorax, ventilator associated infections, sepsis
Implementation
- Maintain ET tube without kinks or obstructions, maintain sterile technique during suctioning, patient position, monitor VS and ABGs, provide emotional support
Evaluation
- Return to preincubation level of functioning
Weaning Mechanical Ventilation
- Weaning Mechanical Support
- Weaning Airway Support
- Weaning O2
- Assess psychosocial barriers before removing the tube
- Check ABG’s for hemodynamic stability
