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NUR5926 > - ADVANCED VENTILATION - > Flashcards

- ADVANCED VENTILATION - Flashcards

1
Q

Describe the major systemic complications of mechanical ventilation

A

CNS: increased ICP
CVS: impaired cardiac function due to increased ITP, reduced RV preload and afterload
RESP: Resp alkalosis, barotrauma, muscle atrophy
GIT: Gastric distention
RENAL/HEPATIC: elevation in ADH and aldosterone, reduction in renal funtion and renal blood flow,

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2
Q

Discuss the concepts of compliance and obstructive problems

A

Obstructive

  • compliance: normal
  • elasticity: reduced
  • *issues with rersistance
  • **difficulty breathing out
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3
Q

Perform plateau pressure

A

Indication:
High PIP

Procedure:
- perform an inspiratory hold

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4
Q

Determine appropriate ventilator settings for a paediatric patient

A 
Mode and control - SIMV +PC
FiO2 - 100%
TV - 5-8mls/kg
RR - 20bpm (or age appropriate)
Flow rate - 40-60LPM
Insp. time - 1 second
I:E ratio - 1:2
Sensitivity - 1
Pressure support ]- 5
PIP 20 (max)
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5
Q

Offer mechanical ventilation strategies for patients with Asthma

A
  • Obstructive
    • Increase expiratiory time
  • decrease RR
  • fast flow
  • no unecessary inspiratory pauses
  • decrease tidal volumes
    if plateau pressure is rising
  • Permissive hypercapnia
  • Aim for MV approx 6L/min
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6
Q

Offer mechanical ventilation strategies for patients with COPD

A
  • Obstructive
    • Increase expiratiory time
  • decrease RR
  • fast flow
  • no unecessary inspiratory pauses
  • decrease tidal volumes if plateau pressure is rising
  • Permissive hypercapnia
  • *** may benefit from some PEEP
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7
Q

Offer mechanical ventilation strategies for patients with Pneumonia

A
  • Restrictive
  • increase inspiratory time
  • look at pts position
  • Reduce peak inspiratory pressures
  • change to pressure control
  • work with PEEP to recruit alveoli
  • Permissive hypercapnia
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8
Q

Discuss permissive hypercapnia

A

Permissive hypercpania is allowing a gradual increase in PaCO2 as a result of lowering the TV (5mls/kg) in order to decrease alvelolar distention and reduce the risk of barotrauma

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9
Q

Discuss prone ventilation

A
  • ventilation pt in prone position
  • can effect the distribution of ventilation
  • may improve oxygenation
  • may decrease the degree of shunt
  • An improvement of 10mmHg within 30 mins will distinguish if pt is a responder
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10
Q

Outline the principles of weaning a patient from mechanical ventilation

A

The ‘wean screen’ should be performed daily

  • lung disease is stable/ resolving
  • low FiO2 (< 0.5) and PEEP (< 5-8cmH2O) requirement
  • haemodynamic stability (little to no inopressors)
  • able to initiate spontaneous breaths (good neuromuscular function)

Techniques include:

  • gradual reduction in mandatory rate during intermittent mandatory ventilation
  • gradual reduction in pressure support
  • spontaneous breathing through a T-piece
  • spontaneous breathing with ventilator on ‘flow by’ and PS=0 with PEEP=0
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11
Q

Discuss the complications of extubation

A

Complications:

  • cardiovascular stress
  • pulmonary aspiration
  • hypoxaemia
  • death
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12
Q

List the signs and symptoms of barotrauma

A
  • tachycardia
  • reduced air entry
  • reduced SaO2
  • poor chest movement
  • hypotension
  • cyanosis
  • CXR
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13
Q

List the Nursing prevention strategies for barotrauma

A
  • set appropriate alarm limits
  • monitor for changes in lung compliance
  • listen for air entry
  • look at chest expansion
  • observe respiratory effort
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14
Q

List the common Restrictive diseases

A
  • ARDS
  • Pneumonia
  • APO
  • Fibrosis
  • Atelectasis
  • Pneumothorax
  • Decreased chest/wall compliance
  • Increased abdominal constraint
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15
Q

List the common Obstructive diseases

A
  • Asthma
  • COPD
  • Emphysema
  • Bronchiectasis
  • Chronic bronchitis
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16
Q

Discuss the advantages of permissive hypercapnia

A

– Reduction in risk of barotrauma / volutrauma.
– Increased PaCO2 enhances oxygen unloading at the tissue
level.
– Adverse effects of acidosis minimised with gradual rise of PaCO2.

17
Q

Discuss the disadvantages of permissive hypercapnia

A

– Acute rises in PaCO2 causes depressive effects on CNS &
CVS.
– Reduces the affinity of Hb for oxygen uptake in the lungs.
– Rapid rise in CO2 leads to respiratory acidosis.

18
Q

What is the purpose of performing a plateau pressure

A
  • Can determine the cause of high PIP (compliance or resistance) and diagnose ventilatory problems
  • Increased PIP + HIGH plateau pressure = DECREASED COMPLIANCE
  • Increased PIP + UNCHANGED plateau pressure = AIRWAY OBSTRUCTIONS
19
Q

What is Peak Inspiratory Pressure?

A

Peak inspiratory pressure is the pressure required to deliver set VT over airway resistance and lung compliance.
The maximum pressure in the lungs that is achieved at the peak of inhalation.
PIP reflects AIRWAY resistance, Plateau Pressure reflects LUNG resistance.

20
Q

What Factors generate PIP?

A
  • tidal volume
  • airway resistance
  • chest wall compliance
  • inspiratory flow rate
  • gut constraint
  • lung tissue compliance
21
Q

What additional factors generate plateau pressures?

A
  • Increased lung resistance
22
Q

Discuss the indications for extubation

A
  • when the conditions that required intubation and mechanical ventilation are no longer present
23
Q

Discuss the conrtaindications for extubation

A

Contraindications:

  • protective airway reflexes absent
  • pt cannot sustain adequate spontaneous respirations
  • persistent respiratory muscle weakness
  • hypoxaemia
  • hypercarbia
  • metabolic derangements
  • cardiovascular instability
  • hypothermia
24
Q

Discuss the nursing considerations of extubation

A

Consider:

  • Full pt Assessment (medical condition)
  • RR, TV and SaO2
  • consider all pertinant and relevant information
  • history of previous difficulty, airway conditions
25
Q

List the equipment needed for extubation

A

Equipment:

  • suction
  • oxygen
  • BVM
  • airway adjuncts
  • Intubation equipment
  • Induction agent and muscle relaxant
26
Q

Discuss the procedure of extubation

A

Procedure:

  • prepare intubation trolley and airway equipment
  • confirm order for extubation
  • confirm patient is ready for extubation
  • pre-oxygenate pt on ventilator
  • Suction ETT
  • Suction mouth
  • Remove tapes
  • Deflate cuff
  • Remove ETT
  • Apply oxygen via face mask

NUR5926 (20 decks)

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