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AG > AG2-Mechanical ventilation > Flashcards

AG2-Mechanical ventilation Flashcards

1
Q

What are 4 main reasons for mechanical ventilation?

A

Respiratory failure, apnea, hypoxia, and respiratory muscle fatigue

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2
Q

What are the 2 levels of pressure support provided with BiPAP?

A

Higher inspiratory positive pressure and lower expiratory positive pressure

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3
Q

What is tidal volume?

A

Volume of air delivered with each machine breath

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4
Q

What is a normal tidal value?

A

6-10ml/kg

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5
Q

What is PEEP?

A

Positive pressure applied at the end of expiration. Can be used to increase functional residual capacity and improve overall oxygenation.

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6
Q

What is a normal PEEP value?

A

5-10 cm H20

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7
Q

What is the flow rate?

A

How fast each breath is delivered by the ventilator. Normal value of 40-80 L/min.

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8
Q

What are 3 methods for weaning the patient off the ventilator?

A

T piece, SIMV mode, and pressure support trials

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9
Q

What is a T piece?

A

Oxygen delivery system that is used in place of the mechanical ventilator for short periods of time to assess the patient’s tolerance and respiratory drive off the ventilator.

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10
Q

What is SIMV mode?

A

Synchronized intermittent mandatory ventilation; rate of the ventilator is gradually decreased allowing the respiratory rate to be a combination of ventilator and spontaneous breathing.

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11
Q

What are pressure support trials?

A

Pressure is gradually decreased to allow the patient to increase is or her own tidal volume.

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12
Q

What is the proper cuff inflation pressure?

A

20-30cm H20

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13
Q

Most common traumatic lung problems caused by mechanical ventilation?

A

Barotrauma: positive pressure from the ventilation distends the lungs and causes the alveoli to rupture.

Volutrauma: excess volume being pushed into the lungs shifts fluid into the alveolar spaces causing lung injury.

Lung injury: prolonged ventilation can decrease the lung’s ability to produce surfactant and increase inflammation in the tissue.

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14
Q

What is a common complication of mechanical ventilation?

A

Ventilator associated pneumonia (VAP)

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15
Q

What are signs of VAP?

A

Fever, crackles, increasing WBC, excessive sputum.

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16
Q

Interventions to prevent VAP?

A
  • elevate the head of the bed at least 30 degrees.
  • frequent oral care
  • oral suction to prevent aspiration
  • pulmonary hygiene (chest physiotherapy, postural drainage, and positioning).
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17
Q

Causes of high pressure alarms going off?

A

Suctioning, coughing, biting on ET tube, obstruction of the ventilator tubing, and pneumothorax.

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18
Q

Causes of low volume alarms going off?

A

Air leaks (flat pilot balloon on ET tube, low cuff pressure)

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19
Q

How long should you oxygenate a patient prior to suctioning with a closed ventilation system?

A

30-60 seconds

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20
Q

What is minimum PEEP used on a ventilator?

A

5

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21
Q

What is the max PEEP used on a ventilator?

A

20

22
Q

PaO2, PaCo2, pH, and SaO2 signs of respiratory failure?

A

PaO2< 60mmHg
PaCO2> 45mmHg
PH< 7.35
SaO2< 90%

23
Q

How is the tidal volume goal calculated?

A

Weight based 7-9mL/kg (ideal body weight)

24
Q

How many liters of oxygen can be delivered with high flow nasal cannula?

A

Up to 60 liters per minute

25
Q

What are the benefits of high flow nasal cannula?

A

Less drying and less nosebleeds because the oxygen is 100% humidified and heated

26
Q

What is the PEEP effect of high flow nasal cannula?

A

Every 10 liters = 1 of PEEP

27
Q

Nursing interventions when patient is on BiPAP?

A

Prevent skin breakdown and monitor for vomiting

28
Q

What are indications for intubation?

A

Chest wall not moving, cyanosis, GCS < or equal to 8, decreased oxygen saturation, abnormal ABGs (PCO2> 50), unable to protect their airway d/t decreased mental status, general anesthesia

29
Q

Explain color changes with CO2 detector confirmation after intubation?

A

Purple- problem, could be in the lungs

Yellow- CO2 is being blown off

30
Q

Why do we need to give PPIs and H2 blockers to ventilated patients?

A

To prevent stress ulcers

31
Q

How often does CHG mouth care need to be done for ventilated patients?

A

Every 2-4 hours

32
Q

How often should we assess for suctioning on a ventilated patient?

A

Q2H

33
Q

How long can an ET tube be in place?

A

10-14 days

34
Q

What ventilator modes will do all the work of breathing for the patient?

A

Volume controlled, pressure controlled, and assist control.

35
Q

What ventilator modes allows the patient to start the work but then takes over the work if needed?

A

SIMV

36
Q

What ventilator modes allows the pt to do some or most of the work but then assists to finish the work?

A

Pressure support, BiPAP, and CPAP

37
Q

What is PIP?

A

Peak inspiratory pressure; Dynamic pressure need to fully inflate the lung (overcome resistive and elastic forces of the lung); how hard the ventilator has to work to blow up the lungs.

38
Q

What can an increased PIP indicate?

A

Patient is going into ARDS

39
Q

What is the goal for PaO2 with a patient with ARDS?

A

> 55

40
Q

What is the goal for PaCO2 for a patient with ARDS?

A

40-50

41
Q

Ventilator adjustments: If PaO2 is low then ?

A

Increase FiO2 and/or increase PEEP

42
Q

Ventilator adjustments: If PaO2 is high then?

A

Decrease FiO2 and/or decrease PEEP

43
Q

Ventilator adjustments: If PaCO2 is high then?

A

Increase RR and/or increase Vt (tidal volume)

44
Q

Ventilator adjustments: If PaCO2 is low then?

A

Decrease RR and/or decrease Vt

45
Q

T/F End tidal should be the same as PCO2?

A

TRUE

46
Q

What are some complications of mechanical ventilation?

A

Cardiac problems, lung problems, GI problems, infection, msl deconditioning, ventilator dependence, and self extubation.

47
Q

Why should we monitor for I&Os, weight, and hydration status in a ventilated pt?

A

PEEP increases intrathoracic press leading to a decrease in cardiac output resulting in hypotension causing RAAS to be activated and leading to fluid retention/decreased urine output.

48
Q

Why should we teach ventilated patients to avoid using the Valsalva maneuver like straining during a bowel movement?

A

It can further increase intrathoracic pressure

49
Q

What are symptoms of failing ventilator weaning trials?

A

Sternomastoid activity, diaphoresis, nasal flaring, cyanosis, tachypnea, abdominal paradox, tachycardia, intercostal recession, and supresternal and supraclavicular recession.

50
Q

What causes a high PIP alarm to go off and how do we fix it?

A

Developing decreased compliance; fix by evaluating for ARDS RRT to adjust

51
Q

How often should we monitor a patient after extubation?

A

Every 5 min for signs of respiratory distress or sudden closure of the airway

AG (30 decks)

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