Fundamentals part 1 Flashcards
What is the first thing to know if a patient is on a ventilator?
First thing is to know WHY they’re on it
What will they try before a patient is put on ventilator?
Non-invasive modalities (and if they fail then you will do the vent)
like nasal cannula
bipap
“drive for breathing”
co2 levels
co2 lab range
35-45
What is the compensation method for too much co2 in a clients system?
hyperventilation bc co2 is dependant on respiratory rate
Patient asks what area of the brain regulates their breathing rate. What do you tell them?
It is their medulla
What happens to the vessels if co2 is high
What does this cause?
Common issues. but can you explain why?
Blood vessels will vasodilate
And then BP drops
fluid retention, kidney & brain problems
How often will oral care orders be for a ventilated patient?
How often will you reposition the patient?
Will you always reposition?
q2 hours
q2 hours
- not always if there is a contraindication
How are meds given when a patient is on a ventilator?
Will change the route to IV
unless it is a navel drug
major sign of co2 build up in a patient
to compensate, they’ll try to hyperventilate
what assessment tool can help assess for co2 build up in a patient
what values
glascow coma scale (due to consciousness measurement)
normal is 15
if less than 8, intubate
how do we check to see if our ventilation intervention was successful for an patient?
check abgs
what is the significance of the medulla obloganta
it sets the respiratory breathing rate
what does the pons do
Takes care of the depth and length of respirations
what part of the brain allows for altering of breathing
cerebrum
List the symptoms of patient with a high Co2.
What does the high CO2 do to BP?
What does this lead to?
fatigue, headache, confusion
If you have too much co2, your vaso will vasodilate so BP drops
Fluid retention
&
Can lead to kidney and brain issues
What happens to vessels if co2 is low?
What happens to the HR next?
the vessels vasoconstrict
HR increases to get more perfusion done
and sometimes the perfusion isn’t enough for peripheral body parts
Your ventilated patients CO2 levels are high. What nursing intervention will you consider doing before calling the doctor?
Suction secretions bc these can block the Co2 from exiting
Check their o2 sat
- remember how to power-shoot if this is off
What should the HOB be at for a ventilated patient?
When we assess the patient’s lungs, what are we assessing for?
HOB at 45 degrees
- to avoid aspiration & pneumonia
Assess for crackles
before suctioning what is a good intervention to do on the mechanical vent?
hyperventilate so they don’t de-sat
You need to reposition your vented patient. Since they’re ventilated, what should you do?
Hold the tubing in place so that it doesn’t accidentally come out.
You hear the high pressure alarm go off for the vented patient.
What does it mean if it goes off?
What do you do?
Your vented patient begins to cough. What do you do?
There is a blocked airway or occlusion.
Or something more serious like a Tension pneumothorax
You should always check and see why it is going off.
Reassure them and tell them to cough. Stay with them & talk them through it.
What does it mean when you hear a low pressure alarm go off on the ventilator?
What should you do if you hear it?
The vent didn’t reach the pressure it needed to be at or exhale wasn’t measured properly.
Check tubing and wipe away any condensation.
You hear alarm go off on the mechanical vent. What should you do in order?
What should you make sure is in the room at the start of the shift?
- Check the patient first.
- Check the tubing.
- Call RT
- Bag pt with ambu bag
Ambu-bag
How can you tell theres disconnected tubing or an air leak
What are some common places for leaks?
You can hear the patient begin to grunt or whisper with the tube in low o2
Cuff, connections, drain & access ports
How do you document for tube on ventilated patients
ETT location = 8F , 22 cm @ the lip
so 8 is the the size of the tube’s gauge
22 cm is how far in
what is a pneumothorax
Types of degrees?
main intervention/fix?
collapsed lung - due to air leaking between lung and chest
Pneumothorax can be complete or partial
chest tube!
- nclex q
- assess it by making sure it is secure.
- check tubing
What does P.E.E.P. stand for?
What if the effect of PEEP?
positive end expiratory pressure
- it is a setting on a ventilator
Effect of peep is to supply pressure to the alveoli in the lungs so they never have to close all the way. it makes gas exchange easier
Where will the PEEP setting be located on the monitor?
Avg PEEP value
what is the overall range a PEEP setting can go to if the lungs are “stiff” (meaning they have issues like ARDS or acute respiratory distress syndrome)
The setting will be on the bottom ribbon (actual pull will be on the top ribbon)
PEEP of 5cm H20
Between 8-12 is common but up to 20 of H20 if the lungs are too stiff to keep pt comfortable at 5
- higher peep, sicker the patient
What does the Tidal Volume setting on the monitor represent?
Which ribbon will this be for the patient is pulling?
Amount of preset air volume of o2 and air that can is set to move in and out of the lungs
top ribbon
- settings from pulm. will be on bottom ribbon
What is vital capacity on the monitor mean?
what is the constant value for this?
Total of the maximum volume that can be inhaled and exhaled in single breath
trick question. not every breath will give you the same tidal volume.
What is F.I.O2?
trend
what aspects help determine this
It is the amount of o2that the vent delivers
- percent or number between 0 and 1
sick people need more fio2
2 abgs
pulse ox
What is ACVC setting on the vent?
Where is the symbol on the monitor?
Stands for assist control meaning every breath is supported so the vent does all the work (regardless if the pt can breath a lil on their own)
C on top ribbon
Good reason a patient will be on the ACVC (all the work) vent setting?
Recently resuscitated ARDS paralyzed or sedated - since they cant consciously breath - not the same thing tho
What is Pressure Support setting on a vent?
Can you be on pressure support and acvc at the same time?
Provides pressure to give the patient that extra push to draw in breath
- back up for peep
no pressure support and acvc cannot work at the same time
What do you need to anticipate if a sedated patient wakes up from you stopping their med drips?
why do we need to calm them ?
They will try to pull out their tubing! don’t let them.
- due to panic
- anxiousness affects breathing
FIO2 meaning
You increase FIo2 on your patient. what happens to pO2 and Co2
FIO2 is the amount of oxygen the vent delivers
po2 increases*
no change for Co2
PIP increase? idk if we talked about this yet
…
Tidal volume meaning
If you increase tidal volume on the vent, what happens to pO2 and Co2
Set amount of air that moves o2 in and out of the lungs
co2 decreases *
po2 increase or no change
What happens to pO2 and Co2 if you increase peep?
Peep is pressure blowing up alveoli w air so
increased o2
if you increase the RR on the vent what happens to the pO2 and Co2
Co2 will decrease bc you breathe it off
o2 increase or no change
What happens to pO2 and Co2 if you increase MAP
the pO2 will increase
Co2 most likely decreases
What is I-time?
norm?
Inspiratory time set for patient to inhale and exhale
0.8-1.2 seconds
If vent patient ABG returns with a high CO2 what do you anticipate ?
You will be trying to get the co2 lowered.
And to do that, you can increase the RR to breathe off the acidic co2
