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Kol- 410 Med Surg II > Intubation / Mechanical Ventilation > Flashcards

Intubation / Mechanical Ventilation Flashcards

1
Q

indications for using intubation or mechanical ventilation

A

◦ Hypoxemia/ unable to oxygenate with other oxygen delivery
◦ Respiratory Acidosis
◦ Surgery or procedures (peri or post)
◦ Inability to protect airway (obtunded or in coma)
◦ Tachypnea
◦ Neuromuscular Disease

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2
Q

why does an ET tube have a radio-opaque line on it?

A

verify placement via xray

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3
Q

why does a an ET tube have a baloon outside and inside?

A

balloon outside tells us how much air is in the cuff inside

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4
Q

3 functions of an artificial airway?

A

• Provide a patent airway
• Provided a means to supply oxygen/ ventilate
• Provide a way to clear secretions

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5
Q

how long can a person have an ET tube in?

A

<10-14 days

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6
Q

can you put an ET tube in your nose?

A

sure betchya

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7
Q

how far down do we want the ET tube to be?

A

2 inches above the carina

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8
Q

who can put in an ET tube?

A

◦ Anesthesiologist, Critical Care Provider, Hospitalist (and more)
◦ Respiratory Therapist
◦ Certified Nurse Anesthetist

in other terms- NOT YOU. not for RN!

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9
Q

doctor says- lets intubate! what are you going to do my new nursing school grad?

A

• Provide oxygen
• Lift head of bed
• **Keep talking to your patient **
• Call for help/ Coordinate care
• Gather supplies
• Assess, assess, assess

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10
Q

3 meds we are giving for intubation- sedation, anaglesics, and paralytics: which one do we give first?

A

sedation

*not everyone gets a paralytic

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11
Q

how long do we limit the intubation attempt time to?

A

30 seconds

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12
Q

how often do we monitor the BP during intubation?

A

every 5 minutes at least

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13
Q

how do we verify ET tube placemnt?

A

xray
waveform capnography
auscultation
bronchoscope
esophageal detector

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14
Q

priority for maintaining ET tube function after palcement

A

frequently check that it is in the correct place –> look at number

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15
Q

being intubated puts patients at risk for ______ later in life

A

delirium

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16
Q

do we put restraints on all intubated patients?

A

nope! only if they needs
–> consider using a mitt instead

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17
Q

DOPE is an acronym for complications from intubations, what does it stand for? whats the last thing you check for?

A

• Dislodgement
• Obstruction (sputum)
• Pneumothorax
• Equipment failure (last thing you should be checking for)

18
Q

which side is more common for ET tube misplacement ?

A

right side- most common, bigger and straighter

19
Q

• Your patient is intubated and is becoming agitated, moving around the bed a lot.
You notice that he becomes tachypneic and tachycardic and his SpO2 falls from
94% to 87%. Upon your assessment, he has diminished breath sounds on the left.
You check the ET tube placement and note that the ET tube is no longer 24 cm, as
you documented this morning. It is now 27 cm at the lips. Your first action is to
• Notify the provider
• Notify Respiratory therapy
• Order a PRN x-ray
• Move the tube back to where it was on your morning assessment

A

• Notify the provider

20
Q

mechanical ventilation allows us to _____ the underlying process

A

fix

21
Q

re mechanical ventilation FiO2 % should be between

A

21-100

22
Q

Vent resp rates should be

A

10-14

23
Q

what is the tidal volume?

A

air going in or air goig out (7-10 mL/kg)

24
Q

the higher the peep the ____ the risk of damaging the alveoli

A

the > the risk

25
Q

breaths on vent can be spontaneous or mandatory - whats the difference in when we use them

A

◦ spontaneous: just need a little pressure support and can breathe on their own
◦ mandatory: paralyzed, beginning of drug overdose

26
Q

◦ highest amount of resistance a person can reach when being mechanically ventilated =

A

PIP or Peak Airway Pressure

27
Q

◦ if ventilator is pushing air in and meets a lot of resistance an alarm will sound
what could cause the PIP/PEak Airway Pressure alarm to sound

A

obstruction, coughing

28
Q

always make sure you understand why your patient is being ventilated

A

thats all!

29
Q

assessment for intubated patient

A

• VS’s
• Patient breathing/ pattern/ rate/ effort
• Breath sounds
• Patient color
• ABG’s- don’t really need one right before we take them off, really only continue to get them if something is continuing to go wrong
• Secretions/ need for suctioning
• ET tube/ measure/ size/ skin breakdown
• Anxiety
• Input/ output

30
Q

do we do ABG’s a lot when someone is intubated?

A

nah …don’t really need one right before we take them off, really only continue to get them if something is continuing to go wrong

31
Q

interventions for intubated patient

A

• ANXIETY
• Suctioning as needed, 5-10 sec, preoxygenate, <3 passes
• Oral Care - every 2 hours
• Head of Bed >30 degrees
• Pulmonary hygiene
• Mobility
• Delirium prevention- assess every shift , reorient, day and night differential
• Chlorhexidine bath daily from neck down (no genitals) for every ventilsted person
• Anti-Acid pharmacologic agent- risk of stomach acid in lungs
• Nutrition

32
Q

head of bed for intubated patient = > __

A

30 degrees

33
Q

why do we give ant acids for intubated patients?

A

risk of stomach acid in liungs

34
Q

what is really important for preventing delirium in ICU?

A

orient to day nad night

35
Q

ventilatior complications include….

A

• Hypotension
• Barotrauma
• Pneumothorax
• Pneumomediastinum
• Volutrauma
• Atelectrauma
• Biotrauma
• Ventilator-associated lung injury
• Ventilator-acquired pneumonia
• Peptic Ulcer
• Malnutrition
• Failure to Wean
• Muscle Deconditioning

36
Q

ultimate goal for a ventilated patient is….

A

to wean them from the vent

37
Q

ACDEF ventilator bundle =

A

• Awake(TURN OFF SEDATION)
• Breathe (TRIAL)
• Coordinate/ Choice of sedation (RN/RT
• Delirium Prevention
• Early Mobility
• Family Presence

38
Q

extubating requires what from the provider?

A

an order to do so

39
Q

what do we assess for with extubation?

A

• Assess your patient’s ability to remain off ventilator
• Assess for stridor

40
Q

who are we working closely with during extubation?

A

RT

Kol- 410 Med Surg II (27 decks)

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