invasive pressure monitoring/ artificial airways/ mechanical ventilation

Question 1

where is the pheblostatic axis

Answer 1

midline of chest and the 4th intercostal space

Question 2

how to zero an invasive pressure monitor

Answer 2

open the stopcock to room air and see a reading of zero

Question 3

when are invasive pressure measurements most accurate?

Answer 3

print form, after expiration

Question 4

complications of invasive pressure monitoring

Answer 4

• hemorrhage (ensure luerlok connections and alarms are activated)
• infection (inspect for local and systemic signs of infection)
• thrombus formation (assess flush like every 1-4 hours, ensure 1-3 ml/hr is being infused)
• neuro impairment

Question 5

how often should tubing and pressure bag be changed?

Answer 5

tubing - q72 hours

bag - q24 hours

Question 6

indications for ET intubation

Answer 6

upper airway obstruction, apnea, high risk of aspiration, ineffective clearance of secretions, respiratory distress

Question 7

when would one consider a tracheostomy?

Answer 7

when LT airway needs are apparent

Question 8

which intubation method is preferred?

Answer 8

oral ET is preferred in emergencies, a larger tube can be used (reduce WOB), and it is easier to remove secretions

Question 9

risks associated with oral intubation

Answer 9

hard to insert if neck cannot be moved, teeth can chip, salivation is increase and swallowing is difficult

Question 10

nasal ET tube indications

Answer 10

used when head and neck manipulation is risky

Question 11

risk with nasal ET

Answer 11

more subject to kinking, linked to causing sinus infection

Question 12

ET intubation procedure

Answer 12

1. get consent, explain pt can’t talk
2. have bag-valve mask attached to O2, suction equip and IV access
3. administer required meds (lubricate nose if nasal ET)
4. pre oxygenate client (3-5 min)
5. each attempt limited to 30 seconds
6. once inserted, confirmation of placement by mechanically ventilating, CO2 detector (none detected, in GI tract)
7. connect to O2 source, bite block inserted
8. chest x-ray, ABG’s within 25 min after insertion

Question 13

types of medications to be given prior to ET intubation

Answer 13

• paralytic and sedative
• sedative-hypnotic-amnestic in the disorientated and combative pt
• rapid onset narcotic to mask pain
• atropine to limit secretions

Question 14

nurse management - ET airway

Answer 14

• maintain tube placement (check q2-4 hr, auscultate)
• maintain proper cuff inflation (20-25 mmHg)
• monitor oxygen and ventilation (ABGs, cont. SpO2)
• monitor tube potency (assess need for suction)
• provide oral care and skin care (rptn tube q24 hr)

Question 15

closed suction technique

Answer 15

action in plastic sleeve connected to O2 circuit - maintain O2 therapy during suction - exposure to secretions minimized

Question 16

complications of suction

Answer 16

bronchospasm, hypoxemia, increase ICP, dysrhythmias, hypertension, hypotension, mucosal damage, pulmonary bleeding

Question 17

what should you be suctioning at

Answer 17

120 mmHg, nothing over that

Question 18

complications of ET intubation

Answer 18

• unplanned extubation

- aspiration

Question 19

what should the HOB be set at for clients with ET tube?

Answer 19

at MINIMUM, 30-45 degrees

Question 20

when is mechanical ventilation indicated?

Answer 20

apnea, impending inability to breathe, respiratory failure, hypoxia, muscle fatigue

Question 21

types of mechanical ventilation

Answer 21

• negative pressure - use of chambers to encase chest (surround with intermittent sub atmospheric or negative pressure) non invasive, artificial airway not required, used in chronically ill pts
• positive pressure - positive pressure pushes air into lungs, and expiration occurs passively; used in the acutely ill

Question 22

modes of volume ventilation

Answer 22

selected according to cut WOB

• controlled mandatory ventilation: setR, setV, cli has no respiratory drive (indep. of clt resps)
• assist-control mandatory vent: presetV, presetF, client initiates breath, gives clt some control
• synchronized intermittent mandatory: presetV, presetV, in synchrony with clt breathing

Question 23

modes of pressure ventilation

Answer 23

• pressure support: + pressure applied during inspiration, expiration is passive, clt must be able to initiate resps
• pressure controlled inverse ratio: pressure limited ventilation

Question 24

complications of positive pressure ventilation

Answer 24

CV - dec. venous return, CO and hypoventilation
Pulm - barotrauma, volutrauma, alveolar hypoventilation, alveolar hyperventilation, ventilator assoc. pneumonia
- progressive fluid retention
- impaired cerebral blood flow
- ulcer formation/ GI bleed

Question 25

nutritional therapy of mechanical ventilation

Answer 25

• soft food diet

- enteral feed supplementation

Question 26

when is the best time to wean someone off a ventilator?

Answer 26

during the day; 12-24 hr recovery