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IM 7 Test 2 > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

indications for mechanical ventilation X4

A

apnea or impending loss of airway

acute respiratory failure

severe hypoxia

respiratory muscle fatigue

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2
Q

short term artificial airway

A

endotracheal tube (ETT)

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3
Q

long term artificial airway

A

tracheostomy (Trach)

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4
Q

are ETT’s emergent or planned

A

can be both

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5
Q

are trachs emergent or planned

A

usually planned

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6
Q

after the ETT is inserted what do you do

A

confirm placement

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7
Q

how do you confirm ETT placement X6

A

end tidal CO2

auscultate lungs bilaterally

auscultate epigastrium

chest wall movement

monitor SpO2

CXR

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8
Q

end tidal CO2 detector confirmation

A 
yes = yellow
problem = purple
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9
Q

what should you hear in the epigastrium when checking ETT placement

A

no air sounds

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10
Q

how far above the carina should the end of the ETT be

A

3-4 in above carina

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11
Q

what should the ETT cuff pressure be

A

<25 cm H2O

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12
Q

what is the carina

A

where the lungs branch off to the right and left

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13
Q

what needs to be at the bedside in case of trach emergencies

A

obturator

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14
Q

how often should you clean the trach stoma

A

q shift and PRN

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15
Q

how should you clean the trach stoma

A

sterile saline, dressing change, and change the ties

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16
Q

how often should you change the inner cannula

A

q shift and PRN

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17
Q

how often should oral care be done with artificial airways

A

q4

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18
Q

when should inline suctioning be done

A

q shift and PRN

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19
Q

how long should suctioning last

A

no more than 10 seconds

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20
Q

how far should you insert the catheter when suctioning

A

until resistance is met

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21
Q

f/RR

A

frequency/respiratory rate

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22
Q

FiO2

A

fraction/percent of inspired oxygen

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23
Q

I:E ratio

A

inspiratory time compared to expiratory time

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24
Q

normal I:E ratio

A

1:2

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25
Q

PEEP

A

positive end-expiratory pressure

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26
Q

normal PEEP

A

5-10

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27
Q

PIP

A

peak inspiratory pressure

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28
Q

normal PIP

A

15-20

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29
Q

Ve

A

minute ventilation/volume

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30
Q

normal Ve

A

6-8 L/min

Vt X RR

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31
Q

Vt

A

tidal volume

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32
Q

normal tidal volume

A

6-8 mL/kg of ideal body weight

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33
Q

normal tidal volume in COPD/ARDS

A

4-6 mL/kg ideal body weight

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34
Q

FiO2 on HFNC

A

delivers O2 from 21%-100%

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35
Q

O2 flow rate on HFNC

A

up to 60 L/min

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36
Q

is there humidification in HFNC

A

yes

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37
Q

what are the functions of HFNC

A

clear physiological dead space of expired air and keeps alveoli open at the end of expiration

38
Q

HFNC cons X3

A

limits patient mobility

requires good fit

requires adequate spontaneous RR

39
Q

what does CPAP provide

A

a preset pressure provided throughout the inspiratory and expiratory phases of the breath

40
Q

how does CPAP work

A

keeps alveoli from collapsing leading to better oxygenation and less work of breathing

41
Q

CPAP only provides X not X

A

only provides airway pressure - NOT O2

42
Q

what must the patient be able to do with CPAP

A

breath spontaneously and do all of the work (breathing coughing)

43
Q

2 bipap settings

A

Inspiratory pressure

expiratory pressure

44
Q

IPAP assists

A

ventilation

45
Q

EPAP assists

A

oxygenation

46
Q

is BIPAP or CPAP more specific

A

BIPAP

47
Q

vent settings to blow off CO2

A

increase RR and/or Vt

48
Q

vent settings to increase PaO2

A

increase FiO2 and/or PEEP

49
Q

what does Assist control ventilation do

A

provides a fixed tidal volume that the vent will deliver at the set time intervals or when the patient initiates a breath

50
Q

how does ACV Vt change when the patient initiates a breath

A

remains the same

51
Q

how does SIMV work

A

vent does half the work - allows patient to spontaneously breathe without vent assistance

52
Q

what happens if the pt takes a breath while on SIMV

A

the patient will only get what they breathe - if they take a breath lower than the tidal volume thats all they will get

53
Q

what type of patient is SIMV best used on

A

a weaning method - patient is improving over time

54
Q

what does PS (pressure support vent) do

A

decreases work of breathing by boosting the patients own self-initiated breaths

55
Q

normal PSV settings

A

5-15

56
Q

what is PEEp

A

expiratory pressure setting to apply positive pressure during exhalation

57
Q

when should you be cautious about peep X3

A

increased ICP

low CO

hypovolemia

58
Q

how to treat aspiration, abdominal distentium or ileus distention

A

insert NG/OG

59
Q

what is oxygen toxicity

A

FiO2 >50% for more than 24-48 hours

60
Q

s/s of oxygen toxicity X5

A

restlessness

dyspnea

chest discomfort

fatigue

atelectasis

61
Q

how to reduce barotrauma

A

PEEP

62
Q

what is barotrauma

A

increased airway pressure distends lungs and potentially ruptures alveoli

63
Q

who is at highest risk for barotrauma

A

noncompliant lungs (COPD)

64
Q

PEEP related issues X2

A

hypotension

H2O retention

65
Q

when does VAP occur

A

48+ hours after intubation

66
Q

VAP Risk factors X5

A

contaminated respiratory equipment

inadequate hand washing

environmental factors

impaired cough

colonization of oropharnyx

67
Q

how to prevent VAP

A

minimize sedation and sedation vacation

early exercise and mobilization

conduct subglottic secretion removal

HOB 30-45

routine oral care

strict hand hygiene

68
Q

when should you assess sedation level

A

q 1 hr

69
Q

when is prone positioning used

A

in patients having severe oxygenation issues

70
Q

how long should prone positioning last

A

12-20 hours

71
Q

goal of prone positioning

A

improve oxygenation by decreasing pressure on lungs from abdomen, heart and lungs themselves

72
Q

CI for prone positioning X5

A

shock

multiple fractures/trauma

pregnancy

raised ICP

tracheal surgery/sternotomy within 2 weeks

73
Q

NI accidental extubation X3

A

assess respiratory effor and O2

call for help

BVM

74
Q

cuff leak alarm NI X3

A

assess for leak

check pressure

call RT and MD

75
Q

leak in vent circuit

A

assess connections and tubing

call RT and MD

76
Q

pt stops breathing in PSV or SIMV

A

assess pt

call RT and MD

BVM (maybe)

77
Q

NI if ETT is disconnected from circuit X2

A

reconnect tubing

assess pt

78
Q

barotrauma alarm

A

assess subq emphysema

call MD and RT

79
Q

mucous plug/increased secretions alarm NI

A

suction

80
Q

patient bites ETT

A

insert bite block

81
Q

pneumothorax alarm NI’s

A

assess for asymmetrical chest risk, decreased breathsounds

call MD

82
Q

pt fighting vent

A

assess pt

emotional support

sedation/analgesia

83
Q

kink in tubing

A

remove kink

84
Q

water collected in tubing

A

empty water

85
Q

pt is coughing

A

continue to monitor

86
Q

bronchospasm alarm NIs X2

A

assess for non-productive consistent coughing

give breathing treatment

87
Q

pulmonary edema NI when ETT X4

A

assess lung sounds and ETT for fluid

suction

pronation?

diuretics?

88
Q

decreased lung compliance alarm NI X3

A

assess lung sounds, RR, BP, O2

RT and MD

vent mode may need to be changed

89
Q

what type of fluid is used in a pressurized art line

A

NS

90
Q

where should the transducer level be

A

level with the insertion point

91
Q

ART line interventions X5

A

0 the BP every 4 hours

flush after drawing labs

infection control

hold pressure/pressure dressing if removed

no medications

IM 7 Test 2 (6 decks)

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