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Mechanical Ventilation Flashcards

1
Q

Mechanical Ventilation purpose

A

support respiratory system until underlying cause of RF is corrected

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2
Q

Mechanical Ventilation indication

A
  1. pt cannot maintain ventilation
  2. pt with acute respiratory failure based off ABGs
  3. life saving therapy while tx plan is put in place
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3
Q

respiratory failure definition

A
  1. PaO2 < 60 mmHg with FiO2 on 0.5
  2. PaCO2 50 mmHg with pH < 7.25
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4
Q

Nurse role

A
  1. provide continuous monitoring
  2. prevent complications
  3. monitor equipment
  4. provide emotional support
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5
Q

Negative pressure ventilation

A

created the thoracic cavity expands , provides pulling on external chest wall

**can be done outpatient

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6
Q

Positive Pressure ventilation

A

pushes air into lungs causing alveoli to participate in gas exchange

**ET tube and tracheostomy

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7
Q

Exhalation remains passive…

A

in pressure cycled ventilators , delivers air into lungs until preset air pressure is reached

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8
Q

supraglottic airway

A

laryngeal mask airway

**used temporary
**quick intubations

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9
Q

CO2 detector

A

used after intubation , turns purple to yellow

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10
Q

volume cycled ventilators

A

deliver air into lungs until preset volume is reached , volume remains constant

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11
Q

FiO2

A

amount of oxygen patient receives from the vent

-can be started at 100% then decreased

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12
Q

FiO2 range

A

21-100%

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13
Q

FiO2 goal

A

maintain PaO2 > 60 mmHg and SaO2 90-92%

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14
Q

Rate (f)

A

number of respirations pt receives per minute

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15
Q

rate range

A

8-12 breaths

-can gradually decrease when pt spontaneously breaths

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16
Q

breathing documentation

A

need to document both ventilator breaths and spontaneous breaths

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17
Q

Tidal Volume (Vt)

A

amount of preset volume delivered with each breath

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18
Q

Tidal volume range

A

4-10 mL / kg

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19
Q

based on patients ideal body weight

A

tidal volume

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20
Q

lower tidal volume…..

A

used with ARDS to avoid barotrauma

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21
Q

PEEP

A

holds alveoli open , positive pressure applied at end of expiration

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22
Q

PEEP range

A

5-20 cm H2O

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23
Q

PEEP modes

A

AC and SIMV or Pressure Controlled vent

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24
Q

PEEP adverse effects

A

increase intrathoracic pressure –> decrease CO –> decrease venous return , volutrauma , barotrauma , increase ICP

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25
Q

Pressure Support

A

extra push of air during spontaneous breathing

-pt initiates breath , more PS applied larger the breath

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26
Q

pressure support range

A

5-20 cm H2O

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27
Q

Flow

A

velocity of gas flow per min

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28
Q

PIP

A

maximum pressure that occurs during inspiration

29
Q

PIP range

A

should remain < 35

30
Q

PIP DANGER LEVEL

A

should never be above 40

31
Q

PIP increasing

A
  1. secretions
  2. bronchospasm
  3. biting ETT
  4. pulmonary edema
  5. ARDS
  6. pleural disease
32
Q

minute ventilation (Ve)

A

amount of air delivered / min

33
Q

minute ventilation formula

A

Ve = Vt x f

34
Q

Assist Control Ventilation ( AC )

A

used for weak respiratory muscles and pts cannot maintain adequate ventilation

-NO PRESSURE SUPPORT
-pt does not initiate breath
-allows workers to take complete control of breathing

35
Q

AC complication

A

respiratory alkalosis

-increased CO2 delivery
-hyperventilation

36
Q

AC modes

A

PEEP
Vt
rate
FiO2

37
Q

SIMV

A

used for patients being weaned from the vent and who need some assistance to maintain ventilation

-HAS PRESSURE SUPPORT
-synchronizes with patient breath

38
Q

SIMV modes

A

rate
Vt
FiO2
PEEP
PS!!!

39
Q

Pressure Support

A

mode is used for weaning or Spontaneous breathing trials

40
Q

pressure support used with….

A

CPAP and SIMV

41
Q

PS modes

A

FiO2
PEEP
PS

42
Q

Mechanical Ventilation complications

A
  1. Hypotension
  2. Infection
  3. Barotrauma
  4. Aspiration
  5. Ventilator assisted pneumonia
43
Q

Hypotension w/ vent

A

increased intrathoracic pressure decreasing venous return to R side of heart –> decreased CO

**SEDATIVES CAN CONTRIBUTE

44
Q

Ventilator infection

A

defense systems of respiratory tract are bypassed , ETT is direct source to the lungs

45
Q

Ventilation Barotrauma

A

lung injury , due to overdistension of alveoli –> tension pneumothorax

46
Q

tension pneumothorax

A

prepare for chest tube insertion to release trapped air

47
Q

Ventilator aspiration

A

keep HOB 30-45 degrees

48
Q

ventilator assisted pneumonia

A

typically develops 48 hours after intubation

-result from aspiration / gastric contents

49
Q

high pressure alarms

A

mucous plug / secretions
patient biting ETT
pneumothorax
pt anxiety
kink in tubing
water collected in vent tubing

50
Q

low pressure alarms

A

cuff leak
deflated cuff (leak in vent circuit)
pt stops breathing OR decreased breathing

51
Q

weaning mechanical ventilation

A

patient should demonstrate cause of RF is reversed

52
Q

indications for weaning

A
  1. breathe spontaneously
  2. adequate oxygenation
  3. hemodynamic stability
53
Q

criteria for weaning

A
  1. RF cause reversed
  2. pH > or = 7.25
  3. PEEP < or = 5-8 cm H2O
  4. FiO2 < or = 0.4 - 0.5
  5. PaO2 / FiO2 > 150 -200 : really MUCH greater
  6. hemodynamic stability
54
Q

pH level for weaning

A

> or equal to 7.25

55
Q

PEEP for weaning

A

5-8 cm H2O

56
Q

FiO2 / PaO2 for weaning

A

> 150 - 200 really need MUCH HIGHER

57
Q

FiO2 for weaning

A

0.4 - 0.5 %

58
Q

FiO2 / PaO2 ratio

A

need to divide PaO2 by FiO2

59
Q

modes for weaning

A
  1. Pressure support
  2. T-piece
  3. CPAP
60
Q

pressure support weaning

A

gradual reduction in 2-5 cm H2O , gradually lengthen time intervals

-discontinue when pt is stable for 2 hours or longer at 5cm H2O

61
Q

t-piece weaning

A

provide humidified oxygen attached to ET tube
start as short as 5 minutes
REST PERIOD 6-8 hours

-discontinue when pt stable for 2 hours

62
Q

CPAP weaning

A

patient performs all WOB
CPAP of 5cm H2O
start with trial for 5 min
REST PERIOD 6-8 hours

-discontinue when patient for 2 hours

63
Q

last option before ventilation

64
Q

extubation complications

A
  1. reintubation
  2. aspiration
  3. airway obstruction s/s
65
Q

reintubation

A

have intubation tray at bedside

66
Q

aspiration

A

COUGH W/ TUBE REMOVAL

67
Q

airway obstruction

A

stridor
dyspnea
cyanosis
coughing
dyspnea
laryngospasm
swelling

68
Q

ventilation care

A

suction
HOB 35-45 degrees
sedation vacation
DVT prevention
oral care
clorahexadine
peptic ulcer prevention

Critical Care (15 decks)

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