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NURS 361 - Advanced Acute Care Nursing Practice I Final > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

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1
Q

What is an example of negative pressure ventilation?

A

Iron Lung

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2
Q

What are some examples of positive pressure ventilation?

A

Machine ventilator
CPAP
Bagger
Another person

Pressure created outside of the lung for inhalation

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3
Q

Why might mechanical ventilation be required?

A
  • Control a patient’s respirations during surgery
  • to oxygenate the blood when the patient’s mechanical ventilation efforts are inadequate
  • rest the respiratory muscles
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4
Q

What are some indications for endotracheal intubation and mechanical ventilation?

A
  • Continuous decrease in oxygenation (PaO2)
  • Increase in arterial carbon dioxide levels (PaCo2)
  • Persistent acidosis
  • Conditions such as thoracic or abdominal surgery, drug overdose, neromuscular disorders, inhalation injury, COPD, multiple trauma, shock, multisystem failure, and coma may all lead to resp failure
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5
Q

What are clinical manifestations that indicate mechanical ventilation?

A
  • apnea or bradypnea
  • respiratory distress with confusion
  • Increased work of breathing not relieved by other interventions
  • Confusion with need for airway protection
  • Circulatory shock
  • Controlled hyperventilation (e.g., patient with a severe head injury)
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6
Q

What are three types of positive-pressure ventilators?

A
  • Volume-cycled
  • pressure-cycled
  • high-frequency oscillatory support
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7
Q

What are key steps to respiratory assessment?

A
  • History
  • Inspection
  • Auscultation
  • Palpation
  • SpO2 monitoring
  • ABG (basic)
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8
Q

What is ventilation?

A

Movement of air in and out of airways

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9
Q

What are examples of invasive airways?

A
  • Oral
  • Nasal
  • Tracheal
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10
Q

What are examples of non-invasive airways?

A
  • OPA (oropharyngeal airway)
  • NAP (nasopharyngeal airway)
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11
Q

What are the characteristics of a volume-cycled ventilator?

A
  • Deliver a pre-set volume of air with each inspiration
  • Exhalation occurs passively
  • Volume of air is relatively constant, ensuring consistent, adequate breaths despite varying airway pressures
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12
Q

What is a disadvantage of a volume-cycled ventilator?

A

Patient may experience barotrauma because the pressure required to deliver the breaths may be excessive

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13
Q

What is barotrauma?

A

Trauma that causes damage to the alveolar capillary membrane and air to leak into the surrounding tissues.

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14
Q

How does a pressure-cycled ventilator work?

A

When a pressure-cycled ventilator cycles on, it delivers a flow of air (inspiration) until it reaches a pre-set pressure, and the cycles off, and expiration occurs passively.

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15
Q

What is a major limitation of pressure-cycled ventilators?

A

The volume of air or oxygen can vary as the patient’s airway resistance or compliance changes. As a result, the tidal volume delivered may beinconsistent, possible compromising ventilation.

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16
Q

How is acute respiratory failure (ARF) clinically defined?

A

PaCO2 greater than 50 mmHg
pH less than 7.30
and/or
PaO2 less than 60 mmHg

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17
Q

What is the most common indication for ventilator support?

A

Acute ventilatory failure. Inability of the lungs to maintain adequate alveolar ventilation. Diagnosed on the basis of the acid-base balance it creates: acute respiratory acidosis.

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18
Q

What is shunting?

A

Refers to the state in which pulmonary capillary perfusion is normal but alveolar ventilation is lacking. Pulmonery capillary blood can’t pick up oxygen from the nonfunctioning alveolar unit; if there are too many non-functioning units, there can be a decrease in SaO2, causing hypoxemia.

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19
Q

What are some common tests to assess pulmonary function?

A

vital capacity, negative inspiratory force, and respiration rate.

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20
Q

What respiratory rate significantly increases the work of breathing, leading to respiratory muscle fatigue?

A

35 breaths per minute

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21
Q

What is the purpose of the cuff at the distal end of the endotracheal tube?

A

When inflated, the tube seals the space between the tube and the trachea so air is directed through the tube into the lower airway, ensuring a predictable volume or pressure

22
Q

What does the diameter of the ET tube reflect?

A

the diameter of the inside lumen

23
Q

Which artificial airway is more commonly used on a patient who requires prolonged intubation because of failure to wean from the ventilator?

A

tracheostomy

24
Q

What is tidal volume?

A

Amount of air that moves in and out of the lungs in one normal breath.

25
Q

What is the range for normal tidal volume?

A

500 - 800 mL in an adult

26
Q

When is there an increased risk for lung injury during mechanical ventilation?

A

When tidal volume is high or peak alveolar pressure increases

27
Q

What is volutrauma?

A

Overstretching of the alveolar cells triggers release of inflammatory mediators and stimulation of the inflammatory response. Volutrauma increases the permeability of the lung’s microvasculature, which may result in pulmonary edema.

28
Q

What is FiO2 (fraction of inspired oxygen)?

A

The % (or decimal) of O2 delivered to the patient. A mechanical ventimator is able to deliver a wide range of oxygen, from 0.21 - 1 (21% - at sea level room air is 21% - to 100%)

29
Q

What is minute ventilation?

A

Amount of air that moves in and out of the lungs in 1 minute.

30
Q

How is minute ventilation measured?

A

Tidal volume x respiratory rate

31
Q

What is positive end expiratory pressure?

A

Set to provide pressure @ the end of expiration, to prevent alveolar collapse and improves patient PaO2 without increasing FiO2

32
Q

What is peak airway pressure? (aka peak inspiratory pressure)

A

The highest level of pressure applied to the lungs during inspiration - measured with all modes of ventilation

33
Q

What are some options for non-invasive intermittent positive pressure ventilation (NIPPV)?

A

oronasal mask, nasal mask, nasal pillows, full-face masks, helmets, and large cannula-type devices

34
Q

What are features and uses of a CPAP?

A
  • Mode of mechanical assistance that provides a continuous level of positive airway pressure for a spontaneously breathing person
  • Does not provide assisted ventilation on inspiration
  • improves oxygenation by opening alveoli and is used in pressures ranging from 5 to 20 cm H2O
  • Delivered by a special flow generator
  • Most commonly used to treat obstructive sleep apnea
35
Q

What kind of alarms may sound when using mechanical ventilation?

A
  • Pressure (high/low)
  • Volume (high/low)
  • Frequency (high/low)
  • Apnea
  • MV (minute ventilation)
36
Q

Which mode is more of a weaning mode?

A

pressure support

37
Q

Which types of support are used more with decreased levels of consciousness?

A

volume control and pressure control

38
Q

When an alarm goes off, what is important to check first?

A

Always check the patient before the ventilator

39
Q

What assessment and interventions are in place for a patient on mechanical ventilation?

A

Clinical
* Vital signs
* ABGs - ventilator changes based on findings
* Work of breathing
* Full respiratory assessment

Mode: settings, measurement

Interventions
* Suctioning
* Mouth care
* Medications (sedation/comfort/anxiety/paralytics)
* Communication
* PT
* Mobilization (positioning)
* Nutrition (for healing)

40
Q

What are cardiovascular complications of mechanical ventilation?

A

Positive pressure ventilation reduces CO by decreasing venous return in three major ways
1) external pressure on the inferior vena cava decreases blood flow into the right atrium
2) Right ventricular afterload increases due to increased lung volume
3)The pressure being exerted on the alveoli increases pulmonary vascular resistance and right ventricular afterload
Decreased CO results in hypotension
Includes lung and thoracic compliance ,airway resistance, and patients’ volemic state.

41
Q

What cardiovascular assessment alterations should accompany a patient on mechanical ventilation?

A

Continuous monitoring of V/S – as per policy
Decreased BP (in presence of hypovolemia and heart failure)
Compensation: Normal BP, increased HR and increased SVR
Monitoring I&O to ensure adequate hydration
Minute ventilation and tidal volume
Monitor lytes and acid base balance (to assess for dysrhythmias)

42
Q

What neurovascular complications can be seen in a patient on mechanical ventilation?

A
  • change in neurovascular status: increased ICP and decreased cerebral perfusion pressure (CPP = MAP - ICP)
  • If CPP drops too low, cerebral hypoxia can result
43
Q

What pulmonary complications can be seen in a patient on mechanical ventilation?

A
  • Altered ventilation and perfusion
  • Barotrauma and volutrauma - can manifest itself as pneumothorax, subcutaneous emphysema, pneumomediastinum
  • Oxygen toxicity - damages endothelial lining of the lungs, decreases alveolar macrphage activity, decreases mucus and surfactant production
  • Ventilator-associated pneumonia (common when ventilated for more than 48 hours
44
Q

What are renal complications associated with patients on mechanical ventilation?

A
  • decreased urinary output
  • Factors contribute to decreased renal function: redistribution of renal blood flow
  • Hormonal alterations (May stimulate the release of ADH, renin, aldosterone, atrial natriuretic factor and catecholamines, which may affect renal blood flow and renal function)
45
Q

What gastrointestinal complications are associated with patients on mechanical ventilation?

A
  • TPN - risk of malnutrition
  • Constipation risk - laxatives and rectal tube
  • Decreased peristalsis - loss of GI function
  • Hepatic dysfunction due to increased pressure on liver
  • Stress induced ulcers major risk factor with mechanical ventilation >48h, gastric hyperacidity - GI bleeding
  • Results from episode of tissue hypoxia with resp failure
  • Exhibited through black tarry stools
  • If ulcer in stomach NG aspirate my appear bright red
  • Decreased hematocrit from bleeding
  • Acalculous cholecystitis
  • GI hypomotility
46
Q

What psychological complications are associated with patients on mechanical ventilation?

A

Anxiety and pain
Sleep pattern disturbance
Depression/Delirium/Delusion
Loneliness
Frustration (inability to vocalize)
Communication - inability to vocalise
Confusion
Impaired social support
Disturbed body image
Amnesia
Memory loss
Anger
Despair

47
Q

What are some artificial airway complications?

A

Airway trauma
Local tissue ischemia
Bypassing normal upper airway defenses that warm and humidify the air
Nasal or oral damage
Cuff trauma
Tracheostomy
* tracheomalcia (weakening or erosion of the tracheal cartilage)
* tracheal stoma erosion
* accidental decannulation

48
Q

What is involved in rapid-weaning from a mechanical ventilator?

A

Rapid weaning (short term)
Patient placed on spontaneous breathing mode (C P A P, P S V, or T-piece) and provided with humidified oxygen

49
Q

What are some considerations in the weaning process?

A
  • Order
  • Patient participation/readiness (LOC, sedation, strength)
  • RRT
  • Previous experience/attempts
50
Q

What are the characteristics of synchronous intermittent madatory ventilation (SIMV)

A
  • Patient spontaneously breathes through the ventilator circuit, maintaining much of the work of breathing
  • Interspersed at regular intervals, the ventilator provides a preset ventilator breath
51
Q

Why might a low exhaled volume alarm go off?

A
  • decreased or low tidal volume (air that moves in and out in one breath)
  • Might be a leak in the cuff

NURS 361 - Advanced Acute Care Nursing Practice I Final (13 decks)

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