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NUR 213 > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

What is the purpose of mechanical ventilation?

A

Mechanical Ventilation is required when a patient cannot maintain adequate ventilation and/or perfusion.

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2
Q

What is the purpose/goal of mechanical ventilation? When can it be discontinued?

A

use is not a cure; the goal is to support the patient until underlying pathophysiological process is corrected. Once underlying issue is corrected vent can be discontinued.

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3
Q

What will happen if a patient cannot support themself off of the vent?

A

may require the mechanical ventilation on a permanent basis.

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4
Q

Nursing dx for Vented patients

A
  • Ineffective airway clearance
  • Ineffective breathing pattern
  • Impaired gas exchange
  • Risk for trauma
  • Decreased cardiac output
  • Impaired verbal communication
  • Risk for infection
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5
Q

A phospholipid and protein substance that covers the aveoli to prevent the aveoli from collapsing by reducing the surface tension in the aveoli, allowing for gas exchange to take place

A

Surfactant

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6
Q

The resistance to airflow within the airways.

A

Airway resistance

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7
Q

Conditions that increase the need for Oxygen

A
  • Fever
  • Infection
  • Anxiety
  • Anemia
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8
Q

Complications associated with mechanical ventilation

A
  • Hypotension
  • Infection
  • Barotrauma
  • Aspiration
  • Ventilator-associated Pneumonia (VAP)
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9
Q

What can be done to correct hypotension in a vented patient?

A
  • Notify HCP
  • IV fluids
  • Ventilator setting may need to be adjusted
  • Sedation may need to be adjusted
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10
Q

What can be done to prevent aspiration?

A

Elevate HOB 30-45 degrees unless contraindicated

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11
Q

What to do if a nurse suspects a pneumothorax?

A

A pneumothorax can be a life-threatening situation for the patient, and the nurse must notify the HCP immediately and prepare for chest tube insertion to allow removal of trapped air in the pleural space

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12
Q

What are some S/S of a pneumothorax

A

-Absent or markly decreased breath sounds
-Cyanosis
Decreased chest expansion unilaterally
-Dyspnea
-Hypotension
-Sharp chest pain
-Subcutaneous
-emphysema AEB crepitus on palpation
-Sucking sound with open chest wound
-Tachycardia
-Tachypnea
-Tracheal deviation to the
-unaffected side with tension pneumothorax

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13
Q

All of the following are S/S of what?

-Absent or markly decreased breath sounds
-Cyanosis
Decreased chest expansion unilaterally
-Dyspnea
-Hypotension
-Sharp chest pain
-Subcutaneous
-emphysema AEB crepitus on palpation
-Sucking sound with open chest wound
-Tachycardia
-Tachypnea
-Tracheal deviation to the
-unaffected side with tension pneumothorax

A

A pneumothorax

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14
Q

What complication associated with mechanical ventilation is this?

a serious healthcare-associated infection resulting in high morbidity, high mortality, and high costs of treatment. It typically develops 48 hrs or more after endotracheal intubation

A

Ventilated associated Pneumonia or VAP

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15
Q

What can be done to prevent VAP

A
  1. minimizing sedation, including daily spontaneous breathing trials (SBTs) for patients without contraindications.
  2. facilitating early exercise and mobilization.
  3. using ETTs w/ suction for patients that are anticipated to have 48 to 72 hrs of intubation.
  4. elevating the HOB 30 to 45 degrees.
  5. changing the ventilator circuit only when visibly soiled or malfunctioning
  6. Preform oral care using chlorahexidine
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16
Q

What should be used when preforming oral care on a vented patient

A

Chlorahexidine

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17
Q

How many types of mechanical ventiation are there? What are they?

A

2
Negative pressure, positive pressure

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18
Q

What is the FiO2 setting on a mechanical ventilator

A
  • Fraction of inspired oxygen.
  • The amount of Oxygen the pt receives from the vent.
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19
Q

If a patient is extremly hypoxic what is their FiO2 started at?

A

100%

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20
Q

How much FiO2 can be provided from a mechanical vent

A

21%-100%

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21
Q

How is the FiO2 adjusted?

A

Based on th patients ABG

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22
Q

What is the goal of the FiO2 setting?

A
  • PaO2 above 60% mmHg
  • SaO2 above 90% to 92% at the lowest possible oxygen setting
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23
Q

What is the F setting on a mechanical ventilator

A
  • Breath rate
  • is the number of respirations the pt receives per minute is set by the vent
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24
Q

The usual F settings

A

8-12 breaths per min

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25
Q

What does the F setting depend on?

A

depends on the mode selected and whether the pt can breathe spontaneously or whether the vent needs to provide mandatory ventilation for the patient.

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26
Q

When can the F setting begin to be gradually decreased?

A

When the patient is able to spontaneously breath

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27
Q

The F setting on a mechanical vent can be decreased until when?

A

The patient is able to maintain oxygen on their own

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28
Q

When documenting respirations for a vented patient what is included?

A

The number of both ventilator and spontaneous breaths

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29
Q

What is the Vt setting on a mechanical ventilator?

A
  • Tidal volume
  • the amount of preset air that is delivered with each breath.
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30
Q

The usual setting for Vt on a mechanical vent

A

8-10 mL/kg

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31
Q

How is the Vt setting on a mechanical ventilator adjusted?

A

According to the ABG results

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32
Q

Using a high Vt setting puts a patient at risk for what

A
  • Barotrauma
  • VAP
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33
Q

Conditions that can be treated with low Vt

A
  • ARDS
  • Acute lung injury
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34
Q

Using a low Vt decreases what?

A

Risk for further lung injury

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35
Q

What is the Flow setting on a mechanical ventilater

A

the velocity of gas flow or volume of gas per minute

36
Q

What is the PEEP setting on a mechanical ventilator?

A
  • PEEP
  • applied at the end of expiration to help prevent alveolar collapse, assist patent alveoli, and redistribute fluid from the alveoli.
37
Q

What is the goal of PEEP and why is it important?

A
  • PEEP improves oxygenation, allowing the FiO2 level to be lowered.
  • This is important because prolonged use of high FiO2 can cause lung injury.
38
Q

Range of PEEP that will minimize alveolar collapse

A

3 to 5 cm H2O

39
Q

What ventilator modes generally require PEEP

A
  • Assist-control ventilation
  • Sychronized intermittent mandatory ventilation
  • Intermittent mandatoy ventilation
40
Q

When PEEP is applied to spontaneously breathing patients what is it reffered to?

A

CPAP

41
Q

What mode of mechanical ventilation is this?

  • used for patients who have weak respiratory muscles and may be unable to maintain adequate ventilation.
  • The respiratory rate and volume of breaths are preset.
  • If the patient does not initiate a breath, the ventilator delivers the breaths at the preset rate and volume.
  • If the patient does initiate a breath it allows the patient to control the rate of breaths
A

Assist-Control Ventilation (a/c)
or
Mandatory Ventilation (CMV)

42
Q

What is the disadvantage of Assist-Control Ventilation (a/c) or Mandatory Ventilation (CMV)

A

If pt is hyperventilating it can lead to respiratory alkalosis

43
Q

What mode of mechanical ventilation is this?

  • provides a combination of ventilator-assisted breaths and spontaneous breaths of the patient.
  • This mode is used for patients who can breathe spontaneously but at a volume and/or rate that does not meet adequate oxygenation.
  • This mode makes sure that a preset volume and rate of breaths are given per minute regardless of the patient’s efforts
A

Intermittent Mandatory Ventilation

44
Q

What is the major advantage of intermittent mandatory ventilation

A

Decreases the risk of barotrauma

45
Q

That is the major disadvantage of Intermittent mandatory ventilation

A

Can lead to the patient breathing against the ventilator

46
Q

What mode of mechanical ventilation is this?

  • used for patients who are being weaned from the ventilator and those patients who require some assistance to maintain adequate ventilation.
  • If the patient does not initiate a breath, the ventilator delivers the preset volume and rate per minute to the patient.
  • This mode allows the patient to breathe spontaneously at his or her own volume and rate between the breaths given by the ventilator.
  • This mode synchronizes with the patient’s efforts to breathe.
  • When used for weaning, the number of breaths given by the ventilator can be decreased so that the patient takes over and breathes spontaneously, without the assistance of the ventilator
A

Synchronized intermittent mandatory ventilation or SIMV

47
Q

What mode of Mechanical ventilation is this?

  • a mode designed for spontaneously breathing patients who require a high level of pressure to effectively recruit alveoli.
  • The high level of pressure forces the alveoli open and contributes to gas exchange.
  • The inflation period is long, and breaths may be initiated spontaneously as well as by the ventilator.
  • This mode allows spontaneous breathing at a preset CPAP that is interrupted by pressure release to a lower pressure.
  • This mode is believed to reduce the risk of ventilator-induced lung injuries such as barotrauma
A

Airway pressure-release ventilation

47
Q

What mode of mechanical ventilation is this?

  • may be used as an independent mode or in conjunction with CPAP or SIMV.
  • This mode gives a set positive pressure during spontaneous inspirations.
  • The patient breathes spontaneously with the patient’s own volume, rate, and inspiratory time but has continuous positive pressure that is maintained during inspiration.
  • This continuous positive pressure assists in reducing the workload of breathing and keeping the alveoli open.
  • When used for weaning, the pressure support helps the patient to overcome the dead space of the ETT
A

Pressure support ventilation or PSV

48
Q

Weaning methods for vented patients

A
  • Pressure support
  • CPAP
  • T-piece
49
Q

What weaning method is this?

  • used to assist the patient in overcoming the resistance of the ETT and assists the alveoli with perfusion support.
  • Patient must have the ability to breath spontaneously
A

Pressure support

50
Q

What weaning method is this?

  • used to assist the patient in overcoming the ETT resistance because there is constant pressure maintained throughout the respiratory cycle.
  • The patient must have spontaneous breathing because there is no additional inspiratory support
A

CPAP

51
Q

What weaning method is this?

  • used when the ventilator is disconnected and the patient breathes through the ETT. Supplemental oxygen is provided, but there is no support provided by the ventilator
  • The patient must be monitored closely for an increased work of breathing because the small diameter of the ETT requires more patient effort for inspiration
A

T-piece

52
Q

After a patient is extubated, what needs to be kept at the bedside and why?

A

Intubation tray
These patients are at a high risk for reintubation

53
Q

What can be done to reduce the chance of aspiration during extubation

A
  • Suction before extubation
  • Instruct patient to cough as tube is being removed
  • O2 is applied per MD order
54
Q

What is an abnormal lung sound in a recently extubated patient and requires you to contact the HCP immediately? Why?

A

Stridor
Reintubation is required

Stridor- A high pitched, crowing sound heard on inspiration

55
Q

What should be encouraged in an extubated patient?

A

Coughing and deep breathing

56
Q

What needs to be monitored after a patient is extubated?

A

vital signs, continuous pulse oximetry, cardiac status, and respiratory status, including respiratory rate and effort.

57
Q

Signs of airway obstruction in an extubated patient

A
  • Dyspnea
  • cyanosis
  • coughing
  • stridor
58
Q

Stridor in a recently extubated patient indicates what?

A

Edema of the glottis or laryngospasm

59
Q

Causes of a high pressure alarm on a vent

A
  • Mucous plug or increased secretions
  • Patient biting the ETT
  • Pneumothorax
  • Patient anxious and fighting the ventilator
  • Kink in the tubing
  • Water collecting in the ventilator tubing
60
Q

If a vent patient has a mucous plug or increased secretions what needs to be done?

A

Suction as needed

61
Q

What needs to be done if a vented patient is biting their ETT

A

Insert an oral airway to prevent biting

62
Q

What are hallmark signs of a pneumothorax? What needs to be done?

A
  • Asymmetrical chest rise
  • Decreased breath sounds over pneumothorax site
  • Call MD immediately
63
Q

What needs to be done if a patient is anxious and fighting the ventilator?

A

Assess the patient, provide emotional support, and reevaluate sedation/analgesic need

64
Q

What needs to be done if there is a kink in the tubing of a mechanical vent?

A

Assess the tubing from ventilator to patient to ensure no kinking of the tube is present.

65
Q

What needs to be done if water is collecting in the ventilator tubing?

A

Empty water from the ventilator tubing.

66
Q

What kind of alarm would come from a vent for these issues?

  • Mucous plug or increased secretions
  • Patient biting the ETT
  • Pneumothorax
  • Patient anxious and fighting the ventilator
  • Kink in the tubing
  • Water collecting in the ventilator tubing
A

High-pressure alarm

67
Q

What would cause a low pressure alarm on a mechanical vent?

A
  • Cuff leak
  • Leak in ventilator circuit
  • Patient stops breathing in the pressure support modes or SIMV
68
Q

If a cuff leak is suspected in a vented patient what needs to be done?

A
  • Assess for cuff leak
  • check cuff pressure
  • call for respiratory and healthcare provider
69
Q

What needs to be done if a vented patient stops breathing in the pressure support mose or SIMV

A

Assess patient; notify the healthcare provider

70
Q

How often does trach care need to be provided

A

4-8 hrs

71
Q

What should be assessed before and after suctioning?

A

Breath sounds

72
Q

When preforming closed catheter suction what should the suction be set at?

A

160 mmHg
or
The lowest level needed to remove secretions

73
Q

Before suctioning a vented patient what do you need to do before inserting the suction cath?

A

Hyperoxygenate the patient

74
Q

When suctioning an ETT should you keep the suction on while inserting the catheter?

A

no

75
Q

When suctioning an ETT how far do you go with the suction catheter?

A

Until you elicit a gag reflex

76
Q

As you withdraw the suction catheter what should be done?

A

Rotate the cath

77
Q

You should suction for no more than ____________

A

10 seconds

78
Q

When suctioning an ETT after you finish what should be done?

A
  • Hyperoxygenate patient again
  • Rinse with sterile water
79
Q

If pulse ox or heart rate drops during suctioning what needs to be done?

A

STOP and give 100% oxygen

80
Q

The following would cause what kind of alarm on a mechanical vent?

  • Cuff leak
  • Leak in ventilator circuit
  • Patient stops breathing in the pressure support modes or SIMV
A

low pressure alarm

81
Q

How long does a patient have to tolerate a SBT without complications to be extubated?

A

30-120 minutes

82
Q

What complications during a SBT would prevent a patient from being extubated?

A
  • Tachycardia
  • Hypertension
  • Hypotension
  • Deteriorating ABG
  • Arrythmias
83
Q

You have a newly extubated patient complaining of a sore throat, what do you tell them?

A

This is expected after intubation

84
Q

After extubation, what needs to be kept at the bedside?

A
  • Code cart
  • tracheostomy kit
  • extra cannulas
  • suction
85
Q

What should be documented and monitored to monitor ET tube for dislodgement?

A

Centimeter refrence marking

86
Q

The cuff on an ETT tube should never be inflated past ______ to prevent pressure necrosis in trachea

A

25 mmHg

NUR 213 (29 decks)

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