Mechanical Ventilation Flashcards
F/RR
Frequency /RR (12-20bpm)
fio2
Fraction /percent of inspired o2
Anywhere between 21% -100
I:e ratio
Inspiration time compared to expiratory time (1:2)
PEEP
Positive and expiratory pressure ( 5-10 cm H2O)
Can go all the way up to 15 on high peep but sometimes can be at 5 to keep alveolar open and to keep it from collapsing during expiration
PIP
Peak inspiratory pressure ( 15-20 cmh20)
max pressure for inspiration
Resistance pressure From air flowthe ventilator all the way that goes down to bronchi
Can be effected by mucous plugging, bronchospasms, kink in the tubing
VE
Minute ventilation /volume ( vtxRR) (6-8l/min)
Amount of air delivered to pt in one minute
VT
Tidal volume ( 6-8 L/kg- ideal body weight ) (very sick lungs use to 4-6 ml/kg
How big the breath is .. the volume that is delivered with each breath
S/s of o2 toxicity from ventilated patients
Restlessness, Dyspnea, chest discomfort, fatigue , atelectasis
Barotrauma
When increased airway pressure distends the lungs and possibly ruptures fragile alveoli or emphysemtous bless ( pt with non compliant lungs such as COPD) at greater risk for this
Ventilator associated pneumonia (VAP)
Pneumonia that occurs 48 hours or more after ET intubation
Low pressure alarm
Cuff leak
Leak in the ventilator circuit
Patient stops breathing in the pressure support modes of SIMV
Unintentional extubation
Tube disconnected from circuit
Barotrauma
Cuff leak
Assess for cuff leak , check cuff pressure , call RT and physician
Leak in the ventilator circuit
Assess all connections and tubing call RT and physician , a new ventilator may be needed
Patient stops breathing in the pressure support modes of SIMV
Assess the pt notify RT and physician may need to provide manual breathes via BVM
Unintentional extubation
Assess pt for need to be reintubated, apply o2, may need to give manual breaths via BVM
Tube disconnects from circuit
Reconnect tubing to circuit ; assess pt
Barotrauma
Assess subq emphysema - notify RT and physician if present
High pressure alarm
Mucous plug or increased secretion
Pt bites ETT
Pneumothorax
Pt anxious and fighting the ventilator
Kink in the tubing
Water collected in the ventilator tubing
Pt coughing
Bronchospasm
Pulmonary edema
Decreased lung compliance
Mucous plug or increased secretions
Suction as needed
Pt bites ETT
Insert oral airway to prevent biting ( bite block)
Pneumothorax
Assess for asymmetrical chest rise , decreased breath sound over pneumothorax site , notify physician
Pt anxious and fighting the ventilator
Assess the pt, provide emotional support , reevaluate sedation /analgesic need
Kink in the tube
Assess the tubing from ventilator to pt to ensure no kindling of the tube is present
water collected in the ventilator tubing
Empty the water from the tubing
Pt is coughing
Continue to monitor
Bronchospasm
Assess for nonproductive consistent cough , give breathing treatments
Pulmonary edema
Assess lung sounds and ETT for fluid ; suction needed may need to be placed prone and given diuretics
Decreased lung compliance
Assess lung sounds RR, BP and sao2 , notify RT and physician , ventilator mode may need to be changed
ETT cuff pressure should be at
<25
If cuff pressure is too low
Puts pt at risk for aspiration, unintentional excubation, and pt can talk to us ( we dont want them to)
If cuff pressure is too high
It can cause tracheal necrosis
Chest xray reveals what about ETT
3-4 cm above carina
What should the capnometer reveal
The color yellow to indicate the presence of CO2
But the purple is a no no
When we sunction the pt what should we do when it comes to the carina
It already sits about 3-4 cm and when you sunction , barely touch it ..it can cause a cough so that’s how we know when we are there
What is the obiturator used for?
If the trache falls out , we can emergently place this to maintain airway..
it is emergency and cold blue situation
What is the first thing we do when there is a change in the condition in the pt
Assess the patient
What can we trouble shoot if pt seems like they are having a hard time breathing with a trache
May have mucous plugs in inner cannula and suction .. then sit and watch to see if it worsens
How often to change inner cannula for the trache
Every shift or PRN
How long should you sunction?
10-15 seconds*** at most 10 seconds
How often to do oral care?
Every 4 hours
What indications for suctioning
Coughing, increase resp, o2 sat down , tachycardia, restless, seeing plegm or hear it when auscultation
Restraints for safety
Restraint release q2 hours and skin assessment
Do you have an order? Are you doing ROM ? Are you keeping up with the order?
Pharm surround mechanical ventilation
Vasopressors
Additional fluid
Bronchodilator
Paralytics
Sedatives
LEAN drugs
Lidocaine
Epinephrine
Atropine
Narcan
Patient safety ETT or trach
Ensure tube is secured
Keep tube patent
Verify maintain placement
Monitor resp status
Bag valve mask in the room
Keep scissors airway from external balloon
How do we make sure air way is what it needs to be with trach
Auscultation , and cuff pressure less than 25
What should you always have at the bedside or when you take the pt anywhere
BVM
Why should we restraint be placed?
Danger to self and combatitive
What should we ensure before suction?
Validate and make sure sunction is working (80 -100 ml of pressure)
And you have pre oxygenated the patient with 100%
Suction order
Check suction make sure its working
Pre oxygenate pt
Insert Catheter suction
And clear for the next use
What should we keep in mind with someone with intracranial pressure if you need to turn them and suction
Give them a break in between
Suction can be seen in
Ventilator , trach , ETT
Oxygenation toxicity
Chest pain Dyspnea , uncontrolled coughing long period
How can we decrease co2?
Increase RR and or tidal volume
What if we are having trouble with pao2?
Increase fio2 ( amount of o2)
Or increase the peep
Important for the nurse in positive pressure ventilation
Verify setting
Assess pt
Ensure pt safety
Trouble shoot as needed
Monitor for ABGs
A/C ventilation
Pt can’t breath slower than what is set
If it is set at 500 ml and they take a spontaneous breath it will sense and make sure breath goes to 500 ml
If pt is doing good they may bring down the breaths per min to see if they can do more breaths on their own
What is an art line used for
ABGs lab work , blood sugar, vasopressor
NEVERRRR for medications
The inflated cuff of an ETT
When inflated produces a seal between the trachea and the cuff to prevent aspiration and ensure delivery of a set tidal volume when mechanical ventilation is used.
Medications ETT intubations
Paralytic, sedative,
( propofol , medazalam versed)
What patient is not for bipap
Shock
Altered loc
Increase airway secretion
Fio2 >50% for more than 24-48 hours
Can cause oxygen toxicity
S/s of o2 toxicity
Restlessness, Dyspnea, chest discomfort , fatigue , atelectasis
