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410 Patho Exam 1 > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

What does SpO2 mean?

A

Amount of artieral oxygen saturation

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2
Q

What does SaO2 (pulse ox) mean?

A

Amount of oxygenated hemoglobin in the blood

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3
Q

What does paO2 mean?

A

Amount of oxygen dissolved in blood

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4
Q

What does pCO2 mean?

A

Amount of CO2 dissolved in the blood

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5
Q

What does FRC mean?

A

Functional residual capacity
Or volume of air in lungs at the end of normal EXHALATION

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6
Q

What does tidal volume mean?

A

Volume of air inhaled and exhaled with each breath

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7
Q

What does fraction of inspired oxygen (FIO2) mean?

A

Oxygen being delivered

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8
Q

Before she begins her lecture video, she wants to start off by saying some non invasive methods that we use to help patients breathe
What’s the first 2 example?

A

CPAP
Continous positive airway pressure

BIPAP

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9
Q

How does CPAP help patients breathe?

A

Think of the analogy she was using with the balloon

Normally all of us healthy people have to blow up the balloon from the start

However, with patients with respiratory disease and conditions, starting up the balloon is gonna be super hard, so with CPAP, it kinda starts it up for you, like a pre-head start into breathing

Just remember instead of ballon, I’m talking about inflating your lungs

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10
Q

Is CPAP used for every breathe?
Like inhalation and exhalation?

A

Yes

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11
Q

What do we mainly used CPAP for?
Mainly used to treat?

A

Obstructive sleep apnea

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12
Q

How we do administer Cpap?

What if they are intubated ?

A

MASK

ET or tracheal tube

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13
Q

As ironic as it is, sometimes CPAP can do what ____?

Mainly who is this?

A

Increase the work of breathing

Patients with myocardial compromise because they fight the CPAP machine

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14
Q

What does BI-PAP mean?

A

Bilevel of positive airway pressure

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15
Q

How does BIPAP work?

A

Deliver oxygen and two levels of positive pressure support

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16
Q

How does the 2 levels of positive pressure support work with BIPAP to help patients?

A

Higher Inspiratory positive airway pressure

Lower expiratory positive airway positive

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17
Q

How do we administer BIPAP?

A

tight fitting mask
Nasal pillows

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18
Q

Something important to note about CPAP and BIPAP is that the patient must do what before they have this treatment?

A

Be able to breathe normally and cooperate

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19
Q

When do we not give CPAP or BIPAP, like contradictions?

A

Struggle to breathe
A lot of trouble of maintaining their oxygen saturation

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20
Q

if your patients develops complications breathing and they need mechanical ventilation assistant what do we use ?

A

endotracheal tube

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21
Q

what do before Endotracheal tube intubation procedure ?
explain the steps to me (3)

A

place the patient in a sniffing position
( there laying on their back, and their chin is tilted upwards )

preoxygetnated using BVM with 100% of oxygen for 3-5minutes

then insert

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22
Q

what position is the patient in when they are doing an endotracheal tube intubation ?

A

sniffing position
( they are laying on there back and their chin is tilted upwards )

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23
Q

when inserting the endotracheal tube for intubation, we always want to do what ?

and for how long before we try inserting the tube in

A

preoxygenated using a BVM with 100% oxygen for 3-5minutes

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24
Q

remember when trying to intubate a patient, we should always try to put in the tube in 1 go, however sometimes it takes time, what is the maximum time we should not exceed to try to put in a tube ?

A

30 seconds

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25
Q

if the attempt is not successful to putting in a tube for a patient, what do we do?

A

we reventilate patient between successive attempts using BVM with 100% oxygen

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26
Q

for the endotracheal tube, there is a cuff at the end of the tube that we need to inflate it with, what are the 2 methods we are going to either do to help inflate the cuff?

A

minimal occluding volume (MOV)
minimal lack technique

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27
Q

what is minimal occluding volume ?
explain to me how this works when inflating a cuff for an endotracheal tube intubation

A

you are looking for the smallest amount of volume of air in the balloon so we occlude the airway completely so there is no air leak around the cuff at the peak inspiration

you place the stethoscope at the trachea, inflate the cuff until you here no air left at the peak of inspiration ( beginning of breath )

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28
Q

what is minimal leak technique ?
explain to me how this works when inflating a cuff for an endotracheal tube intubation

A

its the same thing before, however you remove small air from the cuff until you hear leak at the peak of inflation

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29
Q

once the endotracheal tube is in placed, what are you going to be doing after as a nurse?

A

connect the tube to the mechanical ventilator
secure airway
suction if needed
record and mark position of tube

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30
Q

its important to always get a ____after you put an endotracheal tube in a patient because what?

A

chest x-ray
because we want to make sure its in the right spot

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31
Q

where should the endotracheal tube be at in the chest x-ray, or more so in general where should it be at?

A

end of the tube to be at 2-6cm above the carina

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32
Q

what are the 5 steps of protocol for securing ET tube with adhesive tape ?
explain each step

A
  1. clean the patients skins with mild soap and water
  2. remove oil from the skin with alcohol and allow to dry
  3. apply skin adhesive product to enhance tape adhesive
  4. place hydrocolloid membrane over the cheeks to protect friable skin
  5. secure with adhesive tape
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33
Q

what is the biggest nursing management when it comes to endotracheal tube intubation ?

A

maintaining tube patency
- meaning clear airway is being given to the patient

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34
Q

when a patient has a tube in, its a no brainer that secretions are going to be built up, but do we do this often ?

A

NO!!!!

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35
Q

what are some things that we can see on a patient that suctioning is necessary to perform in order to maintain tube patency when the patient has an endotracheal tube intubation ? (6)

A

visible secretions
aspirations
respiratory distress
coughing producing nothing
sudden drop oxygen
adventurous breath sounds

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36
Q

what are some complications that come from suctioning ?

A

hypoxemia
bronchospasm
increases intracranial pressure
dysrhythmias
mucosal damage
bleeding, pain, infection
increase/decrease BP

37
Q

before we being suctioning what should we do for our patient ?

A

hyper oxygenated before and after the suctioning

38
Q

how long should suctioning be for a patient with an ET tube ?

A

only 10secs and less

39
Q

should we be monitoring for anything while suctioning or just free ball it ?

A

yes
there ECG, pulse ox, bp
before, during and after suctioning

40
Q

its pretty obvious that mucosal damage can occur when a patient is having suctioning cause we are sticking a whole another tube down through throat, however what are 2 things that we can do to help prevent this damage ?

A

suction pressure less than 120 mm hg
avoid overly vigorous catheter insertion

41
Q

how do we manage patients with thick secretions when the patient has an endotracheal tube intubation ? (4)

A

adequate hydration ( iv fluids )
supplemental humidification
mobilize and turn patient
antibiotics if needed ( infection )

42
Q

when your patient is on an artificial airway management, what are some assessments we are going to be monitoring ? (6)

A

ABG’s
spO2
clinical signs of hypoxemia
PACO2
respiratory rate
use of accessory muscles

43
Q

to remember what are some hypoxemia signs in a patient ?

A

mental state - confusion
restlessness
dusky skin - gray-ish/blueish
dysrhythmias

44
Q

what is mechanical ventilation ?

A

process by which fraction inspired oxygen (FIO2) at >21% ( room air ) is moved into and out of lungs by a mechanical ventilator

brooks words
artificially ventilating the patients with oxygen thats higher concentration than room air

45
Q

is mechanical ventilation curative ?

A

no

46
Q

what are some indications of mechanical ventilation ?

A

apnea
inability to breathe
respiratory failure
severe hypoxia
respiratory muscle fatigue

47
Q

its important to note that sometimes patients can find mechanical ventilator to be an ethical problem, in the sense that being put on a ventilator can be near end, like life support situations so its important to ?

A

discuss these decisions with the patient and family members, cause sometimes when you get on a ventilator, you can never come off.

48
Q

dr. brooks Is going to be talking about different forms of mechanical ventilation, what is the main one we use?

A

PPV - positive pressure ventilation

49
Q

Who do we use PPV ?
( Positive pressure ventilation )

A

primarily acutely ill patients

50
Q

how does positive pressure ventilator work ?

A

delivers air into lungs under positive pressure during inspiration -> intrathoracic pressure will increase during lung inflation ( opposite of normal )

then expiration occurs passively

51
Q

how do we set up the mechanical ventilation for any form of treatment ?

A

we assess patients status
- respiratory rate
- tidal volume
- FIO2
- positive end expiratory pressure ( PEEP )

52
Q

based on how much work of breathing the patient should or can perform while on the ventilator we can set up the ventilator to 2 different modes, what are they ?

A

controlled ventilatory support
assisted ventilatory support

53
Q

what is controlled ventilatory support as a mode for mechanical ventilation ?

A

ventilator does all the work of breathing

54
Q

what is assisted ventilatory support as a mode for mechanical ventilation ?

A

ventilator and patient share work of breathing
- patients have the ability to breathe but they aren’t that effective with it, so the machine will come in and assist when they “stop breathing or not a good breath”

55
Q

something to note about positive pressure ventilator is that we can add something called PEEP which stands for ?

A

positive end expiratory pressure

56
Q

why would we want to add PEEP to a patient who is receiving PPV?

A

this pressure prevents the alveoli from collapsing, so think of the balloon earlier, it keeps it open to help not have to struggle to get another breathe again = improving oxygenation

57
Q

what are 4 contraindications that patients may have that we should not be giving them peep?

A

patients with compliant lungs
unilateral or nonuniform disease
hypovolemia
low cardiac output

58
Q

another thing we can use to help patients breathe better is what ?

A

nitric oxide

59
Q

what does nitric oxide do and how is it given ?

A

continuous inhaled can help promote pulmonary vasodilation

can be given through an ET, face mask or tracheostomy

60
Q

nitric oxide is also famous for treating what disease ?

A

ARDS
acute respiratory distress syndrome

61
Q

nitric oxide has been used as a diganostic tool for what ?

A

pulmonary hypertension

62
Q

what type of position might we do for a patient who is struggling to breathe ?

A

prone
( patient is on their stomach with face down )

63
Q

how does prone positioning help patients improve their lung recruitment ?

A

gravity reverses effects of fluid in dependent part of lungs
heart rests on sternum -> uniformity of pleural pressures ( room for lung expansion )

helps keep the fluid moving in the lungs

64
Q

something important to note, do we leave patients in a prone positioning ?

A

no! we move them around

65
Q

ECMO ( extracorporeal membrane oxygenation ) is an alternative form of pulmonary support, how does it work ?

A

partially remove blood from the patient to infuse the oxygen from a machine and back into the patient

66
Q

what is a complication of ventilation
cardiovascular edition ?

what increases this effect?

A

decrease venous return to heart and cardiac output leading to low blood pressure

PEEP

67
Q

what is a complication of ventilation
pulmonary edition ? (4)

A

barotrauma
volutrauma
alveolar hypoventilation
alveolar hyperventilaion

68
Q

what does barotrauma mean?
what does volutrauma mean ?

A

baro - rupture of single aveoli because of pressure of patient disease

volu - larger area of damage to the lung due to high vent settings

69
Q

you can also get ventilator associated pnuemonia (VAP), how does this occur ?

A

48 hours after intubation

70
Q

what if you have pneumonia 48 hours BEFORE ventilation, what does that entail ?

A

that you had pneumonia before you got ventilated and its not VAP

71
Q

what are some risk factors that can cause VAP?

A

inadequate hand washing
impaired cough
poor oral hygiene
contaminated respiratory equipment

72
Q

how do we prevent VAP?

A

Head of the bed elevated
no routine changes of tubing
strict hand hygiene
drain water from tubing
subglottic suctioning - as necessary

73
Q

another thing that can happen to patients who are on PPV is that they have a sodium and water imbalance, but why is so ?

A

the reason why it happens is because of the decrease cardiac output and peripheral perfusion and its a stress response resulting in fluid retention
- decrease urine
- increase sodium

74
Q

when having the patient head elevated in the bead we are helping prevent VAP but also neurological issues like intracrainla pressure , but its important to keep the head aligned why ?

A

neck straight because if not it’ll interfere with the amount of blood going back into the brain and if its too much it’ll cause that intracranial pressure

75
Q

what are the complications from ppv?
gi edition?

A

stress ulcers and gi bleeding

76
Q

how can we prevent stress ulcers?

A

proton pump inhibitors

77
Q

we also want to make sure we are feeding these patients with an gi tube because obviously they aren’t going to be moving and doing a lot. but also since they aren’t moving gas and bowel dilation can occur, so we need to ?

A

help with gas removal, we put in ng tube, it can also be attached to suction to help with decompression

78
Q

musculoskeletal system
complications of ppv
how does it effect?

A

loss of muscle strength and problems with mobility

79
Q

what are some interventions we can do to help the musculoskeletal system complications with ppv?

A

nutrition
early and progression ambulation
physical and occupational therapy

80
Q

notes
psychosocial needs
physical and emotional stress due to inability to speak, eat, move or breathe normally

pain, fear and anxiety related to tubes and machines

ordinary adls are complicated

we need to make sure they are safe, need to know information, regain control, hope and trust
encourage them and involve patients and caregivers in decision making.

give them choices and provide like examples, 1 blink for yes and 2 blink for no

A
81
Q

notes
patients tend to be agitated and anxious
- assess for delirium and always address patients as if they are aware and alert
- provide sedation and or analgesia to help with patient and anxiety

sometimes we have to paralysis patients to help them breathe, remember they know what’s going on, they have alertness

A
82
Q

vents can accidentally get disconnected, so we have to always keep what ?

A

alarms are on!

83
Q

what are the most frequent site for disconnecting ?

A

tracheal tube and adapter

84
Q

after PPV patients end up having what ?
so what do we do ?

A

hyper metabolism
- cause its a lot of calories you are burning when trying to fight for air and breathe

Feed them well with g tube

85
Q

if a patient is trying to eat, we must assess for aspiration, who does this ?

A

speech therapist for swallowing to avoid aspiration

86
Q

nutritional assessment must be made between what time frame ?

A

24-48 hours

87
Q

if patients are not getting proper nutrition what can happen ?

A

o2 transport
ecerise tolerance
all decrease 6

88
Q

what’s the best method of nutriotnal therapy ?
how do we verify ?
what type of diet?

A

enteral gastric feedings, like proper location
x-ray
low carb diet

410 Patho Exam 1 (5 decks)

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