mechanical ventilation

Question 1

negative pressure vent

Answer 1

sucks air out to make more room in the lung
must be stable
any change in weight or size it must be refit

Question 2

positive pressure ventilator

Answer 2

pushes air in

Question 3

non invasive positive pressure ventilation

Answer 3

deliver positive pressure through mask
eliminates need for trach or intubation
decreases risk for pneumonia

Question 4

contraindications for noninvasive positive pressure ventilation

Answer 4

resp arrest
serious dysrhythmia
cognitive impairment
head or facial trauma

Question 5

CPAP

Answer 5

used for obstuctive sleep apnea
continuous pressure exhale and inhale
simple device with little monitoring
cheaper than bipap

Question 6

bipap

Answer 6

used for central sleep apnea and other ventilation disorders (COPD)
different pressures manually opens alveoli (15 in, 5 ex)
not simple and requires monitoring
expensive

Question 7

indications for bipap

Answer 7

resp acidosis
- paO2 less than 55
paCO2 above 50
pH below 7.32
vital capacity less than 10
inspiratory force less than 25

Question 8

Assist control ventilation

Answer 8

machine assumes patient is not breathing at all on own and requires breathing for them

Question 9

synchronized intermittent mandatory ventilation

Answer 9

patient breathes spontaneously with no help from ventilator in between ventilator breaths
patient does more work of breathing
bucking is reduced

Question 10

pressure support ventilation

Answer 10

plateau pressure to the airway within trach tube and ventilator
no mandatory breath but a SIMV backup rate may be added in case

Question 11

volume cycled ventilation

Answer 11

delivers a preset volume of air with each inspiration

Question 12

pressure cycled ventilation

Answer 12

delivers a flow until it reaches preset pressure

Question 13

vent monitoring

Answer 13

settings
water in the tubing
disconnected or kinked tubing
humidification and temperature

Question 14

ventilated patient nursing interventions (monitoring)

Answer 14

pulmonary auscultation
interpretation of abg

Question 15

complications of mechanical ventilation

Answer 15

hypotension
barotrauma and pneumothorax
pulm infection
abd distension

Question 16

minute ventilation equation

Answer 16

volume of air moved out of the lung per unit time
vital capicity times frequency

vital capacity measured by weight

Question 17

ventilator problems (alarms)

Answer 17

low pressure: disconnect
high pressure: water in the tubing or increase

Question 18

patient caused ventilator problems

Answer 18

coughing
mucus plug
pneumothorax
disconnection of tubing

Question 19

readiness of weaning a patient from a vent

Answer 19

importance of checking ABGs
improvement of resp failure
no other organ failure
intact resp drive, coughing reflex, good muscles
appropriate level of consciousness and cooperation

Question 20

weaning criteria (values)

Answer 20

vital capacity 10-15 mL/kg
maximum inspiratory pressure of at least 20
tidal volume 7-9 mL/kg
minute ventilation 6L/min
rapid/shallow breathing below 100
paO2 greater than 60 with FiO2 less than 50%

Question 21

vitals of someone weened to exhaustion

Answer 21

HR above 140
BP above 180/90
RR above 35
sustained increase in HR
anxiety
sweating

Question 22

methods of weaning off vent

Answer 22

AC rate is decreased
SIMV decrease rate until spontaneous
PSV –> CPAP `

Question 24

weaning trial

Answer 24

off the vent but have the t peice or trach mask receiving humidified air but they’re taking their own breaths
monitoring for distress
ABG after 20 minutes
if they’re good they can be extubated in 2-3 hours

Question 25

weaning from the tube

Answer 25

able to clear secretions –> need to be assessed before we start
downsize tubing –> cuffless –> fenestrated –> passy Muir

Question 26

passy Muir valve contraindications

Answer 26

inflated cuff
excessive secretions
severely ill

Question 27

intubation indications

Answer 27

worsening bags
worsening agitation or encephalopathy
inability to tolerate mask
unstable

Question 28

intubation sedative agent

Answer 28

Propofol (diprivan)
onset 15-45 seconds
duration 5-10 minutes
lorazapam
midazolam (versed)
dexmedetomidine (precedex)
short acting barbiturates
pentobarbital
methomexital
thiopental

Question 29

intubation neuromuscular blocking agents

Answer 29

pancuronium (pavulon)
onset 45 secs
duration 6-10 mins

vencuronim norcuron
atacurium tracrium
rocuronium zemuron

Question 30

side effects of sedative agents for intubation

Answer 30

hypotension

Question 31

side effects for neuromuscular blocking agents

Answer 31

hyperkalemia
corneal abrasions
greater risk for skin breakdown
venous thromboembolism

Question 32

intubation assessment

Answer 32

symmetry of the chest moving
auscultate breath sounds
chest x ray

Question 33

intubation documentation

Answer 33

depth of tube
size of tube
chest x ray

Question 34

Normal endotracheal cuff pressure

Answer 34

20-25

Question 35

low cuff pressure of endotracheal cuff could lead to

Answer 35

air leak
aspiration neumonia

Question 36

high cuff pressure of endotracheal cuff

Answer 36

necrosis
ischemia
tracheal bleeding

Question 37

complications of endotracheal mechanical ventilation

Answer 37

decreased cough and gag reflex
life threatening –> self removal of tube causing hypoxemia and larygenal swelling

Question 38

self exubation

Answer 38

most likely to happen overnight

Question 39

extubation monitoring and after

Answer 39

sit in high flowers with humidified oxygen
keep NPO
monitor vitals
have patient perform coughing and deep breathing

Question 40

trach tube indications

Answer 40

if been on endotracheal MV for over 2 weeks
removal of secretions
bypass upper airway obstruction

Question 41

tracheostomy

Answer 41

increases comfort and hygiene
lower hospital mortality
higher weening rates
done in OR
monitor frequently

Question 42

Early complications of tracheotomy procedure

Answer 42

bleeding
pneumothorax
aspiration
air embolism
subcutaneous emphysema –> tracheal deviation
larygenal nerve damage
posterior tracheal wall penetrationl

Question 43

long term complications of trach

Answer 43

necrosis
infection
dysphagia
tracheoesophogeal fistula
tracheal dilation
airway obstruction from secretions
trach ischemia

Question 44

complications of tracheostomy prevention

Answer 44

administer adequate warmed humid air
maintain cuff pressure
suction as needed
maintain skin integrity of site
ausculate lung sounds
monitor for infection –> fever WBC
monitor for cyanosis
maintain hydration
sterile technique

Question 45

closed suctioning

Answer 45

rapid suction when needed and prevents cross contamination or contamination with nurses
decreases hypoxemia
sustains PEEP
decreases anxiety