mechanical ventilation Flashcards
negative pressure vent
sucks air out to make more room in the lung
must be stable
any change in weight or size it must be refit
positive pressure ventilator
pushes air in
non invasive positive pressure ventilation
deliver positive pressure through mask
eliminates need for trach or intubation
decreases risk for pneumonia
contraindications for noninvasive positive pressure ventilation
resp arrest
serious dysrhythmia
cognitive impairment
head or facial trauma
CPAP
used for obstuctive sleep apnea
continuous pressure exhale and inhale
simple device with little monitoring
cheaper than bipap
bipap
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
indications for bipap
resp acidosis
- paO2 less than 55
paCO2 above 50
pH below 7.32
vital capacity less than 10
inspiratory force less than 25
Assist control ventilation
machine assumes patient is not breathing at all on own and requires breathing for them
synchronized intermittent mandatory ventilation
patient breathes spontaneously with no help from ventilator in between ventilator breaths
patient does more work of breathing
bucking is reduced
pressure support ventilation
plateau pressure to the airway within trach tube and ventilator
no mandatory breath but a SIMV backup rate may be added in case
volume cycled ventilation
delivers a preset volume of air with each inspiration
pressure cycled ventilation
delivers a flow until it reaches preset pressure
vent monitoring
settings
water in the tubing
disconnected or kinked tubing
humidification and temperature
ventilated patient nursing interventions (monitoring)
pulmonary auscultation
interpretation of abg
complications of mechanical ventilation
hypotension
barotrauma and pneumothorax
pulm infection
abd distension
minute ventilation equation
volume of air moved out of the lung per unit time
vital capicity times frequency
vital capacity measured by weight
ventilator problems (alarms)
low pressure: disconnect
high pressure: water in the tubing or increase
patient caused ventilator problems
coughing
mucus plug
pneumothorax
disconnection of tubing
readiness of weaning a patient from a vent
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
weaning criteria (values)
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%
vitals of someone weened to exhaustion
HR above 140
BP above 180/90
RR above 35
sustained increase in HR
anxiety
sweating
methods of weaning off vent
AC rate is decreased
SIMV decrease rate until spontaneous
PSV –> CPAP `
weaning trial
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
weaning from the tube
able to clear secretions –> need to be assessed before we start
downsize tubing –> cuffless –> fenestrated –> passy Muir
passy Muir valve contraindications
inflated cuff
excessive secretions
severely ill
intubation indications
worsening bags
worsening agitation or encephalopathy
inability to tolerate mask
unstable
intubation sedative agent
Propofol (diprivan)
onset 15-45 seconds
duration 5-10 minutes
lorazapam
midazolam (versed)
dexmedetomidine (precedex)
short acting barbiturates
pentobarbital
methomexital
thiopental
intubation neuromuscular blocking agents
pancuronium (pavulon)
onset 45 secs
duration 6-10 mins
vencuronim norcuron
atacurium tracrium
rocuronium zemuron
side effects of sedative agents for intubation
hypotension
side effects for neuromuscular blocking agents
hyperkalemia
corneal abrasions
greater risk for skin breakdown
venous thromboembolism
intubation assessment
symmetry of the chest moving
auscultate breath sounds
chest x ray
intubation documentation
depth of tube
size of tube
chest x ray
Normal endotracheal cuff pressure
20-25
low cuff pressure of endotracheal cuff could lead to
air leak
aspiration neumonia
high cuff pressure of endotracheal cuff
necrosis
ischemia
tracheal bleeding
complications of endotracheal mechanical ventilation
decreased cough and gag reflex
life threatening –> self removal of tube causing hypoxemia and larygenal swelling
self exubation
most likely to happen overnight
extubation monitoring and after
sit in high flowers with humidified oxygen
keep NPO
monitor vitals
have patient perform coughing and deep breathing
trach tube indications
if been on endotracheal MV for over 2 weeks
removal of secretions
bypass upper airway obstruction
tracheostomy
increases comfort and hygiene
lower hospital mortality
higher weening rates
done in OR
monitor frequently
Early complications of tracheotomy procedure
bleeding
pneumothorax
aspiration
air embolism
subcutaneous emphysema –> tracheal deviation
larygenal nerve damage
posterior tracheal wall penetrationl
long term complications of trach
necrosis
infection
dysphagia
tracheoesophogeal fistula
tracheal dilation
airway obstruction from secretions
trach ischemia
complications of tracheostomy prevention
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
closed suctioning
rapid suction when needed and prevents cross contamination or contamination with nurses
decreases hypoxemia
sustains PEEP
decreases anxiety
