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critical care exam 1 > mechanical ventilation > Flashcards

mechanical ventilation Flashcards

1
Q

negative pressure vent

A

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

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2
Q

positive pressure ventilator

A

pushes air in

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3
Q

non invasive positive pressure ventilation

A

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

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4
Q

contraindications for noninvasive positive pressure ventilation

A

resp arrest
serious dysrhythmia
cognitive impairment
head or facial trauma

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5
Q

CPAP

A

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

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6
Q

bipap

A

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

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7
Q

indications for bipap

A

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

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8
Q

Assist control ventilation

A

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

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9
Q

synchronized intermittent mandatory ventilation

A

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

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10
Q

pressure support ventilation

A

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

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11
Q

volume cycled ventilation

A

delivers a preset volume of air with each inspiration

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12
Q

pressure cycled ventilation

A

delivers a flow until it reaches preset pressure

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13
Q

vent monitoring

A

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

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14
Q

ventilated patient nursing interventions (monitoring)

A

pulmonary auscultation
interpretation of abg

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15
Q

complications of mechanical ventilation

A

hypotension
barotrauma and pneumothorax
pulm infection
abd distension

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16
Q

minute ventilation equation

A

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

vital capacity measured by weight

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17
Q

ventilator problems (alarms)

A

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

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18
Q

patient caused ventilator problems

A

coughing
mucus plug
pneumothorax
disconnection of tubing

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19
Q

readiness of weaning a patient from a vent

A

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

20
Q

weaning criteria (values)

A

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%

21
Q

vitals of someone weened to exhaustion

A

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

22
Q

methods of weaning off vent

A

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

23
Q
A
24
Q

weaning trial

A

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

25
Q

weaning from the tube

A

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

26
Q

passy Muir valve contraindications

A

inflated cuff
excessive secretions
severely ill

27
Q

intubation indications

A

worsening bags
worsening agitation or encephalopathy
inability to tolerate mask
unstable

28
Q

intubation sedative agent

A

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

29
Q

intubation neuromuscular blocking agents

A

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

vencuronim norcuron
atacurium tracrium
rocuronium zemuron

30
Q

side effects of sedative agents for intubation

A

hypotension

31
Q

side effects for neuromuscular blocking agents

A

hyperkalemia
corneal abrasions
greater risk for skin breakdown
venous thromboembolism

32
Q

intubation assessment

A

symmetry of the chest moving
auscultate breath sounds
chest x ray

33
Q

intubation documentation

A

depth of tube
size of tube
chest x ray

34
Q

Normal endotracheal cuff pressure

A

20-25

35
Q

low cuff pressure of endotracheal cuff could lead to

A

air leak
aspiration neumonia

36
Q

high cuff pressure of endotracheal cuff

A

necrosis
ischemia
tracheal bleeding

37
Q

complications of endotracheal mechanical ventilation

A

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

38
Q

self exubation

A

most likely to happen overnight

39
Q

extubation monitoring and after

A

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

40
Q

trach tube indications

A

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

41
Q

tracheostomy

A

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

42
Q

Early complications of tracheotomy procedure

A

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

43
Q

long term complications of trach

A

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

44
Q

complications of tracheostomy prevention

A

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

45
Q

closed suctioning

A

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

critical care exam 1 (9 decks)

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