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critical care exam 1 questions > mechanical ventilation > Flashcards

mechanical ventilation Flashcards

1
Q

What are the different types of ventilation?

A

Positive and negative pressure ventilators

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2
Q

What does a positive pressure ventilator do?

A

Pushes air in

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3
Q

What is the purpose ofnon-invasive positive-pressure ventilation?

A

Deliver positive pressure via masks
Eliminates the need for endotracheal intubation or tracheostomy
Decreases the risk of nosocomial (hospital-acquired) infections such as pneumonia

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4
Q

What are the contraindications to non-invasive positive-pressure ventilation?

A

Respiratory arrest
Serious dysrhythmias
Cognitive impairment
Head or facial trauma

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5
Q

What are the characteristics of CPAP?

A

Used for oxygenation and obstructive sleep apnea
Continuous pressure
Same pressure during inhalation and exhalation
Used in field
Uses simple device or complicated
Needs little monitoring: set it and forget it
Cheaper than BiPAP

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6
Q

What are the characteristics of BiPAP?

A

Used for ventilation (COPD) and central sleep apnea
Continuous pressure
Pressures are different between inhalation and exhalation
Not commonly used in the field
No simple devices
Needs monitoring of delivered pressures
Expensive

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7
Q

What is the pressure of inhalation in BiPAP?

A

15 cmH2O

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8
Q

What is the pressure of expiration in BiPAP?

A

5 cm H2O

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9
Q

What are the indications of non-invasive positive pressure ventilation?

A

PaO2 <55mmHg
PaCO2 >50 mmHg and pH <7.32
Vital capacity <10mL/kg
The total amount of air exhaled after maximal inhalation
Negative inspiratory force <25 cm H2O
Strength/pressure
FEV1 <10mL/kg
Forced expiratory volume of the 1st second

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10
Q

What are the different ventilator modes?

A

How breaths are delivered to the patient most commonly used mode
Assist-control (AC)
Synchronized intermittent mandatory ventilation (SIMV)
Pressure support ventilation

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11
Q

What is assist-controlled ventilation?

A

Assumes the patient is not breathing at all, does all the breathing for the patient
Rate is 12

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12
Q

What is SIMV?

A

Between ventilator-delivered breaths, the patient can breathe spontaneously with NO assistance from the ventilator on those extra breaths
Rate is lower than 12
Bucking (patient-ventilator dyssynchrony) is reduced
Present number of ventilator breaths is decreased
Patient does more of the work of breathing

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13
Q

What is pressure support ventilation?

A

Applies a pressure plateau to the airway to decrease resistance within the tracheal tube and ventilator tubing
Same as CPAP
No mandatory breath
A SIMV backup rate may be added for extra support

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14
Q

What is volume-cycled ventilation?

A

Delivers a preset volume of air with each inspiration

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15
Q

What is pressure-cycled ventilation?

A

Delivers a flow of air (inspiration) until it reaches a preset pressur

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16
Q

What should the nurse do if a patient on a ventilator becomes confused, agitated or begins bucking?

A

Assess for hypoxia and manually ventilate on 100% oxygen with a resuscitation bag

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17
Q

What is the nurse monitoring for a patient receiving ventilation? (machine)

A

Ventilator settings
Water in the tubing, disconnection or kinking of the tubing
Humidification and temperature

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18
Q

what are the nursing interventions of monitoring a patient on MV

A

Pulmonary auscultation
Interpretation of ABGs

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19
Q

What are the complications associated with ventilation?

A

Alterations in cardiac function (hypotension)
Barotrauma and pneumothorax: Pressure relief valves open when the pressure surpasses a safe level, allowing excess air to escape
Pulmonary infection
Abdominal distension

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20
Q

what is minute ventilation

A

Volume of air moved out of the lungs per unit time

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21
Q

What should be done in order to calculate minute ventilation?

A

Take weight during admission

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22
Q

What would a low pressure alarm indicate?

A

Disconnection of the ventilator circuit

23
Q

What would a high pressure alarm indicate?

A

Water in the ventilator tubing

24
Q

What are patient problems associated with a ventilator?

A

Coughing
Mucus plug
Pneumothorax
Disconnection of tubing

25
How would readiness for weaning from the ventilator be assessed?
Emphasize the importance of checking ABGs Improvement of respiratory failure Absence of major organ failure Intact ventilatory drive: ability to control their own level of ventilation Functional respiratory muscles Appropriate level of consciousness Cooperation: respond to commands Intact cough and gag reflexes Able to expectorate secretions Functional respiratory muscles with ability to support a strong and effective cough
26
what is weaning capacity
Vital capacity 10-15 mL/kg Maximum inspiratory pressure at least -20cmH2O Tidal volume: 7-9 mL/kg Minute ventilation: 6L/min Rapid/shallow breathing index (RSBI): below 100 breaths/min/L; PaO2 >60 mmHg with FiO2 <50%
27
What is weaning to exhaustion criteria?
RR >35/min SpO2 <90% HR <140/min Sustained 20% increase in HR SBP >180 mmHg DBP >90 mmHg Anxiety Diaphoresis
28
What are the methods of weaning?
A/C: control rate is decreased SIMV: decrease rate until patient is breathing spontaneously
29
How are weaning trials done?
Using a T-piece or tracheostomy mask Disconnected from the ventilator, receiving humidified oxygen only and performing all work of breathing ABG after 20 minutes Watch for distress If clinically stable, the patient can be extubated within 2-3 hours after weaning and allowed spontaneous ventilation by means of a mask with humidified oxygen Closely monitor their vital signs and ABGs
30
How is weaning from a tube done?
ful Secretion clearance and aspiration risks are assessed to determine whether active pharyngeal and laryngeal reflexes are intact Once the patient can clear secretions adequately, a trial period of mouth breathing or nose breathing is conducted Downsize the tubing Replaced by a cuffless tracheostomy tube Change to a fenestrated tube
31
What are Passy-Muir valve contraindications?
Inflated cuff Excessive secretions Severely ill patients Can speak
32
What is negative pressure ventilation?
Sucks the air out and makes more space inside the lungs Used for chronic respiratory failure associated with neuromuscular conditions Not for unstable conditions If patient grows or changes weight, it needs to be adjusted
33
What are the indications for intubation?
Worsening ABGs Worsening encephalopathy or agitation Inability to tolerate the mask: Ask them if they can try to tolerate it before intubation Hemodynamically unstable
34
What are the agents used for intubation?
Sedative induction agent (propofol) Onset 15-45 seconds Duration 5-10 minutes Adverse effect: hypotension Paralytic induction agent (succinylcholine) Onset 45 seconds Duration 6-10 minutes Adverse effect: hyperkalemia
35
How would placement of an intubation be assessed?
Check symmetry of chest expansion, auscultate breath sounds or anterior and lateral chest bilaterally Obtain order for chest X-ray to verify proper tube placement
36
What should the nurse document after intubation?
Depth of the tube Size of the tube Chest X-ray taken
37
What is normal cuff pressure for an intubation?
20-25 mmHg
38
What could low cuff pressure in intubation lead to?
Air leak Aspiration pneumonia
39
What could highcuff pressure in intubation lead to?
Tracheal bleeding Ischemia Pressure necrosis
40
What should be done if a patient needs permanent ventilation or long-term ventilation through a mechanical ventilator?
Tracheostomy
41
What reflexes are depressed by the endotracheal and tracheostomy tubes?
Cough and swallowing
42
What are life threatening complications of endotracheal intubation?
Unintentional or premature removal of the the tube Laryngeal swelling and hypoxemia
43
how is extubation done
Give heated humidified oxygen and maintain the patient in a sitting or high Fowler’s position
44
What are the nursing priorities after extubation?
Monitor vital signs Keep NPO for next few hours Gag reflex Teach patient to perform coughing and deep-breathing exercises
45
How long can an endotracheal tube be left?
Up to two weeks
46
Why is a tracheostomy performed?
Increase patient comfort and oral hygiene Lower hospital mortality Higher successful weaning rates in ICU patients receiving prolonged MV
47
Where should a tracheostomy be done?
The OR
48
How often should a nurse monitor a tracheostomy?
Every 6-8 hours
49
What are the indications of a tracheostomy?
Bypass an upper airway obstruction Removal of secretions Long-term use of mechanical ventilation
50
What are early complications of a tracheostomy?
Bleeding Pneumothorax Air embolism Aspiration Subcutaneous or mediastinal emphysema: Could lead to tracheal deviation Recurrent laryngeal nerve damage Posterior tracheal wall penetration
51
What are long-term complications of a tracheostomy?
Airway obstruction from accumulation of secretions of protrusion of the cuff over the opening of the tube Infection Rupture of the innominate artery Dysphagia Tracheoesophageal fistula Tracheal dilation Tracheal ischemia Necrosis
52
What are nursing interventions for a patient with a tracheostomy?
Administer adequate warmed humidity Maintain cuff pressure at appropriate level Suction as needed per assessment findings Maintain skin integrity: Change tape and dressing as needed or per protocol Auscultate lung sounds Monitor for signs and symptoms of infection: Temperature and WBC count Administer prescribed oxygen and monitor oxygen saturation Monitor for cyanosis Maintain adequate hydration of the patient Use sterile technique when suctioning and performing tracheostomy care
53
What is closed suctioning?
Allow rapid suction when needed and to minimize cross-contamination by airborne pathogens Decreases hypoxemia, sustain PEEP, decrease patient anxiety Protects staff from patient secretions
54
What are the side effects of neuromuscular blocking agents?
Make sure always connect to the vent More chance for skin breakdown Eye care (corneal abrasions) Venous thromboembolism

critical care exam 1 questions (5 decks)

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