Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does a positive pressure ventilator do?

A

Pushes air in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

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

A

Respiratory arrest
Serious dysrhythmias
Cognitive impairment
Head or facial trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the pressure of inhalation in BiPAP?

A

15 cmH2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the pressure of expiration in BiPAP?

A

5 cm H2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is volume-cycled ventilation?

A

Delivers a preset volume of air with each inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is pressure-cycled ventilation?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the nursing interventions of monitoring a patient on MV

A

Pulmonary auscultation
Interpretation of ABGs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is minute ventilation

A

Volume of air moved out of the lungs per unit time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What should be done in order to calculate minute ventilation?

A

Take weight during admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

How would readiness for weaning from the ventilator be assessed?

A

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
Q

what is weaning capacity

A

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
Q

What is weaning to exhaustion criteria?

A

RR >35/min
SpO2 <90%
HR <140/min
Sustained 20% increase in HR
SBP >180 mmHg
DBP >90 mmHg
Anxiety
Diaphoresis

28
Q

What are the methods of weaning?

A

A/C: control rate is decreased
SIMV: decrease rate until patient is breathing spontaneously

29
Q

How are weaning trials done?

A

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
Q

How is weaning from a tube done?

A

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
Q

What are Passy-Muir valve contraindications?

A

Inflated cuff
Excessive secretions
Severely ill patients
Can speak

32
Q

What is negative pressure ventilation?

A

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
Q

What are the indications for intubation?

A

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
Q

What are the agents used for intubation?

A

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
Q

How would placement of an intubation be assessed?

A

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
Q

What should the nurse document after intubation?

A

Depth of the tube
Size of the tube
Chest X-ray taken

37
Q

What is normal cuff pressure for an intubation?

A

20-25 mmHg

38
Q

What could low cuff pressure in intubation lead to?

A

Air leak
Aspiration pneumonia

39
Q

What could highcuff pressure in intubation lead to?

A

Tracheal bleeding
Ischemia
Pressure necrosis

40
Q

What should be done if a patient needs permanent ventilation or long-term ventilation through a mechanical ventilator?

A

Tracheostomy

41
Q

What reflexes are depressed by the endotracheal and tracheostomy tubes?

A

Cough and swallowing

42
Q

What are life threatening complications of endotracheal intubation?

A

Unintentional or premature removal of the the tube
Laryngeal swelling and hypoxemia

43
Q

how is extubation done

A

Give heated humidified oxygen and maintain the patient in a sitting or high Fowler’s position

44
Q

What are the nursing priorities after extubation?

A

Monitor vital signs
Keep NPO for next few hours
Gag reflex
Teach patient to perform coughing and deep-breathing exercises

45
Q

How long can an endotracheal tube be left?

A

Up to two weeks

46
Q

Why is a tracheostomy performed?

A

Increase patient comfort and oral hygiene
Lower hospital mortality
Higher successful weaning rates in ICU patients receiving prolonged MV

47
Q

Where should a tracheostomy be done?

A

The OR

48
Q

How often should a nurse monitor a tracheostomy?

A

Every 6-8 hours

49
Q

What are the indications of a tracheostomy?

A

Bypass an upper airway obstruction
Removal of secretions
Long-term use of mechanical ventilation

50
Q

What are early complications of a tracheostomy?

A

Bleeding
Pneumothorax
Air embolism
Aspiration
Subcutaneous or mediastinal emphysema: Could lead to tracheal deviation
Recurrent laryngeal nerve damage
Posterior tracheal wall penetration

51
Q

What are long-term complications of a tracheostomy?

A

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
Q

What are nursing interventions for a patient with a tracheostomy?

A

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
Q

What is closed suctioning?

A

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
Q

What are the side effects of neuromuscular blocking agents?

A

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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions