Mechanical Ventilation Flashcards
1
Q
what are some reasons why a patient would need a mechanical vent?
A
- oxygenate the blood for the pt with poor ventilation
- control respirations during surgery (sedated, paralyzed)
- rest resp muscles
2
Q
name indications for using mech vent
A
decr PaO2 incr PaCO2 peristent acidosis treat resp failure compromised airway
3
Q
what are the 2 major types of ventillators
A
negative
positive
4
Q
is negative pressure still used
A
no- almost never
5
Q
what are the different types of positive pressure ventilators?
A
volume cycled pressure cycled flow cycled time cycled non-invasive (mask)
6
Q
what are the different modes of the vent?
A
AC (Assist Control) IMV(Intermittent Mandatory Vent) SIMV (Synchronized Int Mand Vent) CPAP (Constant Positive Airway Pressure) PS (pressure support) PEEP (Positive End Expiratory Pressure)
7
Q
what is assist control mode?
A
we control everything
8
Q
what is CPAP mode
A
patient controls their own breath and we support them
9
Q
Name the MD orders r/t the Vent?
A
Mode- AC/ CPAP RR TV FiO2 PEEP
10
Q
what is tidal volume
A
volume in ml that is inhaled in a single breath
11
Q
what is a normal tidal volume
A
400-500 mL
12
Q
what is the RR usually set to
A
12-14 bpm
13
Q
what is FiO2
A
the %age of oxygen that is delivered through the machine
14
Q
what is the normal FiO2 that is ordered
A
30-100
15
Q
what is the goal of PEEP
A
to keep alveolar inflated and help exchange of gases
16
Q
what is a healthy persons natural PEEP
A
3
17
Q
what will a vents PEEP be set to
A
5-15
18
Q
what is the absolute highest PEEP you can set PEEP to
A
20
19
Q
how does a negative pressure ventillator work?
A
exerts negative pressure on the external chest
20
Q
what is the modern negative ventillator called
A
chest cuirass
21
Q
what is the old negative ventillator called
A
iron lung
22
Q
how does a positive pressure ventillator work
A
exerts positive pressure on the airway- pushes air in and forces alveoli to expand during inspiration
23
Q
through the use of positive pressure ventillators, does expiration occur passively or actively?
A
passively
24
Q
what is required for the use of a positive pressure ventillator?
A
advanced airway- ETT, trach
25
how are positive pressured ventillators classified?
by the method of ending the inspiratory phase of respiration
26
name the different positive pressured ventillators
volume cycled
pressured cycled
high frequency cycled
non-invasive positive positive pressure ventilation (mask)
27
how do volume cycled vents work?
breath ends when set volume has been delivered
28
how do pressure cycled vents work?
breath ends when set amt of pressure has been delivered
29
how do high freq cycled vents work?
delivers set # of breaths per minute
30
what is the most common positive pressure ventillator
volume cycled
31
what are the major limitations of the pressure cycled vent?
- vol delivered is varied
- vol delivered depends on pts airway resistance and compliance
- alterations in tv can compromise ventilation
32
t/f- high freq oscillatory vent is considred last option vent
true
33
how many breaths does the high freq oscillatory vent deliver?
180-900 bpm
34
does the high freq oscillatory vent deliver a high or low tv and why?
very low- protect lungs from pressure injury
35
does the high freq oscillatory vent deliver high or low airway pressure and how much?
high- 40 mL
36
for what conditions is the high freq oscillatory vent used for
atelectasis
| ARDS
37
What are some indications for Non-invasive Positive pressure ventilation
resp failure
pulmonary edema
chf
sleep related disorder
38
name the different non-invasive positve pressure vents
continuous positive airway pressure (CPAP)
| bi-level positive airway pressure (bi-pap)
39
during CPAP, what kind of support do you get?
pressure support during inhalation, peep support, and exhalation support
40
during bi-pap, what kind of support do you get?
inspiration and exhalation support
41
how does AC mode work?
full ventilatory support
preset tv and RR
every breath (machine or pt) will receive a preset vol
42
IN AC mode, what happens if the pt initiates their own breath?
the machine will deliver the preset volume and assist the breath
43
how does IMV mode work?
- combo of machine and pt breathing
- machine breaths @ preset time and vol
- spontaneous breaths not assisted- neither by time nor vol- pt must use own muscles
44
what is a disadvantage of using IMV mode?
pt often expends energy fighting the machine
45
how does SIMV mode work?
- machine delivers preset tv and RR
- pt can initiate their own breath
- pt breath still not assisted
- pt breath causes machine to sense and will not initiate a machine breathe in opposition of the pts breath
46
what is a disadvantage of the SIMV mode
still does not assist the pt with their own initiated breath
47
what is an advantage of SIMV mode?
decreases the need for the pt to fight the machine
48
is the iMV mode used often
no- never
49
is the SIMV mode used often
no- almost never
50
how does pressure support ventilation work?
machine applies a pressure to the airway throughout the patient triggered breath
51
what are the advantages of using PSV
decr the resistance in the ETT and machine tubing
decr the work of breathing for the patient
PS is reduced as pts strength increases
52
what is PEEP
positive pressure maintained by the ventilator at the end of expiration
53
what are some advantages of PEEP
increases functional residual capacity
opens collapsed alveoli
improves oxygenation and allows for a lower FiO2
54
how does CPAP work?
positive pressure applied throughout the resp cycle to a spontaneously breathing patient
55
what are some of the advantages of CPAP
promotes alveolar and airway stability
56
what are some requirements that must be in place when using CPAP?
no timed cycle
no assist
pt must have own RR
57
how is CPAP admin?
ETT, trach, mask
58
when can CPAP not be used and why?
if a pt is apneic bc they do not have a regular breathing pattern
59
assessment of the patient on a vent
```
systematic assessment of all body systems
focused resp assessment
oxygen status
comfort
coping and emotional needs
communication
```
60
name the components of a focused respiratory assessment
```
capillary refill
abg
O2 Sat
perfusion status
neuro status
bil breath sounds
```
61
initial vent settings
```
TV- 6-12 ml/kg
FiO2- 100---> reduce quickly as pt O2 sat increases
RR- 12-16 BPM
Mode- AC---> CPAP, PSV
PEEP- 5-15 cm H2O
```
62
what are some problems a/s with use of the vent?
alterations in cardiac function
barotrauma
pulmonary function
sepsis
63
how does PEEP affect the body?
it makes the blood returning to the right atrium work harder and decreases the CO
64
what is barotrauma
localized trauma to the alveoli
65
what can barotrauma result in?
bleeding
66
what can cause barotrauma
pressure and TV too high
| invasive air being pushed in
67
sepsis starts _______ and spreads________
locally, systemically
68
what interventions enhance gas exchange?
```
monitor abg's
monitor for indicators of hypoxia
follow trends
auscultate lung sounds frequently
judicious use of analgesics
monitor fluid balance- I/O's
interdisciplinary approach
```
69
what interventions promote effective airway clearance
```
assess lung sounds q 2-4 h
suctioning
cpt
position changes
promote early mobility
humidification- warm and wet
meds
```
70
what meds promote effective airway clearance
bronchodilators
abx
nebulizers
71
how often must tubes and vents be checked?
at least every shift
72
cuff should be managed and assess for what?
```
secretions
seal
proper inflation
not too low
not too hard
```
73
what else should be checked on the trach and ETT?
the suction port and subglottic secretions
74
***HOW DO YOU PREVENT VAP???!!!***
```
daily interruption of sedation
assess daily readiness to extubate
dvt and pud prophylaxis
daily oral care w/ chlorhexidine
oral care with peroxide q 2-4 hrs
hob above 30
HAND WASHING
```
75
the process of weaning is _______
gradual
76
def weaning
process of gradual withdrawal from dependance upon ventilator
77
successful weaning is a _________ process
collaborative
78
what is the criteria for weaning
stable mental status
good and consistent resp assessment
no use of vasopressors
no need for blood
79
how are pts prepped for weaning
```
hob elevated
not sedated
o2 sat is good
TV good
positioning
airway is cleared
RR good and regular
```
80
what method is used for weaning
CPAP trial
81
def extubation
the discontinuation of an artificial airway
82
name indications of extubation of original placement
```
obstruction
protection of the airway
suctioning
ventilatory failure
hypoxemia
```
83
list the guidelines for extubation r/t adequate pulmonary mechanical function
```
RR < 25 BPM
spontaneous TV < 5 ml/kg
Inspiratory force of at least -20 cm H2O
vital capacity at least 10 ml/kg
ABG:
PaO2 >60 mm Hg w/ FiO2 < 0.5
PaCO2 in the normal range for that pt
pH > 7.35
```
84
def chronic ventilation
when long term ventilation is necessary to sustain life
85
name some conditions in which chronic ventilation may be needed
stroke
SCI
neuromucular disorders
chronic illnesses that require repeated tx in ICU
86
def terminal wean
when all life sustaining support is turned off
87
do you need a md order for a terminal wean
yes
88
what else do you need for a terminal wean
patient wish
living will
proxy
89
what is Pulmonary Rehab
a broad program that helps improve the well being of ppl who have chronic breathing problems
90
who does the PR Program benefit?
```
ppl who have:
COPD
Sarcoidosis
Idiopathic Pulmonary Fibrosis
Cystic Fibrosis
```
Need Lung Surgery- Before and After
91
what interventions does the PR program do?
```
exercise training
nutrition counseling
education on ling disease or ur disease and how to mng
energy conserving techniques
breathing strategies
psychological couseling/group support
```
