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409 > Mechanical Ventilation > Flashcards

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
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2
Q

name indications for using mech vent

A 
decr PaO2
incr PaCO2
peristent acidosis
treat resp failure
compromised airway
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3
Q

what are the 2 major types of ventillators

A

negative

positive

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4
Q

is negative pressure still used

A

no- almost never

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5
Q

what are the different types of positive pressure ventilators?

A 
volume cycled
pressure cycled
flow cycled
time cycled
non-invasive (mask)
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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)
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7
Q

what is assist control mode?

A

we control everything

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8
Q

what is CPAP mode

A

patient controls their own breath and we support them

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9
Q

Name the MD orders r/t the Vent?

A 
Mode- AC/ CPAP
RR
TV
FiO2
PEEP
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10
Q

what is tidal volume

A

volume in ml that is inhaled in a single breath

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11
Q

what is a normal tidal volume

A

400-500 mL

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12
Q

what is the RR usually set to

A

12-14 bpm

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13
Q

what is FiO2

A

the %age of oxygen that is delivered through the machine

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14
Q

what is the normal FiO2 that is ordered

A

30-100

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15
Q

what is the goal of PEEP

A

to keep alveolar inflated and help exchange of gases

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16
Q

what is a healthy persons natural PEEP

A

3

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17
Q

what will a vents PEEP be set to

A

5-15

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18
Q

what is the absolute highest PEEP you can set PEEP to

A

20

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19
Q

how does a negative pressure ventillator work?

A

exerts negative pressure on the external chest

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20
Q

what is the modern negative ventillator called

A

chest cuirass

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21
Q

what is the old negative ventillator called

A

iron lung

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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

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23
Q

through the use of positive pressure ventillators, does expiration occur passively or actively?

A

passively

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24
Q

what is required for the use of a positive pressure ventillator?

A

advanced airway- ETT, trach

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25
Q

how are positive pressured ventillators classified?

A

by the method of ending the inspiratory phase of respiration

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26
Q

name the different positive pressured ventillators

A

volume cycled
pressured cycled
high frequency cycled
non-invasive positive positive pressure ventilation (mask)

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27
Q

how do volume cycled vents work?

A

breath ends when set volume has been delivered

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28
Q

how do pressure cycled vents work?

A

breath ends when set amt of pressure has been delivered

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29
Q

how do high freq cycled vents work?

A

delivers set # of breaths per minute

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30
Q

what is the most common positive pressure ventillator

A

volume cycled

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31
Q

what are the major limitations of the pressure cycled vent?

A
  • vol delivered is varied
  • vol delivered depends on pts airway resistance and compliance
  • alterations in tv can compromise ventilation
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32
Q

t/f- high freq oscillatory vent is considred last option vent

A

true

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33
Q

how many breaths does the high freq oscillatory vent deliver?

A

180-900 bpm

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34
Q

does the high freq oscillatory vent deliver a high or low tv and why?

A

very low- protect lungs from pressure injury

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35
Q

does the high freq oscillatory vent deliver high or low airway pressure and how much?

A

high- 40 mL

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36
Q

for what conditions is the high freq oscillatory vent used for

A

atelectasis

ARDS

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37
Q

What are some indications for Non-invasive Positive pressure ventilation

A

resp failure
pulmonary edema
chf
sleep related disorder

38
Q

name the different non-invasive positve pressure vents

A

continuous positive airway pressure (CPAP)

bi-level positive airway pressure (bi-pap)

39
Q

during CPAP, what kind of support do you get?

A

pressure support during inhalation, peep support, and exhalation support

40
Q

during bi-pap, what kind of support do you get?

A

inspiration and exhalation support

41
Q

how does AC mode work?

A

full ventilatory support
preset tv and RR
every breath (machine or pt) will receive a preset vol

42
Q

IN AC mode, what happens if the pt initiates their own breath?

A

the machine will deliver the preset volume and assist the breath

43
Q

how does IMV mode work?

A
  • 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
Q

what is a disadvantage of using IMV mode?

A

pt often expends energy fighting the machine

45
Q

how does SIMV mode work?

A
  • 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
Q

what is a disadvantage of the SIMV mode

A

still does not assist the pt with their own initiated breath

47
Q

what is an advantage of SIMV mode?

A

decreases the need for the pt to fight the machine

48
Q

is the iMV mode used often

A

no- never

49
Q

is the SIMV mode used often

A

no- almost never

50
Q

how does pressure support ventilation work?

A

machine applies a pressure to the airway throughout the patient triggered breath

51
Q

what are the advantages of using PSV

A

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
Q

what is PEEP

A

positive pressure maintained by the ventilator at the end of expiration

53
Q

what are some advantages of PEEP

A

increases functional residual capacity
opens collapsed alveoli
improves oxygenation and allows for a lower FiO2

54
Q

how does CPAP work?

A

positive pressure applied throughout the resp cycle to a spontaneously breathing patient

55
Q

what are some of the advantages of CPAP

A

promotes alveolar and airway stability

56
Q

what are some requirements that must be in place when using CPAP?

A

no timed cycle
no assist
pt must have own RR

57
Q

how is CPAP admin?

A

ETT, trach, mask

58
Q

when can CPAP not be used and why?

A

if a pt is apneic bc they do not have a regular breathing pattern

59
Q

assessment of the patient on a vent

A 
systematic assessment of all body systems
focused resp assessment
oxygen status
comfort
coping and emotional needs
communication
60
Q

name the components of a focused respiratory assessment

A 
capillary refill
abg
O2 Sat
perfusion status
neuro status
bil breath sounds
61
Q

initial vent settings

A 
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
Q

what are some problems a/s with use of the vent?

A

alterations in cardiac function
barotrauma
pulmonary function
sepsis

63
Q

how does PEEP affect the body?

A

it makes the blood returning to the right atrium work harder and decreases the CO

64
Q

what is barotrauma

A

localized trauma to the alveoli

65
Q

what can barotrauma result in?

A

bleeding

66
Q

what can cause barotrauma

A

pressure and TV too high

invasive air being pushed in

67
Q

sepsis starts _______ and spreads________

A

locally, systemically

68
Q

what interventions enhance gas exchange?

A 
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
Q

what interventions promote effective airway clearance

A 
assess lung sounds q 2-4 h
suctioning
cpt
position changes
promote early mobility
humidification- warm and wet
meds
70
Q

what meds promote effective airway clearance

A

bronchodilators
abx
nebulizers

71
Q

how often must tubes and vents be checked?

A

at least every shift

72
Q

cuff should be managed and assess for what?

A 
secretions
seal
proper inflation
not too low
not too hard
73
Q

what else should be checked on the trach and ETT?

A

the suction port and subglottic secretions

74
Q

HOW DO YOU PREVENT VAP???!!!

A 
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
Q

the process of weaning is _______

A

gradual

76
Q

def weaning

A

process of gradual withdrawal from dependance upon ventilator

77
Q

successful weaning is a _________ process

A

collaborative

78
Q

what is the criteria for weaning

A

stable mental status
good and consistent resp assessment
no use of vasopressors
no need for blood

79
Q

how are pts prepped for weaning

A 
hob elevated
not sedated
o2 sat is good
TV good
positioning
airway is cleared
RR good and regular
80
Q

what method is used for weaning

A

CPAP trial

81
Q

def extubation

A

the discontinuation of an artificial airway

82
Q

name indications of extubation of original placement

A 
obstruction
protection of the airway
suctioning
ventilatory failure
hypoxemia
83
Q

list the guidelines for extubation r/t adequate pulmonary mechanical function

A 
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
Q

def chronic ventilation

A

when long term ventilation is necessary to sustain life

85
Q

name some conditions in which chronic ventilation may be needed

A

stroke
SCI
neuromucular disorders
chronic illnesses that require repeated tx in ICU

86
Q

def terminal wean

A

when all life sustaining support is turned off

87
Q

do you need a md order for a terminal wean

A

yes

88
Q

what else do you need for a terminal wean

A

patient wish
living will
proxy

89
Q

what is Pulmonary Rehab

A

a broad program that helps improve the well being of ppl who have chronic breathing problems

90
Q

who does the PR Program benefit?

A 
ppl who have:
COPD
Sarcoidosis
Idiopathic Pulmonary Fibrosis
Cystic Fibrosis

Need Lung Surgery- Before and After

91
Q

what interventions does the PR program do?

A 
exercise training
nutrition counseling
education on ling disease or ur disease and how to mng
energy conserving techniques
breathing strategies
psychological couseling/group support

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