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MS2 Exam 1 > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

Mechanical Ventilation

A

A machine that generates a controlled flow of gas into a patient’s airway

  • O2 and air are generated from cylinders or wall outlets
  • gas is blended according to prescribed “inspired oxygen tension” -FiO2
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2
Q

Indications for Ventilation

A
  • ventilatory failure
  • inability to protect the airway
  • failure to clear the airway
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3
Q

Airway Accesses

A
  • non-invasive ventilation (nasal cannal, face mask, non-rebreather mask, BiPAP)
  • LMA
  • Endotrach tube
  • Tracheostomy (for prolonged intubation)
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4
Q

Types of Ventilators

A
  1. Negative-Pressure Ventilators
  2. Positive-Pressure Ventilators
  3. Non-invasive Ventilation
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5
Q

Negative-Pressure Ventilation

A

Creates negative pressure externally to draw the chest outward and air into the lungs

  • mimics spontaneous breathing
  • used for individuals with neuromuscular disorders
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6
Q

Positive-Pressure Ventilation

A
  • PUSHES air into the lungs
  • can be invasive and non-invasive
  • amount of air delivered in: volume (mL) and specific pressure
  • Used for individuals with Acute Resp. Failure
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7
Q

BiPAP

A
  • Provides ventilator support, but uses a tight fitting mask
  • used to AVOID intubation
  • supportive for patients with: sleep apnea, impending respiratory failure
  • success varies and is limited to patient tolerance
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8
Q

CMV

A
  • Controlled Mechanical Ventilation
  • breaths are delivered regularly and independent of the patient’s own ventilatory efforts
  • used when the patient has NO DRIVE TO BREATHE
  • very rarely used
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9
Q

ACV

A

Assist-controlled mechanical ventilation

  • vent breath is triggered by patient inspiration
  • used to initiate mechanical ventilation, those at risk for respiratory arrest
  • if the patient does not initiate a breath in a preset time to vent fires a breath at the pre-set Vt
  • allows patient to breath faster, but not slower (can breathe over the ventilator, such as 20 per minute, but wont let it fall below say 10 BPM)
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10
Q

SIMV

A

Synchronous Intermittent Mandatory Ventilation

  • allows the patient to breath spontaneously without vent assistance between delivered vent breaths
  • vent has a pre-set rate and tidal volume and will not fire when the patient produces their own breath
  • COORDINATED with the patient’s own resp effort
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11
Q

SIMV commonly used to:

A
  • Support ventilation
  • Exercise the respiratory muscles between vent-assisted breaths
  • During the weaning process
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12
Q

“SIMV of 4 and pt’s RR is 18”

How many spontaneous breaths is your patient taking?

A

14 (on their own)

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13
Q

VT

A

Tidal Volume

volume of air delivered during each ventilator breath

N: 6-10 mL/kg or approx. 400-500 mL

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14
Q

↑ VT

A

↑ risk of barotrauma & ↓ venous return/CO

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15
Q

↓ VT

A

↑ risk of atelectasis

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16
Q

PaO2

A

how much oxygen is available is in the alveoli

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17
Q

SaO2

A

how much oxygen is bound to hemoglobin

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18
Q

Oxygen (FiO2)

A
  • set at the lowest possible level for adequate tissue perfusion
  • FiO2 can be 21% to 100% oxygen
  • Try to keep FiO2 less than or equal to 50% to avoid oxygen toxicity or fibrosis
  • Often have set parameters to keep SpO2 > 90% and PaO2 >60
19
Q

Hypoxemia

A

results from ventilation or circulatory problems

-VQ Mismatching (shunting)

20
Q

Normal RR

A

12 to 20

21
Q

PEEP

A

Positive End-Expiratory Pressure

  • maintains positive pressure in the lungs at the end of expiration
  • improves the VQ relationship and diffusion across the alveolar-capillary membrane
22
Q

PEEP prevents

A
  • atelectasis
  • reduces hypoxemia
  • allows for a lower % of FiO2
23
Q

PEEP helps in a code by…

A

helping with venous return during chest compressions

24
Q

PSV

A

Pressure Support Ventilation

  • Preset pressure delivery augmenting patient own resp effect
  • Applies positive pressure during “spontaneous” inspiration
  • Can be used with all modes of ventilation
25
Q

PSV used to…

A
  • overcome dead space of circuit and pt’s airways

- decreases the work of breathing

26
Q

CPAP

A

Continuous Positive Airway Pressure

  • elevates end-expiratory pressure during spontaneous breaths
  • used for intubated and non-tubated patients
27
Q

CPAP used to…

A
  • maintain open airways

- decrease the work of breathing

28
Q

CPAP Mask or BiPAP

A
  • used to improve oxygenation on patient’s who can breath on their own
  • used for those experiencing sleep apnea at night
  • masks must be very tight on the face
29
Q

High Pressure Limit Alarm

A
  • secretions or condensation in tubing
  • Kink in vent tubing
  • Biting ETT
  • coughing or gagging
  • bronchospasm or pneumothorax
30
Q

Low Pressure Alarm

A
  • vent tubing disconnect

- displaced OETT or Trach tube

31
Q

High Respiratory Rate Alarm

A
  • Anxiety or pain
  • Secretions
  • Hypoxia
  • Hypercapnea
32
Q

Low Exhaled Volume Alarm

A
  • Vent tubing disconnect
  • Cuff leak or inadequate cuff seal
  • Another occurring alarm preventing breath delivery
33
Q

Improper Tube Placement

A
  • inflated lung vs. uninflated lung
  • gastric distention
  • aspiration
  • facial skin necrosis
  • crepitus
  • drying of eyes and MM
  • stress
  • claustrophobia
34
Q

Hospital Acquired Pneumonia

A
  • normal respiratory defense mechanisms bypassed
  • open epiglottis
  • cough/gag reflexes inhibited or impaired
  • secretions often think and tenacious (increases risk of atelectasis)
35
Q

What is vital in preventing HAP?

A

-hand hygiene

36
Q

Complications of Mechanical Ventilation

A
  • Aspiration
  • Oxygen toxicity
  • Resp. acidosis/alkalosis
  • Failure to wean
  • ↓ BP and CO
  • Possible liver and renal dysfunction
  • ↑ intracranial pressure
  • fistulas
  • barotrauma
  • fluid retention
  • loss of muscular conditioning
  • malnutrition
37
Q

Ventilator Weaning

A
  • process of removing ventilator support and re-establishing spontaneous, independent breathing
  • Duration of periods off the vent is gradually increased until patient can maintain adequate independent respirations for several hours
38
Q

Process of ventilator weaning depends on…

A
  • preexisting lung conditions
  • duration of mechanical ventilation
  • patient’s general condition - physically and psychologically
39
Q

_____ and ____ are used for weaning

A

SIMV and PSV

40
Q

Weaning is done when…

A

duration of mechanical ventilation has been longer and respiratory muscle reconditioning is needed.

41
Q

Using SIMV to wean…

A
  • number of vent assisted breaths are gradually decreased

- when pt is able to tolerate an SIMV of 4 bpm, a T-piece or CPAP weaning is attempted

42
Q

Using PSV to wean…

A

Pressure support levels are gradually decreased

-when PSV is just enough to overcome ETT resistance, support is D/C, pt is extubated

43
Q

Terminal wean

A

gradual withdrawal of mechanical ventilation when survival without assisted ventilation is NOT expected

44
Q

Nursing considerations

A
  • need to discuss option with pt/family/SO
  • when? where? what?
  • provide education and comfort

MS2 Exam 1 (13 decks)

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