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Critical Care Test 1 > Mechanical Ventilation lectutre > Flashcards

Mechanical Ventilation lectutre Flashcards

1
Q

Tidal volume (vt)

A

amount of air inhaled and exhaled

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2
Q

Inspiratory Reserve volume (IRS)

A

maximum air inhaled over tidal volume

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3
Q

Expiratory Reserve Volume (ERV)

A

max amount of air exhaled over Tidal volume

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4
Q

Residual volume (RV)

A

amount of air left in lung after exhale

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5
Q

Functional Residual Capacity

A

SUM of ERV and Vt

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6
Q

Oropharyngeal Airway:

-location

A
  • follows natural curvature of the tongue

- holds tongue away from throat to maintain patency

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7
Q

Oropharyngeal Airway:

-what types of patient to use it on

A

UNCONSCIOUS patient who has an absent or diminished gag reflex

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8
Q

Oropharyngeal Airway:

-what are the benefits? complications that it avoids?

A

Avoids the risk of nasal irritation and sinitus

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9
Q

Nasopharyngeal Airway:

-location

A
  • inserted into one nare

- maintains patency of hypopharynx

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10
Q

Nasopharyngeal Airway:

- what does it limit the stimulation of?

A

gag reflex

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11
Q

Tracheostomy:

-what type of patients to use it on?

A

-LONG TERM MANAGEMENT: 7-10 days

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12
Q

Tracheostomy:

-advantages of having a trach for the patient

A
  • more comfortable for the patient
  • patient can eat and talk
  • easier to remove secretions
  • reduces decannulation
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13
Q

Tracheostomy:

-two ways to insert the trach

A

1) OR surgical

2) percutaneous procedure- bedside

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14
Q

Tracheostomy:

-two items to have at the bedside for safety

A
  • obturator
  • 2nd trach + a smaller size for accidental dislodgement
  • vaseline gauze
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15
Q

Tracheostomy:

-complications during insertion

A
  • misplacing the tube
  • hemorrhage
  • laryngeal nerve injury
  • pneumothorax
  • cardiac arrest
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16
Q

Tracheostomy:

-complications in management

A
  • stomal infection
  • hemorrhage
  • fistula
  • tube obstruction and displacement
  • *SKIN BREAKDOWN!
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17
Q

Tracheostomy:

-complications with removal

A
  • days to weeks after:

- stenosis and fistulas

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18
Q

Tracheostomy:

-when should sutures be removed?

A

-only in there for 7-10 days

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19
Q

Endotracheal Tubes:

-location

A
  • insertion into the trachea via the nose or mouth
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20
Q

Endotracheal tubes:

-what type of patients to use it on

A

SHORT TERM management

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21
Q

Endotracheal Tube:

-Indications for use

A
  • protection from aspiration
  • application of positive pressure ventiation
  • high oxygen concentrations
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22
Q

Endotracheal Tube:

-what happens if the air-filled cuff deflates?

A

-risk for aspiration pneumonia

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23
Q

Endotracheal Tubes:

-advantages of use for healthcare professionals

A

First.
Fast.
Easiest

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24
Q

Endotracheal Tubes:

- complications

A
  • ORAL TRAUMA: broken teeth
  • vomiting with aspiration
  • hypoxemia
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25
Q

standard intubation equipment

A
  • laryngoscope
  • oral Endotracheal tube with various sizes
  • ambu-bag and O2
  • suction equip
  • paralytic meds
  • cap CO2 detector- turns purple to yellow
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26
Q

Rapid Sequence Intubation
-7 steps
(1-4)

A

1) preperation
2) Pre-oxygenate for 3-5 min with 100%
3) Pretreatment within 3 min of next step
4) give paralytics and sedatives

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27
Q

Rapid Sequence Intubation (RSI)

1) paralytics
2) sedatives

A

1) succinylcholine and rocuronium

2) Versed, ketamine

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28
Q

Rapid Sequence Intubation (RSI)

-step 5

A

5) Protection and Positioning
- Sniff position
- Sellick maneuver (cricoid pressure) - BURP

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29
Q

RSI:

  • Sniff position
  • Cricoid pressure
A
  • tilt back with neck hyperextended
  • BURP: back, up, right, pressure on trachea
  • closes off risk for aspiration
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30
Q

Rapid Sequence Intubation (RSI):

-stepts 6-7

A

6) Placement of ETT (3-4 cm above carina)
- intubate less than 30 sec, if not, re-oxygenate
7) Post intubation management

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31
Q

Aspiration of as little as ____ mL of gastric content may result in significant injury to the patient

A

20

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32
Q

Prevention of Endotracheal Tube complications:

-tube obstruction

A
  • bite block
  • humidify
  • replace old ETT’s
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33
Q

Prevention of Endotracheal Tube complications

-Tube displacement

A
  • secure tube
  • restraints
  • sedate
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34
Q

Prevention of Endotracheal Tube complications

- Sinusitis and nasal injury

A
  • Avoid nasal intubations

- antibiotics

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35
Q

Artificial Airway Cuffs-

-purpose

A
  • small balloon inflated to prevent leakage of inhaled air past the tube into the upper airway
  • CLOSED SYSTEM
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36
Q

Artificial Airway Cuffs-

-Minimal Leak technique

A

-place stethescope over larynx and inject 0.5 ml of air into the cuff at a time until small inspiratory leak is auscultated

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37
Q

Artificial Airway Cuffs-

-Minimal Occluding Pressure

A

inflate then decrease by 0.2 ml. when you hear an air leak increase to the point air leaks and trachea is sealed
“darth vadar “ noise

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38
Q

how to suction a patient?

A
  • give 3 100% breaths

- do not suction for more than 10-15 seconds

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39
Q

What to do if ET tube pulled out?

A
  • page doctor
  • listen to lungs sounds
  • call RT
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40
Q

what is mechanical ventilation

A

any means in which physical devices or machines are used to either assist or replace spontaneous respirations

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41
Q

Indications for mechanical ventilation

A
  • relieve upper airway obstruction
  • Acute lung failure
  • PaO2
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42
Q

What must you give the patient when on Mechanical Ventilation

A
  • sedation

- neuromusclular blockade

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43
Q

Mechanical Ventilation:

-Negative-Pressure ventilators

A
  • “iron lung”
  • applied externally to patient
  • ** decreases atmospheric pressure surrounding the thorax to initiate inspiration
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44
Q

Mechanical Ventilation:

-Positive Pressure Ventilators: (PPV)

A

-forces gas into the lungs to expand them

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45
Q

Mechanical Ventilation:

-Positive Pressure Ventilators: (PPV) 2 types

A

1) Volume cycled

2) Pressure cycled

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46
Q

Positive pressure ventilators:

1) VOLUME CYCLED

A
  • gas flows into lungs until a preset VOLUME of gas has been delivered
  • constant tidal volume regardless of compliance and airway resistance
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47
Q

Positive pressure Ventilators:

2) PRESSURE CYCLED

A
  • gas flows into the lungs until a preset PRESSURE is reached
  • delivery of desired tidal volume is NOT guarenteed
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48
Q

Mechanical Vent. Settings

-Trigger

A

-what causes the vent to deliver breath (pressure or flow)

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49
Q

Mechanical Vent. Settings

-Sensitivity

A

determines the amount of effort patient must generate before the ventilator will deliver a breath

50
Q

Mechanical Vent. Settings

  • Sensitivity:
  • if setting TOO LOW
  • if setting TOO HIGH
A
  • pt works harder to breath

- asynchronus breathing

51
Q

Mechanical Vent. Settings

-Respiratory rate

A

-6-20
* key way to control CO2
adjust according to PaCO2

52
Q

Mechanical Vent. Settings

-Tidal volume

A

-volume delivered per ventilator breath
-500-800 mL
N (6-10 ml/kg/IDB)
ARDS (4-8)

53
Q

Mechanical Vent. Settings

-fraction of inspired O2 (FiO2)

A

% of air that is being delivered by ventilator each breath
21-100%
*must maintain PaO2 80-100 and SaO2 >90

54
Q

Mechanical Vent. Settings

-Positive end expiratory pressure (PEEP)

A
  • prevents shunt
  • keeps alveoli open to promote gas exchange
  • AFTER EXPIRATION
55
Q

PEEP normal value

A

3-5

ARDS: 5-20

56
Q

Mechanical Vent. Settings

-Flow rate

A

determines how fast tidal volume will be delivered

57
Q

Flow rate:

  • LOW
  • HIGH
A
  • allows long inspiration

- allows fast inhalation for longer exhalation

58
Q

What type of flow rate does COPD want?

A

HIGH FLOW RATE

59
Q

Mechanical Vent. Settings

-I:E ratio

A

duration of inspiration to expiration

1:2

60
Q

Mechanical Vent. Settings

-Pressure Limits

A

-regulate maximum amount of pressure the ventilator will generate to deliver preset tidal volume

61
Q

Positive End Expiratory Pressure

-functions

A
  • Maintain airway pressure
  • Increases FRC
  • improves oxygenation by opening collapsed alveoli at end of expiration
  • decreases FiO2 to less toxic
62
Q

minute volume (MV)

A

total volume of gas inhaled or exhaled over 1 minure

63
Q

Peak Inspiratory Pressure PIP

A

airway pressure at maximum inspiration

-AIRWAY PROBLEM : mucus plug

64
Q

Plateau pressure

A

Pressure applied to small airways and alveoli during PPV

  • Measured during an inspiration pause on the mechanical ventilator
  • LUNG COMPLIANCE
65
Q

Modes of Ventilation:

-continuous mandatory volume (CMV) aka Assist control (AC)

A

-delivers gas at a preset volume or pressure
-patient CAN either trigger the ventilator or machine will give a breath on its own
-

66
Q

CMV/AC

  • advantages
  • disadvantages
  • indications
A
  • guarentees a minimum minute ventilation
  • can lead to RESP ALKALOSIS and Hypotension
  • pts who need full ventilator support and need a steady vt
67
Q

Example of a Ventilator Mode:

-AC 16 (BUR)

A

Back Up Rate

-if patient unable to trigger breathing

68
Q

Modes of Ventilation:

- Synchronized Intermittent Mandatory Ventilation (SIMV)

A
  • a mix of MANDATORY breaths and ASSISTED breaths
  • delivers preset volume or pressure while allowing pt to breath spontaneously
  • “works out lungs”
69
Q

Difference between SIMV and AC

A

-SIMV allows patient to breath without any support when they want to, AC allows support by ventilator

70
Q

SIMV

  • advantages
  • disadvantages
  • Indications
A
  • guarentees minimun minute ventilation. Lower pressure than AC
  • Increased WOB for patient-fatigue
  • needed for patients who are hyperventilating or have high airway resistance
71
Q

REVIEW AC and SIMV

A

AC- receive full support

SIMV- receive partial support

72
Q

Modes of ventilation:

Pressure control ventilation (PCV)

A
  • MANDATORY breaths only

- patient CANT trigger ventilator

73
Q

Pressure Control Ventilation (PCV)

  • advantages
  • Disadvantages
  • Indications
A
  • prevents excess airway pressure, avoids alveolar over-distention, leads to earlier weaning
  • uncomfortable, requires DEEP SEDATION
  • Pts with high risk barotrauma
74
Q

Modes of Ventilation:

- Pressure support ventilation (PSV)

A
  • No mandatory breaths
  • preset positive pressure on patients inspiratory efforts
  • patient controls rate, flow, and vt
    • Pt has control of breaths!
75
Q

Pressure support ventilation (PSV)

  • adavantages
  • disadvantages
  • indications
A
  • supports breathing and helps patients with a stable respiratory drive to overcome increased airway resistance, reduces their work of breathing
  • apnea alarm is only back up
  • assist spontaneous breaths in SIMV or helps weaning
76
Q

neuromuscular blockade

A

paralysis of a patient using drugs that paralyze skeletal muscle but don’t affect cardiac or smooth muscle

77
Q

Uses of neuromuscular blockades

A
  • aids in intubation
  • acts by competing with ACh
  • stops muscles from depolarizing
78
Q

what must you give when you give a neuromuscular blockade?

A
  • pt is paralyzed but fully CONSCIOUS
  • GIVE SEDATIVE and PAIN control
  • versed as an IV drip
79
Q

Neuromuscular Blockade Nursing considerations

A
  • patent airway
    -ambu bag
    ABGs
    -position change and passive ROM
    -Protect eyes with lubricant and eye-pads
80
Q 
Train of 4:
4/4
3/4
2/4
1/4
0/4
A
  • less than 75%
    -75%
    -80% DESIRED
    -90%
    100%
81
Q

Troubleshooting alarms

DOPE

A

D- disconnections
O- obstructions
P-pressure/pneumothorax (check lung sounds and chest Xray)
E- equipment

82
Q

why would an alarm say low pressure?

A
  • patient disconnection
  • tubing disconnection
  • cuff leak
83
Q

why would an alarm say high pressure?

A
  • patient coughing
  • secretions or mucus in airway
  • patient fighting the ventilator
  • increased airway resistance
  • reduced lung compliance
  • water in circuit
  • kinking in the circuit
  • problems with I/E valves
84
Q

why would patient be agitated or in dis-synchrony on the ventilator ?

A
  • secondary to overall discomfort–>increase their sedation
  • ## secondary to air hunger–>adjust respiratory settings (vt, flow rate, ect)
85
Q

complications of mechanical ventilators

A
  • oral and dental damage
  • nasal damage
  • decrease in C.O
  • barotrauma/voltrauma
  • emphysema
  • infection
  • increase WOB
86
Q

Barotrauma/Volutrauma

A
  • alveolar overdistention with resiliant alveolar rupture and air leak
87
Q

effect of mechanical ventilation on renal system

A

decreased urinary output d/t low perfusion to kidneys

* tell Dr if

88
Q

Effect of mechanical ventilation on GI?

A
  • stress ulcers

- give pepcid

89
Q

When to draw ABGs when on a mechanical ventilator

A
  • 30-60 min after ventilations begin

* DO NOT SUCTION for 15 min before drawing ABGs. alters O2 values

90
Q

what else should be checked besides ABG’s

A
  • Hgb

* ensure the absence of anemia and adequate perfusion

91
Q

*** what to do if:

INCREASED PaCO2

A

INCREASE rate or tidal volume

92
Q

*** what to do if:

DECREASED PaCO2

A

DECREASE rate or tidal volume

93
Q

*** what to do if:

INCREASED PaO2

A

DECREASE FiO2 or PEEP

94
Q

*** what to do if:

DECREASED PaO2

A

INCREASE FiO2

95
Q

Process of Weaning:

WEANING

A 
W-WOB
E- electrolytes
A- attitude
N-nutrition
I-infection
N-nonspecifc
G-gases
    • make sure to educate the patient
    • only do spont. breathing trial for 30-120 min
96
Q

weaning methods

1) SIMV weaning

A
  • gradual transition from vent to spontaneous breathing
97
Q

weaning methods:

2) PSV weaning

A

PS mode at a level that achieves spontaneous vt

-augments pt breathing with a + pressure boost during inspiration

98
Q

ACUTE LUNG FAILURE

A

inability of lungs to maintain adequate oxygenation of the blood with or without impairment or CO2 elimination

99
Q

Acute Lung Failure:

Type 1

A

low PaO2 (

100
Q

Acute Lung Failure:

type 2

A

low PaO2 (45)

101
Q

Acute Lung Failure management

A
  • O2 >90%
  • PaO2 45??
  • ventilation: pH
102
Q

Acute Respiratory Distress Syndrome (ARDS)

A

non-cardiogenic pulmonary edema

-alteration of the alveolar capillary membrane

103
Q

ARDS causes:

DIRECT

A
  • aspirate gastric content
  • pneumonia
  • near drowning
104
Q

ARDS causes:

INDIRECT

A
  • sepsis
  • trauma
  • pancreatitis
  • blood transfusions
  • DIC
105
Q

ARDS pathophysiology:

A

injury occurs–> inflammatory response–> immune system releases protein mediators–> this increase the permeability of alveolocapillary membrane–> allows large molecules to enter–> collapse of the alveoli and makes lungs less compliant (stiff)

106
Q

ARDS progression:

1) Exudative phase

A
  • release of INFLAMMATORY MEDIATORS
  • within 72 hrs of injury
  • alveolar edema and Type 1 epithelial cells (flooding)
  • Xray changes in 24 hrs
  • mediators cause damage to alveolar hypoventilation, V/Q prob, intrapulmonary shunting, hypoxemia
107
Q

ARDS progression:

2) Fibropolierative phase

A
  • HEALING begins
  • granulation and collagen deposits
  • fibrotic alveoli
  • scarred pulmonary capillaries
108
Q

ARDS progression:

3) Resolution phase

A
  • REMODELING
  • alveolar fluid goes to interstitium
  • Type 2 epithelial cells multiply
109
Q

ARDS S/S

A
  • within 48 hrs
  • restlessness
  • HTN
  • tachycardia
  • SOB
  • accessory muscle use
  • lung sounds: clear, crackles, or rales
110
Q

ARDS diagnostic findings

-ABGs

A
  • low PaO2

hypoxemia: PaO2/FiO2 less than 200

111
Q

ARDS diagnostic findings:

-CXR

A

“white out”

112
Q

ARDS diagnostic findings:

-PA cathater

A

PAOP

113
Q

ARDS Treatment:

A

-establish airway
-HIGH PEEP!! keep alveolar open
-sedate
-A-line to maintain BP
corticosteroids to help with membrane permeability
-nutrition: TPN
PRON POSITION

114
Q

symptoms of respiratory distress associated with ARDS begin within __ hours of insults to lungs

A

24-48 hrs

115
Q

what is happening at the cellular level to cause hypoxia in ARDS

A

leaking of alveolocapillary membranes

116
Q

high levels of PEEP can cause what ?

A

Decreased C.O because high intrathoracic pressure

117
Q

ARDS POSITIONING txt

A
  • preferential blood flow occurs to the gravity-dependent areas of the lungs
  • positioning is used to place the least damaged portion of the lungs into a dependent position
  • prone
  • rotation
118
Q

ARDS positioning:

1) Prone

A

-improves oxygenation

119
Q

ARDS positioning:

2) Rotation

A

-keep them on special beds 24-48 hrs

120
Q

What would you do first to increase oxygenation in an attempt to decrease FiO2 when in oxygen toxicity?

A

Increase PEEP

121
Q

Inadequate PEEP can increase the risk of:

A

Atelectrauma: open/close can cause alveolar damage.

Critical Care Test 1 (13 decks)

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