Mechanical Ventilation (S.G) Flashcards
INCR. PaCO2 __ RR/TV
INCR.
DECR PaCO2 ____ RR/TV
DECR
INCR PaO2 ____ FiO2/PEEP
DECR,
DECR. PaO2____FiO2/PEEP
INCR.
which airway follows the normal curvature of the tonue and extends past the base?
Oropharyngeal
CANNOT have gag reflex, must be sedated
which airway limits gag reflex
nasopharyngeal
which art. airway allows eating/talking and is long term
Tracheostomy
which art. airway is fast, easy, and done in the ER
Endotracheal tube
how long should an ETT be in place?
7-10 days
When intubating:
what position
sedated in SNIFF position :hyperextend neck
limit intubation to how many seconds
30
where does ETT sit anatomically?
3-4 cm above carina
Indications of ventilator support
- relief of upper airway obstruction
- PaO2 45
- remove secretions
- prevent massive aspiration of stomach contents
- GCS
What must you do before suctioning? And how long do you suction for?
Give 3 100% breaths
suction no more that 10-15 sec
Soft cuff effect of pressure and volume
DECR pressure
INCR volume
Hard cuff effect of pressure and volume
INCR pressure
DECR volume
Types of ventilators:
1) NEGATIVE pressure
decreases atmospheric pressure to initiate respirations
Types of ventilators:
2) POSITIVE pressure
fills lungs with gas to expand lungs
* more common
Initial Ventilator Settings FiO2- Mode f Tv
FiO2- 0.5-1 (50%-100%)
Mode- AC (assisted control)
f- 8-12/min
Tv- 6-10 (4-8 if compromised)
Vent Modes:
AC/CMV
continued mandatory volume
-delivers a preset tidal volume always
Vent Modes:
SIMV
spontaneous and mechanical breathing
* used for weaning
Vent Modes:
PEEP
opens alveoli at end of exhale
PEEP normal values
3-5
PEEP indications
if FiO2 >50 for >24 hours- oxygen toxicity
Complications of PEEP
Barotrauma—> pneumothorax–> Decr. C.O
Neuromuscular Blockade
Paralyzes skeletal muscles
Neuromuscular Blockade
Eyelids and face–> tongue—>neck—>shoulders–>respiratory system
** Recovery from meds is reversed
What must you give with a neuromuscular blockade
PAIN MEDS AND SEDATION
they are fully concious
Paralytic:
Pavulon
takes 4-6 min, lasts 2-3 hours
Paralytic:
Nocuron
takes 2-4 min, lasts 30-40 miN
Nursing care of patient of paralytics
- patent airway
- Ambu bag
- Consider ABGs
- Position/passive ROM
- protect eyes with lube and eyepatch
is Versed a paralytic?
NOO do not choose this answer, it is a SEDATIVE
Complications of Mechanical ventilators
- oral, dental, nasal damage
- subcutaneous emphysema
- infection
Complications of Mechanical ventilators
-cardiovascular
decreased C.O
Complications of Mechanical ventilators
-Pulmonoary
Barotrauma-pnuemothorax
Complications of Mechanical ventilators
-Renal
decreased UO d/t kidneys not being perfused from decreased C.O
Respiratory Failure
TYPE 1
low PaO2 and normal CaO2
Respiratory Failure
TYPE 2
low PaO2 and high CaO2
Acute Lung Injury/ARDS
-non cardiogenic pulmonary edema ( not heart related)
normal PaOP
not a result of heart injury
Acute Lung Injury/ARDS
Direct
near drowning
aspiration of gastric content
penumonia
Acute Lung Injury/ARDS
Indirect
sepsis shock/trauma DIC pancreatitis multiple blood transfusions
Position to put a patient with Acute Lung Injury
PRONE!- improves perfusion and decreases shunting
**always assess their stability before putting them prone
