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G270 MS Exam #1 > Modes of Ventilation > Flashcards

Modes of Ventilation Flashcards

1
Q

What is endotracheal intubation used for?-5

A
  • maintain an airway
  • remove secretions
  • prevent aspiration
  • provide mechanical ventilation
  • bypasses the patient’s normal protective airway mechanisms
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2
Q

What is the endotracheal tube cuff used for?

A
  • prevents air leaks around the tube
  • prevents aspiration
  • ensures ventilator is 100% responsible for patient ventilation
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3
Q

What needs to happen to the balloon before extubating

A

deflate the balloon!!

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4
Q

How to Verify placement of ETT tube (5) and what to do after it is verified (2)

A
  • ETCO2 detector (checks CO2 levels, makes sure the tube is in the trachea and not the esophagus)
  • auscultate chest and epigastric area
  • confirm bilateral breath sounds
  • obtain an order for CXR for placement verification and documentation
  • CXR –> shows it is 3-4 cm above carina
  • secure tube when placement is verified
  • record cm at lip line for reference
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5
Q

ETT nursing care: airway patency -4

A
  • suction as needed- max pressure 120 mmHg (air way patency is priority)
  • maintain and secure tubing with holder
  • monitor and chart cm at the lip line
  • monitor CXR for correct placement
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6
Q

Indications for tracheostomy-5

A
  • long-term mechanical ventilation
  • frequent suctioning
  • protecting the airway
  • bypass an airway obstruction
  • reduce WOB
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7
Q

Indications for ventilation- 3

A
  • hypoxemia (PaO2 < 60mmHg on FiO2 > 0.5)
  • hypercapnia (PCO2 > 50mmHg with pH < 7.25)
  • progressive deterioration (increased RR, decrease VT, increase WOB)
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8
Q

What needs to be in the patients room at all times?

A

manual resuscitation bag (ambu bag)

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9
Q

What is PEEP?

A

pressure applied by the vent at the end of each breath allowing alveoli to remain open

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10
Q

PEEP –> What does it do? pressure ranges

A
  • recruits open alveoli in sick lung and improves oxygenation and max gas exchange can happen
  • 5-20cm H2O
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11
Q

complication of PEEP

A

-may increase intracardiac pressure (decrease venous return and CO) MONITOR FOR DECREASED CO

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12
Q

What does PIP do?

A

maximum pressure is applied to lungs during inhalation

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13
Q

V-AC (volume) –> who triggers support

A

patient triggered support –> pt initiated breaths

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14
Q

What does V-AC do?

A

delivers specific volume, but back up respiratory rate

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15
Q

What is CMV?

A

continuous mandatory ventilation –> ventilator provides 100% respiratory effort and quality

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16
Q

What is P-A/C?

A

pressure control or assist ventilation

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17
Q

What happens in P-A/C?

A

patient triggered support –> delivers specific pressure with a backup respiratory rate

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18
Q

in P-A/C, what does volume get based on?

A

lung compliance –> decreased compliance leads to decreased volume in the lungs

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19
Q

What is the alarm set for in P-A/C?

A

volume

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20
Q

What is the alarm set for in VAC?

A

increased pressure

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21
Q

What disease process if P-A/C typically used for?

A

ARDS

22
Q

Why isn’t volume control used in ARDS?

A

volume control may increase inflammation

23
Q

ventilator settings for ARDS

A
  • pressure control ventilation
  • PEEP for alveoli recruitment (12-14)
  • lower tidal volume
  • monitor hemodynamics/CO
  • alarm set for volume
24
Q

What is pressure support?

A

aid for mechanical ventilation –> keeps the entire lung open, not just alveoli

25
Q

What happens with pressure support?

A

-spontaneous efforts are assisted with preset positive pressure (6-12cm H2O)

26
Q

pressure support uses-5

A
  • decreased WOB through ETT
  • target: bests pressure to achieve adequate TV
  • used on most patients
  • useful in weaning from ventilator
  • keeps airway open
27
Q

What is SIMV?

A

patient or ventilator-initiated breaths w/ their own tidal volume (volume or pressure control)

28
Q

when is SIMV used

A

used more with long-term weaning-trached patients

29
Q

What is high frequency oscillatory ventilation?

A

utilizes a RR greater than four times the normal RR

30
Q

high frequency oscillatory ventilation-4

A
  • very small tidal volumes
  • reduces ventilator-associated lung injury
  • especially useful in ARDS and acute lung injury
  • lung protective ventilation
31
Q

requirements for BiPAP

A
  • tight seal of mask
  • intact respiratory drive and effective respiratory rate
  • able to protect airway
32
Q

CPAP information-4

A
  • requires spontaneous breathing
  • better bronchodilator/steroid effect
  • weaning from vent or delay need for intubation
  • requires patient ready to sustain RR and some volume
33
Q

Main difference between CPAP And BiPAP

A

CPAP is the same pressure throughout the respiratory cycle while BiPAP is higher pressure on inspriration

34
Q

Can you shut off alarms?

A

no! can silence temporarily but cannot be shut off

35
Q

What to do if an alarm is going off and you cannot find the problem?

A

remove pt from ventilator and manually ventilate the patient with ambu bag

36
Q

When would a high inspiratory pressure alarm go off?-3

A
  • coughing or attempting to talk
  • kinks in ventilator tubing
  • need for suctioning
37
Q

Complications of mechanical ventilation-3

A
  • ETT out of position
  • unplanned extubation
  • laryngeal/tracheal injury
38
Q

how to prevent laryngeal/tracheal injury-3

A

-prevent excessive head movement
-routine monitoring of ETT cuff pressure
Cuff pressure shouldn’t be higher than 20-30 cm H2O

39
Q

How does barotrauma occur?

A

alveolar over inflation and rupture due to elevated pressure

40
Q

complications from barotrauma

A

air leaks into extra-alveolar tissue causing pneumothorax or tension pneumothorax

41
Q

How to detect barotrauma-4

A
  • decreased breath sounds
  • tracheal shift
  • subcutaneous emphysema
  • hypoxema
42
Q

What is volutrauma?

A

overdistension of alveoli –> damages lungs similar to ARDS

43
Q

s/s volutrauma-5

A
  • dyspnea
  • tachypnea
  • hypotension
  • severe hypoxemia
  • confusion and extreme fatigue
44
Q

FiO2 of ____% causes and increased risk of airway damage and oxygen toxicity

A

50%

45
Q

s/s oxygen toxicity

A
  • tracheobronchitits

- atelectasis

46
Q

How long can FiO2 of 100% be tolerated

A

24 hours

47
Q

prevention of VAP –> VAP bundle (5)

A
  • hob 30-45 degrees
  • daily sedation interruption (assess readiness to wean)
  • DVT prophylaxis
  • PUD prophylaxis
  • oral care: chlorhexidine
48
Q

readiness to wean-6

A
  • underlying cause for ventilation resolved
  • hemodynamic stability; adequate CO
  • adequate respiratory muscle strength
  • adequate oxygenation without high FiO2 and/or high PEEP
  • mental readiness
  • minimal need for medicines that cause respiratory depression
49
Q

complications of extubation (4)

A
  • stridor
  • hoarseness
  • change in VS
  • low O2 saturation
50
Q

What can be used to prevent need for reintubation?

A

BiPAP

G270 MS Exam #1 (6 decks)

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