Module 7: Nursing Care of Patients with Critical Respiratory Disorders

Question 1

ventilation
When needed

Answer 1

ventilation- mechanical movement of air in and out of lungs
-weak resp muscles
-meds like narcotics- lower rr
-pain- when coughing/breathing –> shallow breathing

-to decrease paO2- partial pr of O2 in arterial blood- more accurate than saO2, increase CO2
-protect airway when lethargic/unconscious

Question 2

sign of acute high CO2

Answer 2

AMS

Question 3

checking placemt of endotracheal intubation

Answer 3

end-tidal CO2
CXR

Question 4

anesthetics

Answer 4

sedatives
fetanyl
verdaid
propofol

monitoring complications

risk for low BP
would need vasopressors
-phenylephrine
-norep
-epinep
-dopamine
-dobutamine
-milirinone

Question 5

cuff pr at end of trach tube

Answer 5

cuff pr should be at 20-25

Question 6

propofol What is propofol infusion syndrome?

Answer 6

does not linger and impede on neuro assessment

risk for:
rhabdomylsis- muscle weakness, dark urine (toxins in urine), dysrhythmias, high creatine kinase CK in blood ==> muscle damage

Question 7

rate, tidal volume, peep, fio2, minute ventilation

Answer 7

rate- set at a certain rate- pt can also increase/decrease rr

tidal volume- ability of lung and chest wall to distend/expand

avg for adult- 500 cm3

PEEP- positive end-expiratory pr maintainenance of positive pr to keep alveoli open after expiratoration to allow gas exchange -> prevent collapse

lowest-5

FiO2- fraction of inspired O2 lowest on ventilator- 30 %- ideal number. high number means pt is more sick and needs more O2
natural wo intubation- 21%

minute/total ventilation- amount of air that enters lungs per minute nml -5-8L/min

Question 8

higher the peep

Answer 8

sicker the pt

put in prone position

Question 9

lowest peep on ventilator

Answer 9

5- low but good

Question 10

ventilator alarm- high pr

Answer 10

pt biting tube- adjust sedation
coughing- suctioning

Question 11

Plan of care for vented trach patients:`

Answer 11

care every 8hr or more as needed
trach cuff pressure 20-25mm Hg
assist of 2 ppl w/ trach strap
obdurator @ bedside all times (keeps hole open)

Question 12

modes of ventilation:

assist control cmv, pressure control, synchronized intermittent mechanical ventilation simv

Answer 12

In a brief comparison and contrast of AC, SIMV, and PC:

Assist-Control (AC) Ventilation:
- Provides full ventilatory support, delivering a preset tidal volume or target pressure with each inspiration.
- Each patient-initiated breath receives full support.
- Can lead to over-assistance and hyperventilation if the patient’s respiratory drive is high.

This is like a machine that makes sure every balloon gets the same amount of air each time, no matter how hard the balloon itself is trying to get bigger. If you want to blow into the balloon yourself, the machine still helps and fills the balloon up all the way. This can make the balloon very full, sometimes too full if you keep trying to blow air into it too

Synchronized Intermittent Mandatory Ventilation (SIMV):
- Blends mandatory breaths with spontaneous breathing.
- Only the mandatory breaths are administered with preset volume or pressure; spontaneous breaths are patient-controlled and unassisted.
- Helps to maintain respiratory muscle function, good for weaning.

Now, imagine a machine that lets you blow up balloons on your own, but every once in a while, it makes sure one balloon gets filled up to the right size. So, you can blow little puffs of air into the balloon yourself, but when it’s the machine’s turn, it fills the balloon up all the way. This helps the balloon not get too tired while still letting it do some of the work

Pressure Control Ventilation (PC):
- Delivers breaths at a preset pressure, offering more consistent pressure throughout inspiration and potentially reducing barotrauma risk.
- Volume delivery can vary with changes in lung compliance.
- Good for patients who require lower peak pressures due to lung pathology.

This one is like having a machine that only focuses on how hard the air is being pushed into the balloon, not how big the balloon gets. So instead of making sure every balloon gets the same amount of air, it makes sure it doesn’t push the air too hard into the balloon. This is safer for the balloon because it means it’s less likely to pop if it’s too weak or already stretched out.

While AC and SIMV can both be set to either a volume-target or pressure-target strategy, PC is strictly a pressure-target form of ventilation. AC and PC modes fully support the patient’s breaths, while SIMV allows for a mixture of full support and spontaneous breathing.

So, AC makes sure the balloons are always full, SIMV allows the balloons to rest between big breaths from the machine, and PC is careful not to push too hard and damage the balloons

Question 13

pt refusing to be ventilation/don’t want to be dnr

Answer 13

non invasive positive pr ventilation

cpap
bipap
epap

Question 14

nursing dx- tracheostomy

Answer 14

ineffective air clearance

Question 15

tracheostomy

Answer 15

replaces endotracheal tube
allows long term use of mechanical ventilation
maintain steriliy when suctioning

Question 16

explain barotrauma

Answer 16

Barotrauma is a type of injury to the body tissues caused by a difference in pressure between the inside of the body and the surrounding environment. It’s like what might happen to a balloon if you blow too much air into it — the balloon stretches and can eventually pop because of the pressure.

In medical terms, it often refers to lung damage that can occur when mechanical ventilation (a machine that helps a person breathe) provides air with too much force or volume. This excess pressure can cause parts of the lungs to overinflate and potentially tear, much like that overstretched balloon. It can also happen naturally, like when someone holds their breath and goes deep underwater or when scuba divers ascend too quickly.

Question 17

High frequency oscilator support ventilor- understanding of:

Answer 17

delivers rapid, small pulses of air down the center of the airways to open up alveoli allowing
alveolar air to exit the lungs along the margins of the airways

Question 18

Effective coughing techniques after a thoracotomy:

Answer 18

clear sounds after cough

Question 19

Why pantoprazole when on a vent?

Answer 19

Pantoprazole, a proton pump inhibitor (PPI), is commonly prescribed to patients on mechanical ventilation to prevent stress ulcers and gastrointestinal bleeding — conditions collectively referred to as stress-related mucosal disease (SRMD). Here’s why:

1. Reduced Blood Flow: Critically ill patients, especially those on mechanical ventilation, can have reduced blood flow to the stomach and intestines due to their illness or the medications used to support their blood pressure, which increases the risk of ulcers.
2. Increased Acid Production: Stress from critical illness can lead to increased acid production in the stomach.
3. Protection from Acid: Pantoprazole works by reducing the amount of acid the stomach produces, which helps protect the stomach lining and reduces the risk of ulcers and bleeding.
4. Prophylactic Treatment: In intensive care, pantoprazole or other PPIs are often given prophylactically (as a preventive measure) because the potential complications from stomach ulcers can be very serious in already critically ill patients.

Pantoprazole is selected for its efficacy, relatively low risk of drug interactions, and the ability to be administered intravenously, which is beneficial for patients who cannot take oral medications.

Question 20

adjusting settings of ventilator

Answer 20

respiratory therapy adjusts settings

Question 21

ventilator alarm

Answer 21

assess pt first

Question 22

nursing management

Enhancing Gas Exchange
Promoting effective airway clearance- suctioning
Promoting the optimal level of mobility- prevent dvt, ulcers
Preventing complications- prevent ulcers, dvt
Promoting optimal communication
Promoting coping abilities
Monitoring and responding appropriately to alarms/potential complications
Recognizing when patient may be ready for support weaning

Answer 22

Enhancing Gas Exchange
Promoting effective airway clearance
Promoting the optimal level of mobility
Preventing complications
Promoting optimal communication
Promoting coping abilities
Monitoring and responding appropriately to alarms/potential complications
Recognizing when patient may be ready for support weaning