Oxygen and Ventilator Management Flashcards
principles of rehab w/ oxygen and ventilator management
early mobilization of the patient
mobilization can occur with ventilator weaning
a patient who gains overall strength will be more likely to wean off the ventilator and be less likely to develop side effects of bed rest
progress is guided by vital signs, not by the volume (size) of the apparatus
“if there’s nothing wrong with their legs, have them walk”
some of the challenges of mobilization with vent
trachs A lines IVs telemetry ventilators pulse oximetry BP monitors Dobhoff/G tubes
causes of respiratory failure
drugs - narcotics metabolism - hyponatremia, hypercapnia neoplasm infections - meningitis, WNV, polio trama - flail chest, contusion of lung other - ALS, MS, OSA, GB, obesity, COPD, CF, ILD, atelectasis, PE
measuring respiratory function
-normal blood gases
PaO2 -80-100 mmHg PaCO2 -35-45 mmHg pH -7.35-7.45 HCO3 -22-26 (base)
measuring respiratory function
- pulse ox tells you…
- what to observe of the patient
- patients may not have
pulse oximetry gives a measure of the % O2 in the blood. it does not tell you the pCO2 level
observe the patient. are they more combative or confused (could be a sign of climbing pCO2). have they turned pale, labored breathing
patients may not have labored breathing with respiratory failure - look for other signs
types of lines and tubes for respiratory support
nasal cannula non-rebreather mask face mask Bipap/Cpap: noninvasive ventilation heated hi-flow
nasal cannula
-flow range
1 to 6 L/min
if more than 6 L/min is needed, what oxygen delivery systems can you use
pendant oxymizer high flow tubing -has its own color simple mask non-rebreather mask
Bipap
-stands for
bilevel positive airway pressure
Bipap
- when would you use it
- can be used as a temporary way to…
patient has to be able to breathe independently
positive airway pressure during inspiration and exhalation
can be used as a temporary way to “blow out” residual CO2 to reduce confusion and improve oxygenation
how does a Bipap work?
“the inspiratory positive airway pressure is higher and supports a breath as it is taken in
conversely, the expiratory positive airway pressure is a lower pressure that allows you to breathe out.
these pressures are preset and alternate just like your breathing pattern
BiPAP/CPAP
- what type of ventilation
- used for…
- what does CPAP stand for?
non-invasive ventilation (NIV) used for sleep apnea temporary artificual ventilation CPAP -continuous positive airway pressure
CPAP
- non-invasive form of…
- can be provided thorugh…
- provides…
- used with what condition
non-invasive form of Positive End Expiratory Pressure (PEEP)
can be provided through a ventilator or via an independent machine
provides constant end-expiratory pressure that keeps the airway open
used with OSA (obstructive sleep apnea)
characteristics of volume control ventilators
- what is set
- what varies
set tidal volume set rate set PEEP set FiO2 (fraction of inspired O2) peak inspiratory pressure varies
characteristics of pressure control
- what is set
- what varies
set inspiratory pressure set rate set PEEP set FiO2 tidal volume varies
modes of ventilation
full support
intermittent ventilation
continuous positive airway pressure
full support ventilator
- what does it do
- disadvantage
set number of breaths
gives additional full breath once patient initiates breath
disadvantage
-barotrauma: you’re pushing too much air into the lungs and the muscles become weak (like putting a brace on someone)
intermittent ventilation
-what type of patient would you use it with
use with a patient who can spontaneously breathe in between breaths given by machine
continuous positive airway pressure
-3 descriptors
ventilator mode
nasal mask
also used for sleep apnea as a unit separate form a ventilator
common abbreviations
- CMV
- SIMV
- CPAP
CMV -controlled mandatory ventilation SIMV -synchronized intermittent mandatory ventilation CPAP -continuous positive airway pressure
common abbreviations
- PS
- PEEP
- ETT
PS -pressure support PEEP -positive end expiratory pressure ETT -endotracheal tube
principles behind weaning
resting settings alternate with weaning settings/time off the ventilator
time off the ventilator increases by 2-4 hours per day
tidal volume, RR, HR, O2 sat and blood gases indicate tolerance for vent weaning
reasons for a tracheostomy
need for artificial/mechanical ventilation greater than 2 weeks
inability to swallow
blockage of the airway (such as laryngectomy)
obstructive sleep apnea
frequent suctioning needed due to ineffective cough
inability to swallow often due to…
stroke or other neuromuscular disease
