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Adult Health I > T2: Airway and O2 Mgmt (2) > Flashcards

T2: Airway and O2 Mgmt (2) Flashcards

1
Q

6 complications of artificial airway:

A

1) tube OBSTRUCTION
2) tube DISPLACEMENT
3) SINUSITIS, nasal injury
4) tracheoesophageal FISTULA
5) mucosal LESIONS
6) laryngeal or tracheal STENOSIS

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2
Q

How can we look for signs of laryngeal stenosis after extubating a pt?

A

listen for hoarseness or stridor;

stridor is serious - call MD

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3
Q

What 2 additional complications do we see with trachs?

A
  • tracheoinnominate artery fistual

- subcutaneous emphysema

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4
Q

Why is a tracheoinnominate artery fistual so dangerous?

A

the pt could bleed out…there’s nowhere to apply pressure

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5
Q

What 6 steps are taken to extubate?

A

1) Hyperoxygenate pt
2) Suction ET and oral cavity
3) Deflate ET cuff
4) Remove tube at peak inspiration
5) Instruct pt to cough
6) Monitor every 5 min for respiratory distress

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6
Q

What is a surgical incision into trachea for purpose of establishing an airway?

A

tracheotomy

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7
Q

What is a stoma (opening) that results from tracheotomy and is more comfortable for the pt?

A

tracheostomy

Remember: stoma sounds like tracheoSTOMY

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8
Q

5 priority pt problems with artificial airway:

A

(Remember: M-COIN)

  • damaged oral MUCOSA
  • inadequate COMMUNICATION
  • reduced OXYGENATION
  • potential for INFECTION
  • inadequate NUTRITION
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9
Q

Other possible complications of an artificial airway:

A
  • pneumothorax
  • subcutaneous emphysema
  • bleeding
  • infection!!!
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10
Q

5 ways to prevent tissue damage with trach:

A

1) Use minimal leak and occlusive techniques
2) Check cuff pressure often
3) Prevent tube friction and movement
4) Prevent/treat malnutrition, hemodynamic instability, hypoxia

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11
Q

Why do we need to warm, humidify, and filter trach air?

A

tracheostomy tube bypasses nose and mouth which normally does those things

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12
Q

Why do we need to ensure adequate hydration with trachs?

A

To keep secretions thin

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13
Q

Common causes of hypoxia in the trach:

A
  • ineffective oxygenation when suctioning
  • catheter too large
  • suctioning too long
  • excessive suction pressure
  • suctioning too frequently
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14
Q

T/F: Tracheostomy tube and nutrition: most pts get nutrition through a G-tube or NG tube

A

True

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15
Q

How long do we elevate the HOB after eating with a trach? Why?

A

at least 30 min

Prevent aspiration during swallowing

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16
Q

Bronchial and Oral Hygiene: Reposition pt every ___ to ___ hrs

A

1 to 2 hrs

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17
Q

Bronchial and Oral Hygiene: Ways to break up mucus and promote drainage

A
  • coughing and deep breathing
  • chest percussion and vibration
  • postural drainage
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18
Q

How do we wean someone from a tracheostomy tube?

A
  • change to uncuffed tube
  • gradually decrease the tube size
  • trach button has potential for dislodging
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19
Q

When is the cuff deflated?

A

when pt can manage secretions and does not need assisted ventilation

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20
Q

What are the 2 types of ventilators?

A
  • negative-pressure

- positive-pressure

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21
Q

What are the 3 versions of POSITIVE-pressure vents?

A
  • pressure-cycled
  • time-cycled
  • volume-cycled
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22
Q

There are 3 main MODES of ventilation:

A
  • AC (Assist-Control Ventilation)
  • SIMV (Synchronized Intermittant Mandatory Ventilation)
  • BiPAP (Bi-level Positive Airway Pressure)
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23
Q

What are the ventilator CONTROL and SETTINGS?

A
  • Vt (Tidal Volume)
  • Rate (breaths per min)
  • FiO2 (fraction of inspired O2)
  • PIP
  • CPAP
  • PEEP
  • Flow rate
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24
Q

What are 4 indications for mechanical ventilation?

A
  • acute impending ventilatory failure
  • refractory hypoxemia
  • secretion/airway control
  • apnea/respiratory arrest
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25
Q

Automatic mechanical device designed to provide all or part of the work the body must produce to move gas into and out of the lungs:

A

ventilator (the machine itself)

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26
Q

Ventilator delivers gas through a set of tubes connected to an airway either an ETT or trach tube:

A

Circuit (tubes that connect vent to pt)

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27
Q

Which mode of ventilation delivers a preset number of breaths at preset tidal volume?

A

AC (assist control) or CMV (continuous mandatory ventilation)

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28
Q

AC or CMV: If pt ____ a breath, machine delivers presest ____ ____ for every breath. (This means the machine takes over after ____ of each breath.)

A

initiates
tidal volume
initiation

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29
Q

Which mode of ventilation delivers a preset Vt using the lowest possible airway pressure? Airway will not exceed preset maximum pressure limit. (to protect the lungs by not forcing air)

A

PRVC (pressure-regulated volume control)

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30
Q

What types of pts are put on a vent with the PRVC setting?

A

those with airway resistance or decreased lung compliance such as ARDS

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31
Q

Which mode of ventilation has preset inspiratory and expiratory pressure?

A

BiPAP (bi-level positive airway pressure)

32
Q

What are the 2 levels of expiratory pressure used in BiPAP?

A

PEEP high

PEEP low

33
Q

Which mode of ventilation delivers a preset number of breaths at preset tidal volume? (If pt initiates breath, machine allows pt to breathe in own Vt.)

A

SIMV (synchronous intermittent mandatory ventilation)

34
Q

Which mode of ventilation provides a slow weaning process as the pt relearns to breath on his own?

A

SIMV

35
Q

Which mode of ventilation delivers constant positive pressure?

A

CPAP (continuous positive airway pressure)

36
Q

What is “pressure support”?

A
  • set pressure delivered upon initiation of breath

- augments pt’s own Vt by assisting movement of air through vent tubing

37
Q

When does “pressure support” kick in?

A

at the BEGINNING of INSPIRATION

38
Q

What does PEEP stand for?

A

Positive end expiratory pressure

39
Q

What is PEEP?

A

Positive airway pressure applied at END of EXPIRATION.

  • Keeps alveoli open
  • Faciliates O2 transport
40
Q

What is tidal volume (Vt)?

A

Amount of air it takes to inflate the lungs with each breath

41
Q

How much air does it take to inflate the lungs (Vt)?

A

~ 10-15 ml/kg

42
Q

What is minute ventilation?

A

amount of gas moved in or out of lungs PER MINUTE

43
Q

What is the formula for minute volume?

A

MV = RR x Vt

44
Q

What is the normal minute volume?

A

5 - 8 L/min

45
Q

What is I:E ratio?

A

Inspiration to expiration ratio (this is the number on the screen that changes from breath to breath)

46
Q

What is the normal I:E ratio to start with?

A

1:2

47
Q

What is the normal I:E ratio for people with COPD? What do you want to prevent with COPD regarding I:E ratio?

A

1:4

breath stacking

48
Q

What is PIP (peak inspiratory pressure)?

A

amount of pressure it takes for vent to deliver Vt or breath

49
Q

What is the #1 reason for increased PIP?

A

mucous in the tube

50
Q

What are reasons PIP will be increased?

A
  • mucous in tube!!!
  • biting (needs more sedation)
  • pneumothorax
  • developing ARDS
  • tube is dislodged
51
Q

What is FiO2 (fracture of inspired O2)?

A

percent or fraction of oxygen delivered by the vent

52
Q

What are the nurse’s jobs with a vent?

A

(Remember: ARM-P)

  • ASSESS…pt 1st, vent 2nd
  • Monitor pt RESPONSE
  • MANAGE vent system
  • PREVENT complications
53
Q

Troubleshooting Alarms:

“High Pressure Limit”

A
  • circuit tubing kinked
  • water collecting in dependent tubing
  • fighting vent (“breath stacking”)
  • airway secretions, coughing
  • ETT in right mainstem bronchus (in too far)
  • decreased lung compliance
54
Q

Troubleshooting Alarms:

“Low Pressure Limit”

A
  • tubing disconnected
  • circuit leak
  • cuff deflated
55
Q

Troubleshooting Alarms:

“Low Exhaled Vt”

A
  • leak in the system
  • cuff not inflated enough
  • leak through chest tube
56
Q

Troubleshooting Alarms:

“Temperature”

A
  • sensor malfunction

- sensor picking up outside airflow

57
Q

Troubleshooting Alarms:

“Apnea”

A
  • sedation
  • neurologic
  • metabolic
58
Q

Troubleshooting Alarms:

“High Respiratory Rate”

A
  • not tolerating weaning
  • neurogenic/metabolic
  • anxiety
  • pain
59
Q

Troubleshooting Alarms:

“Mechanical Ventilator Failure”

A
  • check electrical outlet (plug in red outlet)

- needs replacement

60
Q

What can cause ventilator induced lung injury?

A

(Remember: VABB…Ventilators Are Bad for Bodies)

  • Volutrauma
  • Atelectrauma
  • Biotrauma
  • Barotrauma
61
Q

Excessive PRESSURE in the alveoli:

A

BAROTRAUMA

62
Q

Excessive VOLUME in the alveoli:

A

VOLUTRAUMA

63
Q

Shearing due to repeated opening and closing of the alveoli:

A

ATELECTRAUMA

64
Q

Inflammatory immune response:

A

BIOTRAUMA

65
Q

How do we prevent ventilator induced lung injury?

A
  • plateau pressure kept less than 32 cm H2O
  • use PEEP!!!
  • TV set at 6-10 ml/kg
66
Q

Complications of vents:

A
  • ventilator induced lung injury
  • CV compromise
  • GI disturbance
  • Oxygen toxicity
67
Q

What can cause CV compromise with vents?

A

Increased intrathoracic pressure

68
Q

What does increased intrathoracic pressure lead to?

A

decreased venous return, decreased preload, decreased CO and BP

69
Q

How does the heart compensate when CO and BP are low?

A

tachycardia

70
Q

What additional things can happen regarding CV compromise related to vents?

A
  • hepatic and renal dysfuction

- impairment of cerebral venous return, increased ICP

71
Q

What GI disturbances can occur with vent usage?

A
  • gastric distention
  • hypomotility
  • constipation
72
Q

What can occur if PEEP is set too high?

A

pneumothorax

73
Q

Nosocomial pneumonias…the primary risk factor is ____ ____.

A

mechanical ventilation

74
Q

Ventilator Associated Pneumonia Prevention:

What is the critical time frame?

A

First 24 hours

75
Q

Ventilator Associated Pneumonia Prevention:

Head of bed elevated ___ to ___ degrees.

A

30 to 45 degrees

76
Q

How often should oral care be performed on pts on a vent?

A

Q2hr swab with normal wash and

Q12 hr brush with chlorhexidine

Adult Health I (10 decks)

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