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RTH 132 Hannah > Troubleshooting > Flashcards

Troubleshooting Flashcards

1
Q

Define the “problem”

A

any situation causing discord or the loss of comfort for the patient

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2
Q

What 4 things are associated with discord or loss of comfort for the patient?

A
  • subjective
  • personal perspective
  • solving ventilation problems
  • protecting the patient
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3
Q

Define problem solving

A

determining a solution to a problematic situation

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4
Q

Define troubleshooting

A

identification and resolution of technical malfunctions in the patient ventilator system. purposeful resolution of inappropriate and potentially dangerous situations

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5
Q

Solving the problem

A
  • assess the situation
  • gather and analyze pertinent data
  • examine viable solutions
  • attempt solution
  • monitor response
  • repeat if necessary
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6
Q

Protect the patient

A
  • auscultation
  • SpO2
  • general assessment, accessory muscles
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7
Q

Advantages of disconnect and bag

A
  • insurance that the patient is being ventilated
  • ability to assess (feel) the patient’s lung compliance and airway resistance
  • ability to determine whether the problem lies with the patient or the ventilator
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8
Q

Disadvantages of disconnect and bag

A
  • increased risk of barotrauma because of inappropriate patterns of ventilation and excessive pressures
  • derecruitment of the lungs when PEEP is lose, leading to desaturation
  • increased risk of ventilator-associated pneumonia from contamination of the airways
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9
Q

Causes of distress?

A
  • patient related

- ventilator related

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10
Q

Clinical manifestations of sudden distress

A
  • use of accessory muscles to breathe
  • pursed-lip breathing
  • minimal or absent cough
  • leaning forward to breathe
  • barrel chest
  • digital clubbing
  • dyspnea om exertion (late sign)
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11
Q

Patient related problems

A
  • airway problems
  • pneumothorax
  • bronchospasm
  • secretions
  • pulmonary edema
  • dynamic hyperinflation
  • abnormalities in resp dis
  • change in body position
  • drug-induced distress
  • abdominal distension
  • pulmonary emboli
  • anxiety
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12
Q

Ventilator related problems

A
  • leaks
  • circule malfunction or disconnection
  • inadequate FiO2
  • patient-ventilator asynchrony
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13
Q

What could cause patient-ventilator asynchrony?

A
  • inappropriate mode
  • inadequate ventilator support
  • trigger sensitivity
  • inadequate flow setting
  • inappropriate cycle variable
  • inappropriate PEEP setting
  • problems with close loop ventilation
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14
Q

What are the 7 steps of managing sudden distress?

A
  • disconnect the patient from the vent
  • begin manual ventilation on 80-100% O2
  • manually evaluate compliance and resistance through bag ventilation
  • perform a rapid physical examination and assess monitored indexes and alarms
  • check the patency of the airway by passing a suction catheter
  • if death appears imminent, consider and treat the most likely problems (pneumothorax and airway obstruction)
  • once the patient’s condition has stabilized, perform a detailed assessment and provide any additional treatment required
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15
Q

Common alarm situations

A
  • low pressure alarm
  • high pressure alarm
  • low CPAP/PEEP alarm
  • apnea alarm
  • low source gas pressure or power alarm
  • ventilator inoperative alarm
  • operator settings incompatible with machine parameters
  • I:E ratio
  • other alarms
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16
Q

What alarms go off if in volume control and there’s a leak?

A
  • low VTe
  • low pressure
  • low MVe
  • low peep
17
Q

High pressure alarms indicate what?

A

an obstruction

18
Q

What is the normal drive to breathe?

A

CO2

19
Q

Normal MV

A

5 L/min

20
Q

Unexpected ventilator responses

A
  • unseated or obstructed expiratory valve
  • excessive PEEP/CPAP
  • nebulizer impairment
  • high VT delivery
  • altered alarm function
21
Q

Management of patient-ventilator asynchrony begins with several specific steps. The initial step is to ___

A

disconnect the patient from the vent and perform manual ventilation

22
Q

Rupture of the innominate artery can occur and is most often noticed with

A

tracheostomy tubes

23
Q

True/false: the description of patients as “fighting the ventilator” means that they were doing well but suddenly developed distress

A

true

24
Q

True/false: some patient-ventilator asynchrony may result from a patient’s feelings of panic and can be relieved by manually ventilating and instructing the patient on how to relax while breathing with the ventilatory

A

true

25
Q

If a tension pneumothorax is strongly suspected and death is imminent, the appropriate next step is to ___

A

insert a 14- or 16-gauge needle into the second intercostal space at the midclavicular line

26
Q

Abdominal distension during mechanical ventilation can be caused by ___

A

pneumoperitoneum

27
Q

True/false: the rapid onset of hypoxemia from a pulmonary embolus leads to the increases in heart rate, blood pressure, and respiratory rate with high ventilator rates and flows; however, disconnection from the ventilator and manual ventilation do not help the condition

A

true

28
Q

The occurrence of low pressure, low volume and low alarms indicate that ___ is causing the problem

A

a leak

29
Q

During ventilation with VC-CMV, pleural drainage leaks sometimes can be compensated by increasing ___

A

VT setting

30
Q

True/false: auto-PEEP may interfere with the ventilator’s ability to detect patient efforts. This is corrected by decreasing the sensitivity setting

A

false

31
Q

True/false: during volume ventilation, a concave appearance on the inspiratory pressure curve indicates active inspiration with inadequate flow

A

true

32
Q

Asynchronous breathing may occur when patients with COPD are ventilated with PSV. These patients are known to have an active short inspiration. If the patient begins to actively exhale during the inspiratory phase of PSV, this can be corrected by ____

A

switching to a ventilator with adjustable pressure-cycling characteristics

33
Q

True/false: when externally powered nebulizers are used with ventilators, they add extra flow, which can increase the delivered VT and give artificially high readings of exhaled

A

true

34
Q

A patient on a volume cycled ventilator suddenly becomes very anxious and motions that he cannot breathe. No peak pressures are seen on the manometer. You should immediately ___

A

check for vent disconnect

35
Q

A patient is on mechanical ventilation. The tidal volume is set at 1000 mLs. Delivered tidal volume is only 200 mLs. The most likely cause of this volume difference is ___

A

a large leak in the humidifier

36
Q

A patient being ventilated with a Bennett 7200 begins to sound the high pressure alarm consistently. Possible causes include ___

A
  • tracheal suctioning is required
  • bronchospasm
  • the patient is agitated and uncomfortable

RTH 132 Hannah (12 decks)

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