Unit 2: Mechanical Ventilation Flashcards
When is Mechanical Ventilation Required?
when a patient cannot maintain adequate ventilation and/or perfusion
Indications for Mechanical Ventilation
- acute respiratory failure
- heart failure
- exacerbation of COPD
- protection of the airway d/t cardiac arrest, drug overdose, or respiratory depression
- spinal cord or neurological trauma
Goal of Mechanical Ventilation
- support the patient until the underlying pathophysiological process is corrected
- not a cure, but supportive care
What happens once the underlying condition is corrected?
- mechanical ventilation may be D/C
- patients who cannot support their own ventilatory needs or who cannot maintain optimal oxygenation may require mechanical ventilation on a permanent basis
Members of the Team for someone who is Mechanically Ventilated
when patient requires mechanical ventilation, interprofessional collaboration is required to meet the needs of the patient
- nurse
- primary healthcare provider
- respiratory therapist
- dietician
- physical therapist
- social worker
What is the Nurses Role for someone who is mechanically ventilated?
- continuous monitoring and assessment
- preventing complications from mechanical ventilation
- monitoring the equipment for any problems
- provide emotional support to patient and family
Mechanical Ventilator Settings
prescribed ventilator settings; adjusted on the basis of patients response
-nurse and respiratory therapist work collaboratively w/ healthcare provider in adjusting ventilator settings to meet the needs of the patient
Typical Ventilator Settings Include?
- Fraction of inspired oxygen (FiO2)
- Breath rate (f)
- Tidal volume (Vt)
- Flow
- Positive-End Expiratory Pressure (PEEP)
Ventilator Settings: Fraction of inspired oxygen (FiO2)
amount of oxygen the patient is receiving via the mechanical ventilator
- 21%-100%
- may be started at 100% if pt extremely hypoxic; decreased on basis of ABG results
- Goal: maintain a PaO2 above 60% mm Hg and SaO2 above 90-90% at the lowest possible oxygen setting
Ventilator Settings: Rate (f)
number of respirations/breaths per minute the patient receives via ventilator
- 8-12 breaths/min
- may be gradually decreased in a pt who is breathing spontaneously until the patient is able to maintain adequate ventilation
- when respiratory rate on a mechanical ventilator is assessed, document numbers of both ventilator and spontaneous breaths
Ventilator Settings: Tidal Volume (Vt)
amount of preset air that is delivered with each breath
- 8 to 10 mL/kg
- based on body weight
- adjustments made from ABG results
- large amounts of Vt may cause barotrauma (injury to the lungs caused by positive pressure) or increase the risk for ventilator-associated lung injury
Ventilator Settings: Positive End-Expiratory Pressure (PEEP)
positive pressure applied at the end of expiration to help prevent alveolar collapse, assist patent alveoli, and redistribute fluid from the alveoli
-improves oxygenation, allowing the FiO2 levels to be lowered
Ventilator Modes: Controlled Mechanical Ventilation (CMV)
- used in patients who are unable to sustain ventilation; weak respiratory muscles
- delivers preset rate and volume of breaths per minute by ventilator independent of the patients respiratory effort
Ventilator Modes: Assist-Control Ventilation
- if the patient does not initiate a breath, the ventilator delivers a preset rate and volume
- if the patient does initiate a breath, the ventilator delivers the preset volume (assisted breath), allowing patient to control the rate of breaths
Ventilator Mode: Intermittent Mandatory Ventilation
- combination of ventilator-assisted breaths and spontaneous breaths of the patient regardless of the patients effort
- for patients who can breathe spontaneously but at a volume and/or rate that does not meet adequate oxygenation
Ventilator Modes: Synchronized Intermittent Mandatory Ventilation (SIMV)
used for patients who are being weaned
- if patient does not initiate a breath, the ventilator delivers a preset volume and rate
- some times used w/ pressure support ventilation
Ventilator Modes: Airway Pressure-Release Ventilation
designed for spontaneously breathing patients who require a high level of pressure to effectively recruit alveoli
-used with CPAP that is interrupted by pressure release to a lower pressure
Ventilator Modes: Pressure-Support Ventilation
independent mode or in conjunction with CPAP or SIMV.
- This mode gives a set positive pressure during spontaneous inspirations;
- pt breaths spontaneously w/ patient’s own volume, rate, and inspiratory time but has continuous positive pressure that is maintained during inspiration
- assists in reducing the workload of breathing and keeping the alveoli open
- when used for weaning, the pressure support helps the patient to overcome the dead space ETT
Complications Associated with Mechanical Ventilation
- hypotension
- infection
- barotrauma
- aspiration
- ventilator-associated pneumonia (VAP)
Ventilator Alarm Systems
- alarm indicates when there is a need for intervention
- nurse required to monitor
- nurse immediately assesses the patient and the ventilator to find out what is interfering w/ the ventilator and causing the alarm
- High-pressure alarm
- Low-pressure alarm
Safety Alert: Ventilator Alarm
- alerts the nurse that something is wrong w/ the pressure, volume, or rate of air being delivered to the patient
- when alarm is activated, the nurse’s responsibility is to immediately check the patients ventilation and oxygenation; priority is patient first then ventilator
- if nurse cannot immediately identify the problem, nurse disconnects the patient from the ventilator and uses a manual resuscitation bag to ventilate the patient while calling for assistance
- failure to ensure adequate ventilation = injury to the pt (anoxic brain injury or death)
Causes for the High-Pressure Alarm
> Mucous Plug or increased secretions
-suction PRN
Patient biting the ETT
-insert an oral airway to prevent biting
Pneumothorax
-assess for asymmetrical chest rise and decreased breath sounds over the pneumothorax site; contact health care provider immediately
Patient anxious and fighting the ventilator
-assess the patient, provide emotional support, reevaluate sedation/analgesic need
Kink in tubing
-assess tubing from ventilator to patient to ensure no kinking of the tube is present
Water collected in the ventilator tubing
-empty water from the ventilator tubing
Causes for the Low-Pressure Alarm
> Cuff leak
-assess for cuff leak, check cuff pressure; call for respiratory and healthcare provider
Leak in the ventilator circuit
-assess all connections and tubing
Patient stops breathing in the pressure support modes or SIMV
-assess patient notify health care provider
Nursing Interventions: Actions
- HOB elevation between 30 and 45 degrees unless contraindicated
- Clear airway secretions w/ suctioning, CPT, frequent position changes, and increasing activity
- Daily “sedation vacation” and readiness-to-wean assessment
- Peptic ulcer disease prophylaxis; meds that reduce gastric activity
- DVT prophylaxis
- Daily oral care w/ chlorhexidine
Prevention of Ventilator-Assisted Pneumonia (VAP)
- assess readiness to extubate daily through combined spontaneous awakening trials (SATs; sedation interruption/minimization) and spontaneous breathing trials (SBTs)
- early exercise and mobility
- elevate HOB 30 to 45 degrees
- minimize pooling of secretions above the endotracheal tube cuff by using an endotracheal tube w/ subglottic suction capability in patients w/ anticipated intubation greater than 48 to 72 hours
- change ventilator circuits only if visibly soiled; do not change routinely
- perform oral care using chlorhexidine
- use ventilator bundles to reduce ventilator-associated events (VAE) and VAP
Connection Check: The nurse is screening patients for their risk of developing VAP. The nurse considered which patient at greatest risk?
A. a patient who was extubated within 24 hours of being intubated
B. a patient intubated and placed on mechanical ventilation less than 72 hours ago
C. a patient w/ the HOB elevated 45 degrees
D. a patient who was placed on nasal cannula after being extubated
B. patient intubated and placed on mechanical ventilation less than 72 hours ago
