ventilated patient Flashcards
what 2 ABG parameters indicate respiratory status
pH and PaCO2
what are indicators a pt can not ventilate or oxygenate
hypercapnia (high CO2) respiratory failure low PO2 RR >35 nasal flaring tri podding use of accessory and intercostal muscles paradoxical breathing
what are late signs of respiratory failure
confusion, stupor, cyanosis, bradypnea, bradycardia, hypotension, dysrhythmias
what is indicative of respiratory failure
CO2 greater than 50 and low pH
if a pt is retaining CO2 we want to ______ the ______ volume and ________ rate
increase; tidal; respiratory
If their O2 sats are within normal limits but showing respiratory acidosis it an oxygenation or ventilation problem
ventilation
where should the ET tube be placed
3-4cm right above the carina
*pt will be coughing if ETT is on the carina and if you go in with suction and hit it it will cause damage
what is the gold standard when ETT is placed
capnometer
*when intubated you will put this at the end of the tube and when pt exhales and it turns yellow its good (auscultate too)
after using the capnometer and its successful what is next
secure the ET tube
what should the ETT balloon measure and why does it have to be that certain measurement
25mmHg
if overinflated it will cause tissue necrosis
if under inflated pt could aspirate whatever was sitting on top of balloon
what is minimal leak technique?
when you hear noises coming from where the ETT balloon is you get a 3cc syringe and inflate slowly until you hear nothing
when suctioning how long can you take
no longer than 10
when a pt has an ETT in what should the HOB be at all times
up
static compliance is
how stiff your lungs are
how can lungs be stiff?
every time pt has bronchitis or pneumonia for example it scars the lung tissue therefore decreasing static compliance (from coughing and damaging tissue)
f/RR (normal is 12-22)
frequency/ respiratory rate
fraction of inspired oxygen necessary to meet oxygenation goals (RA 21%)
FIO2
what is the I:E ratio
inspiratory time to expiratory time. normal 1:2 indicating exhalation time is twice as long as inhalation time
positive end-expiratory pressure. generally added to mitigate end- expiratory alveolar collapse (keep alveoli open) can decrease venous return to the heart
PEEP
why do we increase peep
when pt has really bad atelectasis we want to open up the alveoli and if we increase peep and pt inhaled it expands and when they exhale they deflate a little but don’t collapse
how can PEEP decrease venous return
if its increased pressure in thoracic it presses against vessels therefore decreasing venous return
peak inspiratory pressure shows the greatest airway pressure at the end of the inspiratory cycle on the ventilator
PIP
*normal is 15-20 cmH2O
minute ventilation/volume is the amount of air delivered to the lungs in one minute
Ve
*Vt x f = Ve
normal is 6-8L/min
tidal volume is the amount of air delivered with each breath.
Vt norm is 8-10 mL/kg
what ventilator is a FULL support mod and controls all the work of breathing
*requires least amount of pt effort
Assist control AC/ACV
- pt is guaranteed the preset Vt, RR, FIO2, and PEEP
- pt can only spontaneously trigger the ventilator to initiate a breath. Vt will remain the same can’t draw in anymore only what its set at
is a set airway pressure to assist the patient with spontaneous breaths
*it decreases work of breathing by giving the patient a little boost on the breaths they initiate on their own
pressure support PS/PSV
*decreases respiratory rate and increases spontaneous Vt
pressure support is decreased as the patient improves
what other ventilator can PS/PSV be activated with
CPAP
same as PS/PSV this one just means that a preset pressure is present in the circuit and lungs throughout both the inspiratory and expiratory phases of the breath
*patient does ALL the work
CPAP
- serves to keep alveoli from collapsing resulting in better oxygenation and less work of breathing
- blows continuous air
- apnea parameters are always set
for a pt on CPAP who starts breathing fast or shallow what can be added
PS/PSV to give them a boost to slow RR and increase their own Vt
_____ can be used non invasively on a non intubated pt using a face mask
CPAP
what is very commonly used to evaluate the pt’s readiness for extubation
CPAP
same as PSV but has 2 pressures IPAP and EPAP
BIPAP
*IPAP= inspiratory positive airway pressure (top number)
EPAP= expiratory positive airway pressure (bottom number)
how does IPAP work
PS> boost> slow RR> increase Vt
can be increased to blow off CO2
how does EPAP work
PEEP
can be increased to improve PO2 if already on 100% FIO2
what is BIPAP used for
pt with COPD conditions unable to exhale against higher airway pressures to help resolve CO2 problems
high pressure alarms can be caused by
kinked tube pt biting tube excessive secretions or mucus plug coughing, anxiety, pain pulmonary edema pneumothorax pt "bucking the vent"
if a pt is “bucking the vent” what should be done
pt is fighting against the ventilator so give only enough sedation med to calm them down not to knock them out
how can you determine the lung injury PaO2: FIO2 ratio
divide the PaO2 by the FIO2 (decimal of percent)
what is the normal lung ratio
300-500
what is the acute lung injury ratio
200-300
what is the ARDS ratio
<200 is very significant
if your PaO2 is 80 and FIO2 is 80% what is the lung injury
80/.8= 100
ARDS
what 2 indicators are there for HYPOventilation
high PaCO2 and low pH
how can HYPOventilation be corrected
increase respiratory rate and or tidal volume
low pressure alarms caused by
unintentional extubation tube dislodged or disconnected oxygen depleted cuff leak circuit leak
what is oxygen toxicity
FIO2 > 50% for more than 24-48 hrs
what are S/S of oxygen toxicity
restlessness, dyspnea, chest discomfort, fatigue, atelectasis
what does it mean if you have High V/q
ventilation is higher than perfusion
what does it mean if you have Low v/Q
perfusion is higher than ventilation (will have a high A-a gradient)
does mechanical ventilation affect both sides of the VQ?
YES
how do you tell if pt is in pain or anxious
increase BP, respiratory rate
what is the best way to feed ventilated pt
through the GUT, but if you can’t do that there is TPN
*if you don’t feed the gut it dies and then translocation happens (becomes septic)
