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Advanced Clinical Nursing Theory > Ventilation > Flashcards

Ventilation Flashcards

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1
Q

what are the 3 different ways ventilation may be achieved during anaesthesia?

A

spontaneous
manual
mechanical

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2
Q

what pressures are involved in spontaneous ventilation?

A

negative pressure

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3
Q

what is an example of negative pressure ventilation?

A

spontaneous ventilation

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4
Q

what pressures are involved in mechanical and manual ventilation?

A

positive pressure

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5
Q

what happens within the lungs during negative pressure ventilation?

A

air drawn into the lungs by creating of negative pressure by diaphragm and intercostal muscles

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6
Q

how does air move into the lungs during positive pressure ventilation?

A

system pushes gas into the lungs

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7
Q

what is the ideal method of ventilation during anaesthesia?

A

spontaneous

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8
Q

why is spontaneous ventilation the preferred type?

A

most physiologically normal

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9
Q

what are the 3 overriding factors which affect spontaneous ventilation?

A

physiological/anatomical
external
internal restriction

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10
Q

what are the main physiological/anatomical factors which affect spontaneous ventilation?

A

airway obstruction
stenotic nares
excess tissue around the airway
hypoplastic trachea
obesity and associated pressure on the diaphragm

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11
Q

what are the main external factors which affect spontaneous ventilation?

A

ET tube too small
external restriction (surgeon applying pressure / sandbags)

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12
Q

why can external factors effect spontaneous ventilation?

A

prevent the thorax from expanding

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13
Q

what are the main internal restriction factors which affect spontaneous ventilation?

A

effusions

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14
Q

what are the indications for assisted ventilation?

A

reduced drive to ventilate
inability to ventilate or ventilate effectively

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15
Q

what can decreased respiratory drive be caused by?

A

anaesthetic drugs
CNS disease
raised ICP
encephalopathy
hypothermia

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16
Q

what can cause an inability to ventilate?

A

open thoracic cavity
muscle failure
nerve failure
external factors affecting lung inflation

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17
Q

why will an open thoracic cavity lead to an inability to ventilate?

A

no negative pressure

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18
Q

what types of muscle failure can lead to an inability to ventilate?

A

NMBA (peri and post)
myasthenia gravis

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19
Q

what nerves may fail leading to an inability to ventilate?

A

intercostal
diaphragmatic

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20
Q

what are the external factors affecting lung inflation that can lead to an inability to ventilate?

A

sandbag positioning
surgeon

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21
Q

what can you use to identify if a patient requires ventilation?

A

ventilatory pattern
tidal or minute volume
blood gases
EtCO2
pulse oximitry

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22
Q

how can a patients ventilatory pattern be assessed?

A

watching the chest

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23
Q

how can tidal or minute volume be assessed?

A

spirometry

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24
Q

what is the most useful method for assessing patient ventilation?

A

looking at the chest

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25
Q

what equipment is required for manual ventilation?

A

breathing system
ET tube

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26
Q

what are the advantages of manual ventilation?

A

easy to perform
cheap
not much equipment required

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27
Q

what are the disadvantages of manual ventilation?

A

dependent on operator knowledge and skills
poor control of airway pressures
each breath may be different
operator fatigue
can be boring!
time consuming

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28
Q

what are the advantages of mechanical ventilation?

A

hands free anaesthetic
ensures appropriate volumes of gas are administered

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29
Q

what are the disadvantages of mechanical ventilation?

A

not always available
expensive
requires skill

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30
Q

what forces air into the lungs during ventilation?

A

positive pressure

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31
Q

what structure within the chest is affected by positive pressure ventilation?

A

vena cava

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32
Q

what is the role of the vena cava?

A

returning blood to pulmonary circulation

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33
Q

what is the effect of positive pressure ventilation on the vena cava?

A

pressure exerted on the veins which are easily collapsible - limits venous return

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34
Q

what is the effect of positive pressure ventilation on cardiac output?

A

venous return reduced when veins collapse under pressure so CO is reduced

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35
Q

in what patients is the effect of ventilation on the CVS worse?

A

hypovolaemic

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36
Q

what are the side effects of IPPV on the CVS?

A

decreased CO
decreased venous return
reduced stroke volume
reduced preload
reduced BP

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37
Q

what are the systemic effects of IPPV?

A

reduced organ perfusion due to CVS effects

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38
Q

what organs are particularly effected by reduced perfusion?

A

kidneys
liver

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39
Q

what is the role of the renin angiotensin aldosterone system?

A

protection of the kidneys and perfusion of the body

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40
Q

what is the main effect of the renin angiotensin aldosterone system?

A

preservation of water

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41
Q

what triggers the renin angiotensin aldosterone system?

A

identification of reduced BP by sympathetic nervous system

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42
Q

what is triggered by identification of reduced BP by sympathetic nervous system?

A

increased HR and cardiac workload

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43
Q

what does increased cardiac workload lead to?

A

increased oxygen requirement

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44
Q

what effect does the renin angiotensin aldosterone system have on the body?

A

vasoconstriction
urine retention
ADH release

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45
Q

what are the pulmonary side effects of IPPV?

A

barotrauma
sheer stress effect (volutrauma)
oxygen toxicity

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46
Q

when can barotrauma be seen in IPPV patients?

A

if pressures are too high

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47
Q

what causes the sheer stress effect during IPPV?

A

excessive air

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48
Q

what is oxygen toxicity?

A

if on 100% O2 for more than 6 hours free radicals can form which cause damage

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49
Q

what is the maximum length of time patients should be left on 100% O2?

A

up to 6 hours

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50
Q

what are the main ways efficacy of ventilation can be monitored?

A

observation
auscultation
capnography
pulse oximetry
arterial blood gases

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51
Q

how can observation be used to monitor efficacy of ventilation?

A

look at thoracic movement
check for anything which may compromise this
look at the abdomen

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52
Q

how can auscultation be used to monitor efficacy of ventilation?

A

can sounds be heard/is air entering both lungs in all areas

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53
Q

what may be causing reduced lung sounds on auscultation?

A

bronchial intubation
atelectasis of one lung or area of a lung
mass affecting lung expansion
fluid or other material in pleural space

54
Q

what information cannot be gained from capnography?

A

tidal volume

55
Q

what should be altered about ventilation if EtCO2 is high?

A

increase minute ventilation

56
Q

what should be altered about ventilation if EtCO2 is low?

A

reduce minute volume

57
Q

how useful is pulse oximetry for ventilation monitoring?

A

doesn’t indicate efficacy of ventilation and only shows perfusion in the area where it is sited

58
Q

what is PaO2 a measure of?

A

O2 in arterial circulation

59
Q

what is a better indicator of oxygen saturation than SpO2?

A

arterial blood gases

60
Q

what should PaCO2 compare to?

A

EtCO2

61
Q

what may a large difference between PaCO2 and EtCO2 indicate?

A

blood shunting within the lungs

62
Q

when may a difference between PaCO2 and EtCO2 be seen in surgical patients?

A

if the chest is open

63
Q

what should be done about ventilation if PaCO2 is high?

A

increase minute volume

64
Q

how can minute volume be increased on a ventilator?

A

increase volume or rate (usually rate)

65
Q

what should be done about ventilation if PaO2 is low?

A

look at Fi and consider increasing
potential for atelectasis

66
Q

what is a ventilator?

A

machine designed to provide mechanical ventilation to a patient by moving air into and out of the lungs

67
Q

why may a ventilator be needed?

A

apnoeic patient
poorly ventilated
thoracotomy
diaphragmatic rupture
NMBAs

68
Q

where did the main drive to develop ventilators originate?

A

polio epidemic in the 50s

69
Q

when may mechanical ventilation be used?

A

anaesthesia
ICU

70
Q

why must ventilator use be justified?

A

is not a benign procedure

71
Q

what are the main ventilator settings?

A

frequency of breathing
tidal volume / minute volume
I:E ratio
inspiratory flow rate
PIP
PEEP

72
Q

what is described by inspiratory flow rate?

A

flow of gas per minute

73
Q

what does PIP stand for?

A

peak inspiratory pressure

74
Q

what does PEEP stand for?

A

positive end expiratory pressure

75
Q

what does PIP describe?

A

highest pressure measured during the respiratory cycle

76
Q

what does PEEP describe?

A

pressure applied by the ventilator at the end of each breath to ensure that alvioli are not prone to collapse

77
Q

what is ventilator cycling?

A

the change from inspiration to expiration

78
Q

what is determined by the cycling variable?

A

when and how the ventilator moves from inspiration to expiration

79
Q

how many variables are used to determine when to cycle to expiration?

A

4

80
Q

what are the four variables used to determine when to cycle to expiration?

A

pressure
volume
time
flow

81
Q

how do the variables used to determine when to cycle to expiration work?

A

maximum parameter level before cycling to expiration

82
Q

how does pressure controlled ventilation work?

A

ventilator maintains set airway pressure for set inspiratory time

83
Q

when does pressure controlled ventilation cycle to expiration?

A

max pressure is pre-set by user and ventilator delivers volume of gas until this pressure is reached

84
Q

how is the expiratory cycle triggered during pressure controlled ventilation?

A

inspiratory flow of gas is delivered until a trigger pressure is reached. This causes inspiratory cut off and will begin the expiratory cycle

85
Q

when is pressure controlled ventilation unsuitable?

A

if lung compliance changes

86
Q

when may lung compliance change?

A

if the chest is opened

87
Q

why is pressure controlled ventilation not suitable for thoracotomy patients?

A

lung compliance changes so a much larger volume of gas will be delivered before the trigger is reached which cn cause over inflation of the lungs

88
Q

what must be set before volume controlled ventilation can be started?

A

tidal volume
pressure limit
rate
inspiratory time or I:E ratio

89
Q

what is the calculation for tidal volume

A

10-15 ml/kg

90
Q

once VCV is started what should be checked?

A

chest expansion
CO2

91
Q

what is illustrated about VCV by assessing chest expansion?

A

tidal volume

92
Q

what is illustrated about VCV by assessing CO2?

A

ventilation

93
Q

what is a key benefit of VCV?

A

doesn’t rely on airway compliance change to trigger cut off (like PCV) so set volume is given whether the chest is open or closed

94
Q

what may be needed in VCV to avoid over inflation?

A

pressure cut off

95
Q

how does time cycling ventilation work?

A

ventilator breath switches from inspiration to expiration after a certain time reached

96
Q

how is time controlled ventilation set up?

A

setting respiratory rate
inspiratory time or I:E ratio

97
Q

how do flow cycling ventilators work?

A

ventilator delivers a set flow until the total volume has been delivered then it switches to expiration

98
Q

when is flow cycling ventilation often used?

A

paediatrics

99
Q

what are the two ventilator control modes?

A

assist control
control

100
Q

what is assist control mode?

A

breath is initiated by the patient

101
Q

what is control mode?

A

breath is controlled fully by the machine

102
Q

what does the I:E ratio refer to?

A

ratio of inspiratory to expiratory time in normal spontaneous breathing

103
Q

what is the standard I:E ratio?

A

1:2

104
Q

how do expiratory and inspiratory time compare in a I:E ratio?

A

expiratory is usually twice the inspiratory time

105
Q

what is the total breath time of an I:E ratio of 1:2?

A

breath lasts 3 seconds

106
Q

what does I:E ratio drive?

A

RR

107
Q

what are the main types of ventilators?

A

bag squeezer
mechanical thumb
intermittent blower
volume divider

108
Q

what are the types of bag squeezer ventilator?

A

ascending bellow
descending bellow
horizontal bellow

109
Q

what is a mechanical thumb ventilator similar to?

A

t-piece

110
Q

how does an intermittent blower ventilator work?

A

no bag, gas is blown in

111
Q

what are bag squeezer ventilators made up of?

A

bag in bottle bellow
connected to a bag port

112
Q

what can be set on a bag squeezer ventilator?

A

volume
I:E time
TV
inspiratory time

113
Q

what cycling is used on mechanical thumb ventilators?

A

pressure
inspiratory time

114
Q

where are mechanical thumb ventilators often used?

A

small animal anaesthesia

115
Q

how do intermittent blower ventilators work?

A

takes driving gas and divides into smaller volumes which are used to push the gas into the patient

116
Q

what are the 2 main types of intermittent blowers?

A

merlin
nuffield

117
Q

what cycling is used on a merlin ventilator?

A

time
pressure
volume

118
Q

what are two types of bag squeezer ventilators?

A

hallowell EMC 2000
JD medical (equine)

119
Q

what cycling is used on hallowell EMC 2000 ventilators?

A

time

120
Q

what cycling is used on JD medical ventilators?

A

pressure

121
Q

how do minute volume divider ventilators work?

A

collect continuous flow of gas into reservoir within unit
delivered to patient under positive pressure

122
Q

how is fresh gas flow calculated within minute volume divider ventilators?

A

intended minute volume divided into required breaths per min

123
Q

what is a negative of minute volume divider ventilators?

A

expensive in terms of FGF

124
Q

what is the main minute volume divider ventilator type?

A

manley MP3

125
Q

what cycling is the manley MP3 run on?

A

VCV

126
Q

what bellows are on the manley MP3?

A

main and storage

127
Q

what can be set on manley MP3 ventilators?

A

TV
inspiratory time

128
Q

what is involved in patient care during long periods of ventilation?

A

oral care
humidification of gases
ET tube care
monitoring efficacy of ventilation
periodic ‘sigh’
physiotherapy
turning patient
eye care
limb mobilisation
managing excretion

129
Q

what is involved in ET tube care of patients undergoing long periods of ventilation?

A

suctioning
deflation of cuff
repositioning of tube

130
Q

what is the benefit of a periodic sigh in longer term ventilator patients?

A

larger breath given every now and then
prevents lung atelectasis

131
Q
A

Advanced Clinical Nursing Theory (36 decks)

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