Ventilator Modes and Alarms/ Neuromuscular Blocker Sedations

Question 1

“set volume &
pressure varies

Answer 1

Volume Assist Control
V-A/C

Question 2

Volume Assist Control
V-A/C

Answer 2

Rate
Tidal Volume VT (based on ideal weight and height)
PEEP (positive end expiratory pressure)
FiO2

Question 3

“set pressure & volume varies”

Answer 3

Pressure Assist Control
P-A/C

Question 4

Pressure Assist Control
P-A/C

Answer 4

Rate
Pressure limit
PEEP
FiO2

Question 5

“client controls volume on spontaneous breaths”

Answer 5

Synchronized Intermittent Mandatory Ventilation - SIMV

Question 6

Synchronized Intermittent Mandatory Ventilation - SIMV

Answer 6

Rate
Tidal volume VT
Pressure Support
PEEP
FiO2

Question 7

“no rate or tidal volume set, client controls rate and tidal volume”
Spontaneous breathing trial. Hopefully getting ready to extubate pt.

Answer 7

Continuous Positive Airway Pressure – CPAP

Question 8

Continuous Positive Airway Pressure – CPAP

Answer 8

Pressure support (gonna augment pts breaths vent will tell give them oxygen)
PEEP
FiO2. (about 40-30%)

Question 9

PEEP (Positive end expiratory pressure) does what?

Answer 9

keeps the alveoli open

Question 10

Standard PEEP is

Answer 10

5

Question 11

Assess need for suction when

Answer 11

q 1-2 hours and prn. Suction only when needed

Question 12

Assess depth of ET tube at the teeth or gum and security of the tube, when?

Answer 12

q 2 hours and prn.

Question 13

client speaking, air hissing or decreased SaO2
what do you do?

Answer 13

• Assess for air leak around cuff

Question 14

Assess cuff pressure at least

Answer 14

8 hours

Question 15

Maintain cuff pressure at what

Answer 15

20-25 mmHg

Question 16

How to prevent VAP

Answer 16

– increase HOB (30-45 degrees), DVT prophylaxis, PUD prophylaxis, oral hygiene care with chlorhexidine, head of bed elevated during feedings, daily sedation vacation and assessment of readiness to extubate.

Question 17

Causes of High pressure alarm

Answer 17

a. mucous plug or increased secretions
b. client biting an oral ET tube
c. decreased lung compliance –pulmonary edema, pneumothorax, ARDS, pulmonary hypertension
d. client anxious and fighting ventilator (breath stacking)
e. Kinks in tubing

f. water collecting in dependent loops of tubing
g. ET tube in right mainstem bronchus

h. bronchospasm

Question 18

Interventions for High pressure alarms

Answer 18

a. Suction as needed to clear secretions.
b. May require bite block, notify RT
c. Assess breath sounds for changes including wheezing & notify RT/MD.

d. May need sedative or neuromuscular blocking agent.
e. Assess tubing from ventilator to client to ensure no kinks of tubing
f. Empty water from ventilator tubing.

g. Check breath sounds and tube position at lip, notify RT/MD if absent breath sounds on left or tube has moved.
h. Assess client, suction as needed and notify RT/MD. Bronchodilators

Question 19

Causes for Low pressure alarm

Answer 19

a. cuff leak or deflated

b. Leak in ventilator circuit or tubing disconnect
c. tube displacement

d. Client stops breathing in PSV or SIMV mode

Question 20

Interventions for Low pressure alarm

Answer 20

a. Assess for cuff leak, check cuff pressure, re-inflate to minimal occluding volume, notify RT
b. Assess all connections and tubing connections.
c. Assess tube placement and breath sounds
d. Assess client; notify HCP.

Question 21

Pt can only be extubated on

Answer 21

Presedex

Question 22

Neuromuscular blockers: paralytics produce skeletal muscle paralysis

-Succinylcholine (Anectine) - short acting

Answer 22

DO NOT PUSH THIS AGENT

Question 23

Agents used for sedation:
Propofol (Diprivan)

Answer 23

RNs CAN’T PUSH BUT CAN HANG IN A DRIP

Question 24

Propofol (Diprivan) is not adminstered if patient has what allergy

Answer 24

eggs or soybean oil

Question 25

Agents used for sedation:
Etomidate (Amidate)

Answer 25

RNs CAN NOT PUSH

Question 26

Agents used for sedation:
Dexmedtomidine (Precedex)

Answer 26

RNs CANNOT PUSH

Question 27

Benzodiazepines: ): actions - amnesia, anxiolytic, mild sedation
-Midazolam (Versed)
-Diazepam (Valium)
-Lorazepam (Ativan)

Answer 27

RNS CAN PUSH

Question 28

Benzodiazepine antagonists (reversal)

Answer 28

-Flumazenil (Romazicon) - antagonizes or reverses effects benzodiazepines

Question 29

Opioids
Fentanyl (Sublimaze) – sedative, analgesic
-Morphine

Answer 29

RNS CAN PUSH

Question 30

Antidote for Opioids

Answer 30

NALAXON (narcan)

Question 31

During procdure if clients blood pressure drops down to 60s and patient is hypotensive what do you do

Answer 31

GIVE FLUIDS