Ventilator Modes and Alarms/ Neuromuscular Blocker Sedations Flashcards
“set volume &
pressure varies
Volume Assist Control
V-A/C
Volume Assist Control
V-A/C
Rate
Tidal Volume VT (based on ideal weight and height)
PEEP (positive end expiratory pressure)
FiO2
“set pressure & volume varies”
Pressure Assist Control
P-A/C
Pressure Assist Control
P-A/C
Rate
Pressure limit
PEEP
FiO2
“client controls volume on spontaneous breaths”
Synchronized Intermittent Mandatory Ventilation - SIMV
Synchronized Intermittent Mandatory Ventilation - SIMV
Rate
Tidal volume VT
Pressure Support
PEEP
FiO2
“no rate or tidal volume set, client controls rate and tidal volume”
Spontaneous breathing trial. Hopefully getting ready to extubate pt.
Continuous Positive Airway Pressure – CPAP
Continuous Positive Airway Pressure – CPAP
Pressure support (gonna augment pts breaths vent will tell give them oxygen)
PEEP
FiO2. (about 40-30%)
PEEP (Positive end expiratory pressure) does what?
keeps the alveoli open
Standard PEEP is
5
Assess need for suction when
q 1-2 hours and prn. Suction only when needed
Assess depth of ET tube at the teeth or gum and security of the tube, when?
q 2 hours and prn.
client speaking, air hissing or decreased SaO2
what do you do?
• Assess for air leak around cuff
Assess cuff pressure at least
8 hours
Maintain cuff pressure at what
20-25 mmHg
How to prevent VAP
– 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.
Causes of High pressure alarm
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
Interventions for High pressure alarms
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
Causes for Low pressure alarm
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
Interventions for Low pressure alarm
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.
Pt can only be extubated on
Presedex
Neuromuscular blockers: paralytics produce skeletal muscle paralysis
-Succinylcholine (Anectine) - short acting
DO NOT PUSH THIS AGENT
Agents used for sedation:
Propofol (Diprivan)
RNs CAN’T PUSH BUT CAN HANG IN A DRIP
Propofol (Diprivan) is not adminstered if patient has what allergy
eggs or soybean oil
