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ventilator module Flashcards

1
Q

what is negative-pressure ventilators

A

external ventilators that decerase atmospheric pressure surrounding the thorax to initiate inspiration.
i.e. iron lung

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2
Q

what is positive pressure ventilation

A

-common in acute care
-forces air into lungs via ETT of trach
-can use non invasive masks i.e. bipap

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3
Q

4 phases of ventilation

A
  1. change from exhalation to inhalation
  2. inspiration
    3.change from inspiration to exhalation
    4.exhalation
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4
Q

4 different ventilator variables

A

-volume
-pressure
-flow
-time

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5
Q

what is the “trigger”

A

the phase variable that initiates the change from exhalation to inspiration
-can be pressure triggered or flow triggered, breaths can also be triggered

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6
Q

what is the “limit” or “target”

A

the variable that maintains inspiration
-can be pressure-limited, flow-limited, or volume-limited

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7
Q

what is the “cycle”

A

the variable that ends inspiration

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8
Q

what is the “baseline”

A

the variable that is controlled during exhalation
-the pressure is always adjusted to this variable, the pt exhales to a certain pressure that is set on the vent at 0 (atmospheric pressure) or above atmospheric pressure (PEEP)

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9
Q

what are volume-cycled ventilators?

A

designed to deliver a breath until a preset volume is delivered

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10
Q

what are pressure-cycled ventilators

A

delivers a breath until a preset volume is delivered

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11
Q

what are flow-cycled ventilators

A

delivers a breath until a preset inspiratory flow rate is achieved

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12
Q

what are time-cycled ventilators

A

delivers a breath over a preset time interval

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13
Q

what is assist control (AC) ventilation?

A

-ventilator provides a full ventilation for the client, takes over the work of breathing
-tidal volume and vent rate is preset
-vent will deliver preset # of breaths if the client does not initiate a breath
-if client triggers the vent, it will deliver a preset tidal volume (CAN CAUSE HYPERVENTILATION->RESP ALKALOSIS, client may require sedation to dec resp rate/triggers)

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14
Q

what is synchronized intermittent mandatory ventilation (SIMV)

A

-tidal vol and vent rate are preset
-between vent-assisted breaths, allows client to breathe spontaneously at their own rate and tidal volume
-used as regular mode of vent or mode to wean client off
-if weaning # of SIMV resps is gradually dec as client triggers inc (can cause inc breathing workload->resp fatigue)

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15
Q

what is positive end-expiratory pressure (PEEP)

A

-baseline (preset) pressure that prevents the client from exhaling past that pressure during exhalation. elevated baseline adds positive airway pressure to mechanically deliver breaths
-improves oxygenation by enhancing gas exchange and preventing atelectasis, keeps airway open at the end of exhalation preventing alveolar collapse->inc # alveoli available for ventilation

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16
Q

normal PEEP value

A

5-15cm H2O
-normal physiologic glottis closure occurs at 5, with artificial airway glottis remaining open and normal PEEP does not occur

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17
Q

what is continuous positive airway pressure (CPAP)

A

-application of positive pressure during spontaneous breaths
-invasive or non-invasive
-non-invasive can be used to deliver positive pressure during breaths to delay intubation while tx is initiated, also used for OSA

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18
Q

what is pressure support ventilation (PSV)

A

-positive pressure delivered to the client on inspiration
-alleviates WOB which inc oxygenation and ventilation
-may allow for lower o2 conc to be used
-helps avoid atelectasis
-can be used during weaning, during weaning PSV is decreased

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19
Q

normal pressure support ventilation (PSV) value

A

5-20cm H2O
baseline PSV (5cm) is used to overcome resistance/workload imposed by the artificial airway

20
Q

what is FiO2 and normal value

A

conc of oxygen delivered to the client
-goal is maintain PaO2 of >60mmHg using FiO2 of 40% or less

21
Q

what is tidal volume and normal value

A

the volume of air the client received with each breath
-5-8ml/kg of ideal body weight

22
Q

what is I:E ratio

A

comparison of inspiratory to expiratory time

23
Q

what is peak airway pressure and normal value

A

maximal pressure level achieved during a breath
<40cm H2O

24
Q

what is sensitivity

A

determines the inspiratory effort required to trigger a mechanical ventilated breath

25
Q

physiologic complications of mechanical ventilation

A

-barotrauma
-pneumothorax
-subcut emphysema
-malnutrition
-muscular deconditioning
-hypotension
-alterations in cardiac function
-fluid retention
-hemodynamic compromise
-oxygen toxicity
-aspiration
-gastro ulcer
-client-ventilatory asynchrony
-ventilator dependence
-ventilator-associated pneumonia (VAP)

26
Q

what is ventilator-associated pneumonia (VAP)

A

pneumonia acquired during ventilation
-direct and indirect factors promote development of VAP
-bypasses normal lung defense mechanisms creating possibility of contamination of lower airway within 24h
- vents, nebs, IPPB, nasogastric tubes, enteral feeds, and meds also promote pneumonia

27
Q

2 most important nursing interventions for vented patients

A

-respiratory assessment
-ABG analysis

28
Q

what is included in resp assessment of vented pt

A

-ETT location
-observe/palpate subcut emphysema
-review vent settings/alarms
-promote airway clearance/suction PRN

29
Q

effective airway clearance for vented pt

A

resp assessment Q2-4h to identify issues such as secretions that need to be suctioned
-humified o2 liquefies secretions
-bronchodilators help dilate brochioles

30
Q

nutrition for vented patients

A

enteral feed are preferred if GI system is intact
-start initial feeds slowly, observed for intolerance (dehydration, diarrhea)
-monitor BG
-rate is increased when tolerated, high protein is required for resp muscle strength

31
Q

eye care for vented patients

A

-may not have blink reflex
-instill lubricating drops/ointment
-apply eye shields
-apply moisture chamber
-scleral edema can be reduced by elevating HOB

32
Q

mouth care for vented patients

A

-intact mucosa prevents infection
-increased comfort, dec thirst, and preserved mucosa

33
Q

preventing trauma and infection in vented patients

A

-position tubing so its not pulling or kinked
-check cuff for pressure and leaks
-observe colour and odor of sputum
-elevate HOB to prevent aspiration and pneumonia
-PPI for ulcer prophylaxis

34
Q

psych care for vented patients

A

-psychological distress can be caused by sleep deprivation, sensory overstimulation, pain, fear, inability to communicate, medications
-vent can precipitate psychological dependence
-support family

35
Q

medications used in vented patients

A

-used to minimize discomfort, reduce anxiety and agitation, facilitate vent and improve oxygenation
-commonly used ones are analgesics, sedatives and neuromuscular blocking agents (i.e. pavulon, norcuron) used in conjunction with a sedative or anxiolytic agent

36
Q

pain medication for vented patient

A

-administered if client has pain-producing illness or surgery

37
Q

immobility and vented patients

A

-prevent skin breakdown
-prevent atelectasis
-DVT prevention

38
Q

neuromuscular blocking agents and vented patients

A

-can result in skeletal muscle weakness
-paralysis is monitored using peripheral nerve stimulation

39
Q

preventing ventilator-associated pneumonia (VAP)

A

-elevated HOB 30 deg
-temporarily interrupt sedation and conduct spontaneous breathing trial each day
-adequate pain control
-CAM assessment
-using oral tubes vs nasal tubes for trachs or G tubes
-provide oral care
-hand hygiene

40
Q

what is weaning

A

the gradual withdrawal of mechanical ventilator support and the reestablishment of the client’s spontaneous breathing.
-only begins after client has been stabilized and reason for needing the vent has been corrected

41
Q

how do you wean a client off the vent

A

-evaluate clients LOC, physiologic and hemodynamic stability, adequacy of oxygenation and ventilation, spontaneous breathing capability, resp rate and pattern
-position client upright, suction airway if needed
-provide reassurance
-assess immediately before and frequently during for signs of intolerance

42
Q

methods to wean a client off the vent

A
  1. T-piece trials
  2. synchronous intermittent mandatory ventilation (SIMV)
  3. pressure support ventilation (PSV)
43
Q

what is bucking/fighting the vent

A

the client’s respiratory effort is not synced with the vent (asynchrony)
-client tries to breath out when the machine is in inspiratory phase which causes a jerk movement and increased use of abdominal muscles
-contributing factors include: sedation level, pulmonary edema

44
Q

high pressure alarm and interventions

A

-secretions in airway (suction)
-decrease in airway size->bronchospasms (medication)
-ET dislodged (retube)
-vent tube kinked or obstructed (remove obstruction)
-cough/gag/bite tube (suction, bite block, ready to be weaned/extubated, sedation)
-anxiety (sedation, reassurance)

45
Q

low pressure alarm and interventions

A

-disconnected or leak in vent tubing or ET cuff (reconnected, check connections, assess cuff pressure

advanced concepts (9 decks)

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