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Medical Nursing > Ventilators > Flashcards

Ventilators Flashcards

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1
Q

Why are ventilators important?

A

Gas exchange

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2
Q

What is qualitative and quantities ventilation?

A

Qualitative ( efficiency of ventilation, CO2 elimination, oxygenation)
Quantitative ( breathing in and out respiratory rate Tidal volume)

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3
Q

How is ventilation different to spontaneous breathing?

A

Ventilation forces air into the lungs

Spontaneous breathing generates negative pressure allowing the lungs to fill with air

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4
Q

What is the tidal volume?

A

Normal volume of lungs

Can exaggerate insp and esp if need be

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5
Q

How do you calculate minute volume?

A

Tv x respiratory rate

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6
Q

What is compliance of the lungs?

A

Change in volume for any given pressure (ability to stretch)

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7
Q

What controls ventilation within the dog and cat?

A

Respiratory centre in the medulla and pons
There are stretch receptors in the lungs and peripheral chemoreceptors that will alter ventilation if the pH and CO2 alters

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8
Q

What are the indications for quantitative and qualitative ventilation?

A

Quantitative failure to breath (drugs, control damage, cervical lesion, tetanus)
Qualitative drug induced depression V/Q mismatch
Lung disease
Prevent respiratory exhaustion

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9
Q

What two ways can you give ventilation?

A

IPPV ( manuallynor mechanically)
Negative pressure ventilation
(HF jet ventilation)

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10
Q

How do you control ventilation what are the types of ventilation and the types of breath?

A

Manually vs mechanically
Controlled and assisted
Volume controlled and pressure controlled breath

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11
Q

Name the two types of ventilation?

A

Rebreathing ambu bag (demand valve, short inspiration, assess thoracic movements)
Ventilators

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12
Q

What are the pros and cons of using a rebreathing bag?

A 
Pros 
Easy economic does not depend on conditions can be less harmful than ventilators
Cons
Depends on operator 
Irregular administration of breaths 
Poor control of ventilatory parameters
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13
Q

What are the pros and cons of ventilators?

A 
Pros
Automatic 
Set regular breaths 
Allows different types of ventilation 
Additional features PEEP CPAP
Cons 
Requires equipment and power 
More complicated to operate 
Risk of injuries
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14
Q

Describe spontaneous breathing and how it is controlled?

A

Inspiratory flow determined by the patient
Breath terminated by the patient
Breath initiated by the patient

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15
Q

Describe assisted ventilation and how it is controlled?

A

Inspiratory flow determined by the ventilator
Breath terminated by the ventilator
Breath initiated by the patient

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16
Q

Describe supported ventilation and how it is controlled?

A

Inspiratory flow is controlled by the ventilator
The breath is ended via the patient
The breath is started via the patient

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17
Q

Describe mandatory controlled ventilation and how it is controlled?

A

Inspiratory volume is controlled by the ventilator
Breath is ended by the ventilator
Breath is started by the ventilator

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18
Q

Describe the types of mandatory ventilation?

A

Continuous mandatory

intermittent mandatory

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19
Q

What are the additional features of the mandatory ventilator?

A

Pressure support ventilation ( flow delivered by ventilator)
Positive End Expiration Pressure ( Small amount of air left in the lungs)
Continuous Positive Airway Pressure (CAP) same as PEEP but always on spontaneous breathing

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20
Q

What are the two methods of controlling IPPV?

A 
Pressure controlled (dangerous if open thorax) 
Volume controlled (set volume at the end of inspiration)
21
Q

What are the risk of IPPV to the cardiovascular system?

A 
Decreased cardiac output 
decreased venous return 
Direct affect on the heart 
Poor perfusion of the organs 
increased sympathetic, RAA and ADH (increase blood pressure)
22
Q

What are the risks of IPPV directly on the lungs?

A

Trauma (barotrauma)
Very high pressure required in supported lungs
volumtrauma
Shear stress effect
volutrauma/atelectotrauma (ventilator induced lung injury, large scale inflammation)
oxygen effects ( 100% less than 6 hours reduce o2 to 30/40% to reduce free radicals)

23
Q

Risks of IPPV acid base disturbances?

A 
Sympathetic effect of high CO2 
affect on cerebrl perfusion 
<20mmhg vasconstriction and poor perfusion 
>60mmhg vasodilation, affect on ICP 
metabolic impact
24
Q

What are the ventilators variables and settings?

A 
Breathing frequency 
Tidal volume/minute volume
I:E ratio
Inspiratory time/expiratory time 
inspiratory flow rate 
Peak inspiratory pressure 
Positive End Expiratory pressure
25
Q

What is the calculation for minute volume?

A

Tv X RR

26
Q

What is the calculation for respiratory rate?

A

60/ (inspiratory time+expiratory time)

27
Q

What is the calculation for tidal volume|?

A

inspiratory time X inspiratory flow rate

28
Q

What are the three control phases of breathing for ventilators?

A

Cycling-end of inspiration
Triggering_end of expiration
Limitting-maximum

29
Q

What re they types of triggering ventilators that you can get?

A 
Time triggered (Set expiratory time)
Pressure triggered (negative pressure generated by the patient)
Volume triggered (set expiratory volume)
Flow triggered (detection of decreased expiratory flow)
30
Q

What are the types of ventilators that are cycling?

A 
Time-cycled (set inspiratory time)
Pressure cycled (changeover when pre-determined pressure is reached)
Volume-cycled (change over when determined volume is reached)
Flow- cycled (changeover when flow decreases to pre-determined value)
31
Q

What are the types of ventilators that are limiting?

A 
Safety, set maximum value 
pressure-limiting (max pressure)
Volume-limiting (max volume) 
Flow limiting (max flow) 
can stop inspiration prematurely (before set value)
32
Q

List the four different types of ventilators?

A

Bag squeezer (horizontal, Ascending, descending)
Intermittent blower
Mechanical thumb
Volume divider

33
Q

List the different types of bag squeezer and the type of ventilator that they are?

A

Mie ventmaster (time-cycled, can set up exp and insp time, volume will set flow)
Hallowell EMC 2000
Time-cycled pressure limited (alarm will sound)
JD medical (equine)
pressure-cycled pressure limited

34
Q

Describe the characteristics of a bag squeezer

A

bag in a bottle (bellow) connected to a bag port
Mimics the effect of a hand regularly pressing on the bellow
if the bag doesn’t fill full there is a leak in the system

35
Q

Describe the characteristics of the mechanical Thumb

A

T-piece valve is occluded on expiratory limb
Newton valve - action depends on flow from ventilator, associated with ventilator
Air is forced back into the patient inspiration time is the time the valve is occluded for
Tidal volume= flow rate and occlusion

36
Q

Name a mechanical thumb ventilator

A

Vetronic SAV03

change flow rate impact on the volume and pressure on the airways

37
Q

Describe the characteristics of the intermittent blower

A

Proportional flow valve (electronically timed and activated).
or pneumatically timed oscillator (powered by both gas and electricity)
Divides the driving gas up into tidal volumes of a set size and rate

38
Q

List two intermittent blowers and their characterisitcs

A

Merlin
microprocessor-control precision piston
time, pressure or volume (piston pushes air in and out, will stop if patient starts fighting it)
Nuffield
Pneumatic oscillator (driving gas makes ventilator work tidal volume= exspiratory flow and inspiratory flow
time-cycled
set inspiratory time, flow

39
Q

Describe the characteristics of a minute volume divider

A 
continuous flow of gas into reservoir
air is delivered to the patient via positive pressure 
pressurised reservoir by a weight
fresh gas flow= intended minute volume 
divided up into the required BPM 
expensive in terms of gas flow 
FGF over one minute= minute volume
40
Q

Name a minute volume divider

A 
Manley MP3 
spontaneous= mapelson D
main bellow/storage bellow
volume triggered (when storage full)
volume-cycled
set tidal volume and insp time
41
Q

How do you start ventilation?

A

NMBA
decrease co2 ( drops below the level which triggers breathing give an extra breath)
decrease sensitivity to co2 (drugs, opiods, midazolam )

42
Q

How do you set up a ventilator?

A

t-piece connect it to expiratory limb
Bain, circle connect to the re breathing bag port
close the apl valve
adjust the flow rate

43
Q

How do you set up the minute volume for a ventilator?

A

tidal volume 10-15ml (start smaller in compromised patients, increase progressively, adjust according to monitoring|)
breathing rate pre-op (may need to be higher initially to control breathing)
adjust according to monitoring

44
Q

How do you set up the inspiration and expiration volume for a ventilator?

A

Short inspiration long expiration I:E ration 1:2 adjust according to RR
Inspiration shorter if RR higher
Expiration is passive and gives the lungs time to recoil

45
Q

What monitoring equipment should you use whilst ventilating?

A

Spirometery
capnography
Spo2
blood gas analysis

46
Q

How does spirometery work?

A

Volumes and pressures administered effectively
dynamics of ventilation (compliance)
Visualisation of PEEP

47
Q

How doe a capnograph work during ventilation?

A

EtCO2 value hypo/hyperventilation
adjust on qualitative basis
detects problem with the system rebreathing, occlusion

48
Q

How is blood gas monitoring used during ventilation?

A

Best way to assess ventilation/oxygenation

Discontinuous monitoring

49
Q

How do you stop ventilation?

A

Make sure spontaneous breathing is possible
antagonise NMBA
decrease/stop resp depressant drugs
allow CO2 to rise decrease ventilation

Medical Nursing (22 decks)

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