N362 Mechanical Ventilation

at concentrations higher than 21%

how is oxygen administered

6L/min

maximum amount of FiO2 delivered via low flow nasal cannula

24-28%

1-2 L/min FiO2

32-40%

3-5 L/min FiO2

44%

6 L/min FiO2

10 L/min

15 L/min

Amount of FiO2 delivered via high flow nasal cannula

65%

10 L/min high flow FiO2

90%

15 L/min high flow FiO2

5-8 L/min (40-60%)

simple mask

8-11 L/min (50-75%)

partial rebreather mask

10-15 L/min (80-95%)

nonrebreather mask

2-15 L/min (24-60%)

venturi mask

watch COPD pt

nursing interventions for low flow nasal cannula

better tolerated by children

nursing interventions for high flow nasal cannula

may need nasal cannula at meals

claustrophobia

nursing interventions for simple mask

watch for kinks in bags, tubing

skin checks

nursing interventions for partial rebreather mask

partial rebreather mask

helps conserve oxygen, exhaled air trapped in bag and mixes with oxygen

simple mask

vents for exhaled CO2

nonrebreather mask

delivers the highest O2 concentration

venturi mask

most precise delivery of O2

IPPB

used more for peds, pushes positive pressure into lungs

CPAP

method of keeping the airways open by providing constant mild air pressure

BiPAP

two pressure settings; higher pressure delivered during inspiration and lower pressure during expiration

able to initiate breaths on own

what is necessary for noninvasive positive-pressure ventilation (CPAP and BiPAP)

dyspnea on exertion

abnormal ABG

fatigue

LOC changes

trauma

pain

S/Sx of respiratory distress

hypoxemia

hypoxia

dyspnea

indications for use of supplemental oxygen

hypercapnia

retained CO2

oxygen toxicity

oxygen held in the lungs

hypercapnia

oxygen toxicity

when would you be cautious of using supplemental oxygen

hypoxia

with hypercapnia, what does pt rely on for resp drive

surfactant

helps maintain alveoli and keep open

fibrotic changes

increased capillary congestion

interstitial space thickening

paresthesia

dyspnea

restlessness

pulmonary edema

S/Sx of oxygen toxicity

PEEP

CPAP

treatment for oxygen toxicity

incentive spirometry

feedback to patient about ability to take deep breaths

deep inspiration

what does incentive spirometry encourage

q 6 seconds

rate of ambu-bag rescue breaths

endotracheal tube

provides patent airway when simpler methods cannot be used

emergency care

when is an endotracheal tube the method of choice

through mouth or nose

how is an endotracheal tube inserted

cuffed ET

better secretion clearance, some aspiration protection, pt can’t talk

uncuffed ET

airway clearance but no aspiration protection

no longer than 3 weeks

how long can an endotracheal tube be used for

Tracheostomy tube

provides patent airway to bypass upper airway, permit long-term mechanical vent, and remove tracheobronchial secretions

into the trachea

how is a tracheostomy tube inserted

lung sounds

end-tidal CO2

chest x-ray

how is the placement of endotracheal tube checked

inner cannula

outer cannula

obturator

what does a tracheostomy tube consist of

help pt be able to talk

what does a fenestrated tracheostomy tube do

humidified O2

room air

what can you attach tracheostomy tube to in addition to vent

1-2 hour oral assessment and care

what is needed frequently with endotracheal tube

bag the pt, can’t put it back in

what happens if an endotracheal tube gets dislodged

hypoxemia

bradycardia

hypotension

what can accidental removal of endotracheal tube lead to

tracheal bleeding

ischemia

what can high cuff pressure of an endotracheal tube lead to

aspiration

hypoxia

what can low cuff pressure of an endotracheal tube lead to

crackles under the skin

what will you hear with subcutaneous emphysema

monitor O2

cuff management

maintain patent airway

oral/skin care

safety

nursing care of pt with ET or trach

LOC changes

anxiety

dusty skin

dysrhythmias

S/Sx of hypoxemia

grunting

LOC change

intercostal spaces evident

color

seesaw chest

nasal flaring

retractions

tachypnea

S/Sx of resp complications

pt requires mechanical ventilation

high risk for aspiration

when does the cuff need to be inflated

20-25 mmHg

what should cuff pressure be maintained at

q 6-8 hrs

how often should cuff pressure be checked

Chest PT

position changes

increased mobility

suctioning

how to promote effective airway clearance

visible secretions

onset of resp distress

suspected aspiration

adventitious breath sounds

decrease SpO2

increased peak airway pressure

indications for suctioning

inline suctioning

allows suctioning without disconnection from vent

sustains PEEP

open suctioning

sterile procedure with higher risk for hypoxia

0.12% chlorhexidine gluconate 2x/day

what to rinse pt mouth with when they have an ET

q 2-4 hrs

how often do you need to cleanse mouth between brushings

q 4 hours

how often should deep suctioning be performed with a ET tube

every 8 hours

how often should you change or cleanse the inner cannula of a trach

q 2-4 hours

how often to monitor ET tube for correct placement

30-45

what should the HOB be with ET tube pt

mechanical ventilation

breathing device which maintains ventilation and oxygenation

90% positive pressure

compromised airway

drug overdose

shock

trauma

multi-system failure

COPD

indications for mechanical ventilation

negative pressure ventilation

decreases intrathoracic pressure during inspiration and allows air to flow into the lungs

chronic respiratory failure

neuromuscular conditions

when is negative pressure ventilation used

adaptable for home use

does not require intubation

benefits of negative pressure ventilation

Positive pressure ventilation

intrathoracic pressure is raised during lung inflation by air being pushed into the lungs, and the pt exhales passively

volume cycled

pressure-cycled

high-frequency oscillatory

noninvasive positive-pressure

what are the types of positive pressure ventilation

FiO2

percent of oxygen given to patient

PEEP

used when O2 is high and should be decreased

CMV (controlled mechanical ventilation)

most controlled ventilator mode

A/C (Assist control Ventilation)

telling you how fast to breathe, and how much volume

IMV (Intermittent mandatory ventilation)

run own cadence, given minimum amount

PSV (pressure support ventilation)

stage of ventilation when close to getting extubated

APRV (airway pressure release ventilation)

keep pressure up, ultimately keep volume up

always assess pt first, then alarm

rule with management of vent alarms

increased secretions

bronchospasm

displaced tube

stiff airway

kinked tubing

what is a high pressure vent alarm caused by

disconnection or leak in system

what is a low pressure vent alarm caused by

pt off vent

tubing disconnected

what is an apnea vent alarm caused by

needs more water for humidification

what is a temperature vent alarm caused by

infection (VAP)
pneumothorax

lung damage

hypotension

risks associated with mechanical ventilation

progressive fluid retention, decreased UO, increased Na

how does mechanical ventilation cause sodium and water imbalance

decreased peristalsis

stress ulcers and GI bleeding

how does mechanical ventilation affect the GI system

hypermetabolism (critical illness)

what is a big nutritional issue with ventilator pt

gradual removal from vent

removal of ET or trach

removal from O2

stages pf weaning off vent

hemodynamically and physiologically stable

spontaneous breathing

when does weaning process occur

2-3 hours

how quick can extubation occur within post-weaning

spontaneous breathing

cough up own secretions

swallow

move jaw

when is removal of trach possible

occlusive deressing

what do you place over stoma when trach is removed

VAP

one of the most common nosocomial infections

48+ hours after mechanical ventilation with intubation

when does VAP occur