NUR317 Supporting Ventilation

Nasal cannula

common low flow device; allows eating and talking; can dry nares at higher flows

Simple mask

has open side ports for air to enter and escape, must fit well, can feel claustrophobic (interferes with talking/eating)

Nursing focuses with nasal cannula’s and simple masks

device fit, skin protection, mucosal dryness, ordered flow, and patient response

When are venturi masks often used?

when accurate oxygen deliver is important

What should you never do with a venturi mask?

do not randomly change the flow; verify the ordered FiO2 and device setup

What is a non-rebreather mask used for?

High-concentration oxygen for significant hypoxemia or acute deterioration

What does a non-rebreather mask provide?

A high concentration of oxygen

What is the purpose of the reservoir bag?

It stores a high concentration of oxygen for the patient to inhale

When is a non-rebreather commonly used?

During significant hypoxemia or acute respiratory deterioration

Nursing checks for a non-rebreather mask

correct flow, mask seal and patient tolerance, reservoir bag inflation, SpO2/RR/WOB/LOC, escalate if not improving

What is HFNC?

Heated and humidified oxygen delivered at a high flow rate

What FiO₂ can Optiflow deliver?

Up to 100% FiO

What should the nurse monitor with HFNC?

SpO₂, respiratory rate, work of breathing, mental status, skin, and tolerance

Does HFNC replace assessment for respiratory failure?

No. The patient must still be assessed for worsening oxygenation or ventilation

How does CPAP provide pressure?

It provides continuous positive pressure during inhalation and exhalation

What does CPAP help keep open?

The upper airway and alveoli

Does CPAP actively assist CO₂ removal?

No

How does BiPAP provide pressure?

Higher pressure during inhalation and lower pressure during exhalation

What is a common use for BiPAP?

COPD exacerbation with hypercapnia

What should the nurse monitor with CPAP or BiPAP?

Oxygenation, ventilation, work of breathing, mental status, mask tolerance, and skin integrity

When should CPAP/BiPAP be avoided?

When the patient cannot protect the airway, has excessive secretions/vomiting, or severe facial trauma/burns

What is an NPA (nasopharyngeal airway)?

A soft, flexible airway inserted through the nose

What is an OPA (oropharyngeal airway)?

A rigid plastic airway inserted through the mouth

Can an NPA be used in an awake patient?

Yes. It is usually tolerated with an intact gag reflex

Can an OPA be used in an awake patient?

No. It is generally used only in unconscious patients

Why is an OPA avoided when the gag reflex is intact?

It can trigger gagging and vomiting

How does an OPA prevent airway obstruction?

It prevents the tongue from obstructing the airway

When should an NPA be avoided?

With severe facial trauma or suspected basilar skull fracture

What are common reasons for intubation?

Severe respiratory failure, cardiac arrest, major trauma, and postoperative support

What is the priority with an ETT?

Maintain tube security, oxygenation, and ventilation while preventing complications

What is mechanical ventilation?

Life support that assists when a patient cannot maintain oxygenation or ventilation

What does mechanical ventilation provide?

Controlled or assisted breaths

How does mechanical ventilation support oxygenation and ventilation?

It helps deliver oxygen to the lungs and it helps remove CO2

What should nurses monitor on a mechanically ventilated patient?

Patient response, tube security, alarms, sedation, comfort, and complications

Trach used for how long?

prolonged ventilatory support > 10-14 days

Advantages of a tracheostomy?

better oral and bronchial hygiene, less risk of damage to the vocal cords

What can a tracheostomy do compared to a endotracheal tube?

a tracheostomy can improve comfort, oral care, secretion management, and communication options

What is a cuffed tracheostomy tube?

A tube with a balloon that creates an airway seal

When is a cuffed trach commonly used?

Mechanical ventilation or high aspiration risk

What is an advantage of an uncuffed trach?

More airflow can pass around the tube, allowing easier speech

What is a fenestrated tracheostomy tube?

A tube with openings that allow airflow through the upper airway

What is a non-fenestrated trach?

A tube without openings; airflow occurs through the tub

What can a fenestrated trach help with?

Speech and weaning toward decannulation

What are signs of tracheostomy obstruction?

Respiratory distress, decreased airflow, thick secretions, falling SpO₂, or inability to pass a suction catheter

What should you do if a trach patient is deteriorating?

Do not delay calling for assistance

What assessment findings indicate a need for suctioning?

Coarse breath sounds, visible secretions, ineffective cough, increased WOB, or falling SpO

How long should each suction pass last?

About 10–15 seconds

Should normal saline routinely be instilled before suctioning?

No

What is thoracentesis?

A needle or catheter removes pleural fluid, diagnostic/therapeutic, patient usually sits upright learning forward, monitor respiratory status/pneumothorax risk

What is a chest tube?

tube remains in pleural space, continuously removes air/blood/fluid, restores negative pressure, allows lung re-expansion

What may indicate a pneumothorax after pleural procedures?

worsening dyspnea, decreased breath sounds, falling SpO2

Why are chest tubes used for pneumothorax?

To remove air and allow the lung to re-expand

How should the patient be positioned for chest tube insertion?

Arm raised above the head on the affected side; HOB around 45° when possible

Nursing assessment for chest tubes

monitor pain, respiratory status, insertion site, drainage, and system function

What does the suction control regulator do?

Controls the amount of suction using a mechanical regulator/dial

What does the water-seal chamber do?

Acts as a one-way valve preventing air from returning to the pleural space

What does the air-leak monitor show?

Whether air is passing through and the approximate size of the leak

What do the collection chambers do?

Collect drainage from the chest

What is the most important rule when assessing a chest drainage system?

Always assess the patient first

What is tidaling?

The rise and fall of fluid with respirations

What can no tidaling indicate?

Lung re-expansion or an obstruction

What can marked tidaling suggest?

Ongoing pressure changes, unresolved air, or increased respiratory effort

When can intermittent bubbling occur?

During treatment of a pneumothorax

What does continuous bubbling usually indicate?

An air leak

What should the nurse do with continuous bubbling?

Assess the patient, connections, and drainage system

Should chest tubes routinely be clamped?

No

When should the provider be notified about chest tube output?

When drainage is greater than 100 mL/hr

What is the priority during a chest tube emergency?

Maintain oxygenation and prevent air from entering the pleural space

What should you do if the drainage system breaks?

Place the distal end in 2 cm sterile water if directed by policy and call for help

What is a flutter valve drainage system?

A one-way valve that allows air or fluid to leave the pleural space

What is an advantage of a flutter valve?

It allows increased patient mobility

What is the nursing focus with a flutter valve?

Respiratory status, drainage, device integrity, and patient teaching

Can a flutter valve function when the patient changes position?

Yes. It functions in any position and allows ambulation