215 Vents

HESI Live Mandatory Review Sessions

  • Overview:

    • Three-day NCLEX review mandatory for all attendees.

    • Attendance is essential for success.

  • Session Timing:

    • Dates: Specific dates should be confirmed.

    • Time: 08:30 to 15:30.

  • Lunch:

    • No lunch provided; attendees must bring their own food/snacks.

  • Purpose of HESI Review:

    • Comprehensive NCLEX preparation focusing on key concepts.

    • Encourages collaborative learning among peers.

  • Understanding NCLEX:

    • NCLEX comprises multiple concepts; focus will be on a select few during the review.

    • Emphasis on passing NCLEX on the first attempt.

  • Workbook Requirement:

    • Attendees must complete the HESI workbook to qualify for a refund if they do not pass NCLEX.

  • Location Details:

    • Day 1: Location: LX 199

    • Days 2 & 3: Location: Health Science Building Auditorium.

  • Preparation:

    • Participants are encouraged to bring workbooks and stay engaged.

Review Content Overview

  • Oxygenation Content:

    • Discussions will include general ventilator settings, indications for ventilation, weaning patients off ventilators, and a review of arterial blood gases (ABGs).

    • Additional focus on Acute Respiratory Distress Syndrome (ARDS).

  • Key Respiratory Structures:

    • Lungs: Location of gas exchange.

    • Trachea: Airway passage leading to bronchi.

    • Alveoli: Critical for gas exchange; must expand and contract for effective function.

    • Hemoglobin: Responsible for oxygen transport in the blood.

Key Terms and Concepts

  • Gas Exchange:

    • Requires alveolar expansion and contraction.

    • Hemoglobin carries oxygen from the alveoli to the tissues.

  • Key Measurements:

    • PaO2: Partial pressure of oxygen; indicates blood oxygen levels; measured via arterial blood gas analysis.

    • Sensitivity to hypoxemia indicators.

    • SaO2: Oxygen saturation; measured using pulse oximetry; indicates the percentage of hemoglobin saturated with oxygen.

    • FiO2: Fraction of inspired oxygen; indicates the concentration of oxygen in the air we breathe.

    • Normal: Approximately 21% in ambient air.

  • Oxygenation Goals:

    • Aim for SaO2 levels above 92%.

    • PaO2 normal range to maintain optimal oxygenation; higher ratios indicate better oxygen delivery to tissues.

  • Oxygen Administration Devices:

    • Nasal Cannula: Up to 6 L/min; first-line therapy for patients with mild hypoxemia.

    • Simple Face Mask: For patients who cannot use nasal cannula (e.g., facial injuries).

    • Venturi Mask: Provides precise levels of oxygen; ideal for COPD patients.

    • Non-Rebreather Mask: Delivers high concentrations of oxygen (used in emergencies).

    • CPAP: Used for sleep apnea; maintains open airways during sleep.

    • BiPAP: Provides both inspiratory and expiratory pressure support for patients needing ventilation support.

Ventilation Techniques and Types

  • Mechanical Ventilation Indications:

    • Patients unable to breathe on their own or facing severe respiratory failure.

    • Ethical concerns about ventilator use and patient consent.

  • Ventilator Settings:

    • Assist Control (AC): Patient receives preset tidal volume at a specific frequency; supports full breath delivery.

    • Pressure Control Ventilation: Pressure is set; tidal volume varies based on lung compliance.

    • Synchronized Intermittent Mandatory Ventilation (SIMV): Combines spontaneous breathing with controlled breaths; allows for some patient initiation.

    • Pressure Support Ventilation: Enhances patient-initiated breaths with positive pressure.

  • PEEP (Positive End Expiratory Pressure):

    • Maintains lung inflation at the end of expiration; prevents alveolar collapse and improves gas exchange.

Complications and Nursing Considerations

  • Potential Risks:

    • Hyperventilation: Can lead to respiratory alkalosis; caused by patient anxiety or insufficient sedation.

    • Barotrauma: Risks of overpressure leading to lung injury.

    • Aspiration Risk: Patients on BiPAP at risk if they vomit; need close monitoring.

  • Monitoring and Assessment:

    • Importance of monitoring patient’s hemodynamic status, respiratory rate, ABGs, and oxygen saturation levels.

    • Regular assessment for signs of respiratory distress, skin breakdown from masks, and signs of agitation or increased work of breathing.

  • Ventilator Alarms:

    • Understanding alarms: low pressure indicates disconnection; high pressure indicates an obstruction.

  • Patient Communication and Comfort:

    • Utilizing communication aids for non-verbal patients (e.g., whiteboards, technology aids).

    • Managing sedatives and analgesics to maintain comfort without compromising respiratory function.

  • Preventing Ventilator-Associated Complications:

    • Oral care to prevent pneumonia and other infections.

    • Early mobility when possible to reduce complications.

  • ICU Delirium Prevention:

    • Daily assessments, analgesic and sedation management, and reorienting patients to maintain a sense of normalcy.

Conclusion

  • Study Preparedness:

    • Review all mentioned concepts, terms, and strategies as they will be crucial for success in both the classroom and in clinical settings.

    • Engage with practice questions and participate actively in the upcoming HESI sessions for effective learning and retention of the material.