Critical Care Nursing, Medical Surgical
Nursing 3 Exam 3 (Answered) 2022 Graded
A+
Non-invasive positive pressure "ventilator" types
CPAP
BiPAP
NIPPV is a method of positive-pressure ventilation that can be given via facemasks that
cover the nose and mouth, nasal masks, or other oral or nasal devices such as the
nasal pillow (a small nasal cannula that seals around the nares to maintain the
prescribed pressure). NIPPV eliminates the need for endotracheal intubation or
tracheostomy and decreases the risk of nosocomial infections such as pneumonia.
CPAP
CPAP provides positive pressure to the airways throughout the respiratory cycle.
Although it can be used as an adjunct to mechanical ventilation with a cuffed
endotracheal tube or tracheostomy tube to open the alveoli, it is also used with a leak-
proof mask to keep alveoli open, thereby preventing respiratory failure. CPAP is an
effective treatment of obstructive sleep apnea because the positive pressure acts as a
splint, keeping the upper airway and trachea open during sleep. To use CPAP, the
patient must be breathing independently.
BiPAP
Bilevel positive airway pressure (BiPAP) ventilation offers independent control of
inspiratory and expiratory pressures while providing pressure support ventilation (PSV).
It delivers two levels of positive airway pressure provided via a nasal or oral mask, nasal
pillow, or mouthpiece with a tight seal and a portable ventilator. Each inspiration can be
initiated either by the patient or by the machine if it is programmed with a backup rate.
The backup rate ensures that the patient receives a set number of breaths per minute.
BiPAP is most often used for patients who require ventilatory assistance at night, such
as those with severe COPD or sleep apnea. Tolerance is variable; BiPAP usually is
most successful with highly motivated patients.
High Frequency Oscillatory Support Ventilator:
These types of ventilators deliver very high respiratory rates (i.e., 180 to 900
breaths/min) that are accompanied by very low tidal volumes and high airway pressures
(hence the name high-frequency oscillatory support). These small pulses of oxygen-
enriched air move down the center of the airways, allowing alveolar air to exit the lungs
along the margins of the airways. This ventilatory mode is used to open the alveoli in
situations characterized by closed small airways, such as atelectasis and ARDS, and it
is also thought to protect the lung from pressure injury
Mechanical Ventilation Patient care responsibilities shared with RT
, Correct tube placement
Proper cuff inflation
Monitor oxygenation/ ventilation
Tube patency
Oral care/ skin integrity
Comfort/ communication
Safety/ assess for complications
Complication Types with Ventilators
Unplanned extubation
Barotrauma >>pneumothorax
Aspiration
Ventilator associated pneumonia (VAP)
Ventilator circuit issues
Ventilator Bundle Orders
Elevate HOB 30-45 degrees
Strict oral care (every 2 hours)
Daily "sedation vacation" - assess readiness for extubation
Peptic ulcer prophylaxis (H2 blockers, PPI drugs)
DVT prophylaxis (SQ heparin, SCD's)
Relationship between CO and increased intrathoracic pressure due to positive pressure
ventilation
Alterations in cardiac output may occur as a result of positive-pressure ventilation. The
positive intrathoracic pressure during inspiration compresses the heart and great
vessels, thereby reducing venous return and cardiac output. This is usually corrected
during exhalation when the positive pressure is off. The patient may have decreased
cardiac output and resultant decreased tissue perfusion and oxygenation.
To evaluate cardiac function, the nurse first observes for signs and symptoms of
hypoxia (restlessness, apprehension, confusion, tachycardia, tachypnea, pallor
progressing to cyanosis, diaphoresis, transient hypertension, and decreased urine
output). If a pulmonary artery catheter is in place, cardiac output, cardiac index, and
other hemodynamic values can be used to assess the patient's status.
Criteria that indicates that a patient is ready for ventilator weaning
Underlying physiological issue corrected
ABG's WNL
Hemodynamically stable
Clear chest x-ray
Minimal secretions
Awake, alert, & able to follow commands
Able to pass spontaneous breathing trials (SBT)
Propofol Infusion Syndrome
Propofol is used to sedate patients on mechanical ventilation. Propofol infusion
syndrome is a rare but sometimes fatal adverse effect of long-term infusion with high
doses usually observed in critically ill ICU patients. The syndrome affects both children
and adults and is characterized by metabolic acidosis, rhabdomyolysis, dysrhythmias,
Nursing 3 Exam 3 (Answered) 2022 Graded
A+
Non-invasive positive pressure "ventilator" types
CPAP
BiPAP
NIPPV is a method of positive-pressure ventilation that can be given via facemasks that
cover the nose and mouth, nasal masks, or other oral or nasal devices such as the
nasal pillow (a small nasal cannula that seals around the nares to maintain the
prescribed pressure). NIPPV eliminates the need for endotracheal intubation or
tracheostomy and decreases the risk of nosocomial infections such as pneumonia.
CPAP
CPAP provides positive pressure to the airways throughout the respiratory cycle.
Although it can be used as an adjunct to mechanical ventilation with a cuffed
endotracheal tube or tracheostomy tube to open the alveoli, it is also used with a leak-
proof mask to keep alveoli open, thereby preventing respiratory failure. CPAP is an
effective treatment of obstructive sleep apnea because the positive pressure acts as a
splint, keeping the upper airway and trachea open during sleep. To use CPAP, the
patient must be breathing independently.
BiPAP
Bilevel positive airway pressure (BiPAP) ventilation offers independent control of
inspiratory and expiratory pressures while providing pressure support ventilation (PSV).
It delivers two levels of positive airway pressure provided via a nasal or oral mask, nasal
pillow, or mouthpiece with a tight seal and a portable ventilator. Each inspiration can be
initiated either by the patient or by the machine if it is programmed with a backup rate.
The backup rate ensures that the patient receives a set number of breaths per minute.
BiPAP is most often used for patients who require ventilatory assistance at night, such
as those with severe COPD or sleep apnea. Tolerance is variable; BiPAP usually is
most successful with highly motivated patients.
High Frequency Oscillatory Support Ventilator:
These types of ventilators deliver very high respiratory rates (i.e., 180 to 900
breaths/min) that are accompanied by very low tidal volumes and high airway pressures
(hence the name high-frequency oscillatory support). These small pulses of oxygen-
enriched air move down the center of the airways, allowing alveolar air to exit the lungs
along the margins of the airways. This ventilatory mode is used to open the alveoli in
situations characterized by closed small airways, such as atelectasis and ARDS, and it
is also thought to protect the lung from pressure injury
Mechanical Ventilation Patient care responsibilities shared with RT
, Correct tube placement
Proper cuff inflation
Monitor oxygenation/ ventilation
Tube patency
Oral care/ skin integrity
Comfort/ communication
Safety/ assess for complications
Complication Types with Ventilators
Unplanned extubation
Barotrauma >>pneumothorax
Aspiration
Ventilator associated pneumonia (VAP)
Ventilator circuit issues
Ventilator Bundle Orders
Elevate HOB 30-45 degrees
Strict oral care (every 2 hours)
Daily "sedation vacation" - assess readiness for extubation
Peptic ulcer prophylaxis (H2 blockers, PPI drugs)
DVT prophylaxis (SQ heparin, SCD's)
Relationship between CO and increased intrathoracic pressure due to positive pressure
ventilation
Alterations in cardiac output may occur as a result of positive-pressure ventilation. The
positive intrathoracic pressure during inspiration compresses the heart and great
vessels, thereby reducing venous return and cardiac output. This is usually corrected
during exhalation when the positive pressure is off. The patient may have decreased
cardiac output and resultant decreased tissue perfusion and oxygenation.
To evaluate cardiac function, the nurse first observes for signs and symptoms of
hypoxia (restlessness, apprehension, confusion, tachycardia, tachypnea, pallor
progressing to cyanosis, diaphoresis, transient hypertension, and decreased urine
output). If a pulmonary artery catheter is in place, cardiac output, cardiac index, and
other hemodynamic values can be used to assess the patient's status.
Criteria that indicates that a patient is ready for ventilator weaning
Underlying physiological issue corrected
ABG's WNL
Hemodynamically stable
Clear chest x-ray
Minimal secretions
Awake, alert, & able to follow commands
Able to pass spontaneous breathing trials (SBT)
Propofol Infusion Syndrome
Propofol is used to sedate patients on mechanical ventilation. Propofol infusion
syndrome is a rare but sometimes fatal adverse effect of long-term infusion with high
doses usually observed in critically ill ICU patients. The syndrome affects both children
and adults and is characterized by metabolic acidosis, rhabdomyolysis, dysrhythmias,
