Critical Care Nursing, Medical Surgical Nursing 3 Exam 3 (Answered) 2022 Graded A+

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,