Exam #1 NUR 2940
Indications for Mechanical Ventilation - ANS--airway compromise - loss of patency
-hypoxemia RF (pa02 < 60)
-hypercapnea RF (CO2 > 50)
-need to protect airway (burns, aspiration, no gag or cough reflux)
Continuous Positive Airway Pressure (CPAP)*** - ANS--preset pressure in lungs during
inspiration and expiration
-tx for sleep apnea and to evaluate readiness for extubation
-keeps upper airway, trachea, and alveoli open during sleep
-must have spontaneous breathing to use
BiPAP - ANS--inspiratory positive airway pressure (helps patient's own inspiration to
decrease WOB and increase alveolar ventilation)
-expiratory positive airway pressure (keeps alveoli open during exhalation)
Contraindications for Artificial Airway - ANS--DNI/DNR
How to Confirm Tube Placement*** - ANS--auscultation of chest
-symmetrical chest rise
-tube location marked
-CO2 detector
-Chest xray
Post Intubation Care - ANS--confirm placement
-secure tubing
-obtain ventilator settings
-ABG's (about 1 hour post intubation)
-assess need for restraints and sedation
-establish method of communication
Assist/Control Mode - ANS--delivers pre-set volume, rate, and flow rate
-patient CANNOT have spontaneous breaths
Synchronized Intermittent Mandatory Ventilation (SIMV) - ANS--delivers pre-set rate at
set volume and flow rate
-patient CAN generate spontaneous breaths between set breaths
-used for weaning
,-detects spontaneous breath attempt and doesnt initiate ventilator breath - prevents
breath stacking
Ventilation Nursing Care - ANS--suctioning
-interpreting ABG's
-frequent oral care (prevents VAP)
-address pain/anxiety
-frequent pulmonary auscultation, repositioning, and ROM
-monitor fluid balance
-HOB at least 30 degrees
-nutrition (NGT, PPN, TPN) (gut is best)
-promote communication
Mechanical Ventilation Complications*** - ANS--decreased cardiac output from positive
pressure
-barotrauma from excessive positive pressure ventilation - pneumothorax
-infection (VAP) - good oral care is important***
-DVT from immobility
-stress ulcers
High Pressure Alarms*** - ANS--obstructions (water condensation)
-secretions (mucous plug)
-kinks in tubing (patient biting tubing)
-bucking the vent
-coughing
-patient laying on tubing
-tubing stuck in bed rails
-bronchospasms
-worsening of illness
-attempt to quickly fix problem
-bag patient and call RT
Low Pressure Alarms*** - ANS--leak in tubing or ventilator (cuff)
-cuff on tube/humidifier not tight
-attempt to quickly find problem
-bag patient and call RT
Accidental Extubation - ANS--attach ambu bag to flowmeter and turn it on
, -attach facemask to ambubag, supply patient with ventilation
-make sure to mark tube
Weaning of Mechanical Ventilation - ANS--must be hemodynamically stable and
improving
-collaboration
-vital signs, ABG's, muscle strength, vital capacity WNL
-vent settings and o2 gradually decreased to allow patient to do more work of breathing
Indications Patient Not Ready to be Weaned Off Ventilator - ANS--tachycardia
-hypertension
-tachypnea/low respirations
-decreased O2 sats
-dysrhythmias
-fatigue
-panic
-cyanosis
-labored breathing
How many days until tracheotomy recommended? - ANS-10-14 days
Every ventilated patient must have what at the bedside?*** - ANS--ambu bag and mask
-obturator
-spare trach correct size
Cuff pressure should be between? - ANS--15-25 mmHg
-RT responsible for cuff pressure
-pressure too high - tissue damage
-pressure too low - low pressure alarm
What position should trach patient be in? *** - ANS-Semi Fowlers Position
Indications for Suctioning*** - ANS--low O2 with tachycardia
-rhonci or crackles during auscultation
-respiratory rate
-increased work of breathing, using accessory muscles
-suctioning is PRN, not ordered***
-limit suction time to no more than 10 seconds***
-stop suctioning if bradycardia or tachycardia presents
Indications for Mechanical Ventilation - ANS--airway compromise - loss of patency
-hypoxemia RF (pa02 < 60)
-hypercapnea RF (CO2 > 50)
-need to protect airway (burns, aspiration, no gag or cough reflux)
Continuous Positive Airway Pressure (CPAP)*** - ANS--preset pressure in lungs during
inspiration and expiration
-tx for sleep apnea and to evaluate readiness for extubation
-keeps upper airway, trachea, and alveoli open during sleep
-must have spontaneous breathing to use
BiPAP - ANS--inspiratory positive airway pressure (helps patient's own inspiration to
decrease WOB and increase alveolar ventilation)
-expiratory positive airway pressure (keeps alveoli open during exhalation)
Contraindications for Artificial Airway - ANS--DNI/DNR
How to Confirm Tube Placement*** - ANS--auscultation of chest
-symmetrical chest rise
-tube location marked
-CO2 detector
-Chest xray
Post Intubation Care - ANS--confirm placement
-secure tubing
-obtain ventilator settings
-ABG's (about 1 hour post intubation)
-assess need for restraints and sedation
-establish method of communication
Assist/Control Mode - ANS--delivers pre-set volume, rate, and flow rate
-patient CANNOT have spontaneous breaths
Synchronized Intermittent Mandatory Ventilation (SIMV) - ANS--delivers pre-set rate at
set volume and flow rate
-patient CAN generate spontaneous breaths between set breaths
-used for weaning
,-detects spontaneous breath attempt and doesnt initiate ventilator breath - prevents
breath stacking
Ventilation Nursing Care - ANS--suctioning
-interpreting ABG's
-frequent oral care (prevents VAP)
-address pain/anxiety
-frequent pulmonary auscultation, repositioning, and ROM
-monitor fluid balance
-HOB at least 30 degrees
-nutrition (NGT, PPN, TPN) (gut is best)
-promote communication
Mechanical Ventilation Complications*** - ANS--decreased cardiac output from positive
pressure
-barotrauma from excessive positive pressure ventilation - pneumothorax
-infection (VAP) - good oral care is important***
-DVT from immobility
-stress ulcers
High Pressure Alarms*** - ANS--obstructions (water condensation)
-secretions (mucous plug)
-kinks in tubing (patient biting tubing)
-bucking the vent
-coughing
-patient laying on tubing
-tubing stuck in bed rails
-bronchospasms
-worsening of illness
-attempt to quickly fix problem
-bag patient and call RT
Low Pressure Alarms*** - ANS--leak in tubing or ventilator (cuff)
-cuff on tube/humidifier not tight
-attempt to quickly find problem
-bag patient and call RT
Accidental Extubation - ANS--attach ambu bag to flowmeter and turn it on
, -attach facemask to ambubag, supply patient with ventilation
-make sure to mark tube
Weaning of Mechanical Ventilation - ANS--must be hemodynamically stable and
improving
-collaboration
-vital signs, ABG's, muscle strength, vital capacity WNL
-vent settings and o2 gradually decreased to allow patient to do more work of breathing
Indications Patient Not Ready to be Weaned Off Ventilator - ANS--tachycardia
-hypertension
-tachypnea/low respirations
-decreased O2 sats
-dysrhythmias
-fatigue
-panic
-cyanosis
-labored breathing
How many days until tracheotomy recommended? - ANS-10-14 days
Every ventilated patient must have what at the bedside?*** - ANS--ambu bag and mask
-obturator
-spare trach correct size
Cuff pressure should be between? - ANS--15-25 mmHg
-RT responsible for cuff pressure
-pressure too high - tissue damage
-pressure too low - low pressure alarm
What position should trach patient be in? *** - ANS-Semi Fowlers Position
Indications for Suctioning*** - ANS--low O2 with tachycardia
-rhonci or crackles during auscultation
-respiratory rate
-increased work of breathing, using accessory muscles
-suctioning is PRN, not ordered***
-limit suction time to no more than 10 seconds***
-stop suctioning if bradycardia or tachycardia presents
