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Mechanical Ventilation Provides assistance with or controls ? breathing for patients unable to maintain adequate ventilation on their own.
Mechanical ventilation is Warranted for patients who have ? and are unable to maintain what? acute respiratory failure and are unable to maintain normal gas exchange.
Mech vent Is not a cure, but ? supports the patient through a crisis
Mechanical Ventilation Indications 1-Apnea or impending apnea, 2-Hypercapnic Respiratory Failure-PaCO2 > 45 mmHg with pH < 7.25 , 3-Severe hypoxia, 4-Respiratory muscle fatigue
Negative Pressure Ventilators Apply sub-atmospheric pressure to the chest wall and abdomen, pulling the chest outward and reducing intrathoracic pressue. Expiration occurs passively by elastic recoil of the lungs. Advantages: non-invasive, mimics physiologic ventilation.
Positive Pressure Ventilation Ventilator inflates the lungs by pumping air into them.The opposite of physiologic ventilation.
Pos pres vent Requires use of an ? via? artificial airway.Endotracheal tube, Tracheostomy
Volume Ventilation Programmed tidal volume (Vt) is delivered with each mechanical breath. Peak pressure exerted on the lungs will vary with lung compliance and airway resistance.
Pressure Ventilation Each mechanical breath is delivered until a programmed ? what varies? pressure limit is reached. Vt varies.
Basic Ventilator Settings Rate-Number of breaths per minute, Tidal Volume-If pressure ventilation - maximum inspiratory pressure, FiO2, High Pressure Limit, Protect from barotrauma, Mode (5 Total)
Volume Ventilation Modes Controlled Mandatory Ventilation (CMV)-Programmed rate, programmed volume, Assist/ Control (A/C)-Programmed minimum rate, programmed volume, Spontaneous efforts trigger the vent to deliver the programmed volume, Synchronized intermittent mandatory ventila
Pressure Ventilation Modes -Pressure support ventilation (PSV)-Patient initiates each breath - ventilator ‘assists’., volume is determined by patient. Pressure controlled ventilation Inverse Ratio ventilation (PC-IRV)-Prolonged inspiratory period, Adjunctive Ventilator Therapies
Adjunctive ventilator therapies PEEP:Positive end expiratory pressure, CPAP: Continuous positive airway pressure, Prone positioning, Nitric Oxide, HFV: High frequency ventilation, ECMO: extracorporeal membrane oxygenation
Supportive Mechanical Therapy BiPAP: Bi-level positive airway pressure,Degree of positive pressure programmable for inspiration & expiration,Utilizes a mask to apply positive pressure to the airway.
Complications of Ventilators-pulmonary? Cardio? GI? Psych, Muscle? Pulm-Barotrauma, Volutrauma, Ventilator-associated pneumonia (VAP). Cardio-↑PVR → decreased LV preloa, Low BP. GI-stress ulcers and sedation-related ileus. Psych-Confusion, depression, agitation. Muscle wasting, as patient is usually sedated or paralyzed
Nursing care for Vent pts. Maintain patent airway… suction PRN, Monitoring, Sedation/ pain/ paralytic, Mouth Care, Nutrition … parental/ feeding tube, H2 pump inhibitors (what are some?), ROM with each turn, Talk to patient!!!
Indications of client ready to wean: Is the patient's respiratory failure resolving or improving? Is the patient hemodynamically stable? Is oxygenation adequate with a PaO2 of >60 mm Hg with an FiO2 of <40% and a PEEP of <5 cm H2O? Are the acid-base status and electrolyte status optimized?
How to Wean 3 general approaches to weaning are pressure support ventilation (PSV): All breaths spontaneous, slowly decrease PS, synchronized intermittent mandatory ventilation (SIMV): Mandatory rate slowly dec., Spontaneous Breathing Test (SBT): T-tube/bar/ piece with spont. Resp and no PS, only O2.
Evaluation for possible extubation include Normal/ unchanged blood pressure, respiratory rate, heart rate, and gas exchange (ABG results)
Nasal Cannula Liters per minute Impact on a someone with blocked nasal passages or a mouth breather? 1 – 6: 24% to 40% Oxygen provided. (Room air : 21%)
Venturi Mask: flow rate? Adaptors? A variable flow rate mask with interchangeable adaptors., Adaptors provide 24%, 28%, 31%, 35%, 40%, or 50%.
Partial Rebreather Mask Used to deliver what levels O2? Up to? L? high concentrations of oxygen. It can deliver 70% to 90% oxygen at a flow of 6-15 Liters per minute.
Non-rebreather Mask Used to deliver? L? high flow oxygen. It can deliver 90% to 100% oxygen at a flow of 15 Liters per minute.
Pulmonary Edema an abnormal build up of ? where? Which leads to? fluid in the air sacs of the lungs, which leads to SOB
Causes of pulmonary edema? Heart Failure (fluid leaks from the veins into air sacs because of increased pressure), Fluid Overload (accumulated fluid, such as with renal failure)., Lung Tissue Damage (infection, trauma, inhaled poisons)
Signs &Symptoms of pulmonary edema? anxiety, Cough, Diff. breathing, Excessive sweating, "air hunger" or "drowning" paroxysmal noctural dyspnea", Grunting or gurgling sounds w/breathing, Pale skin, Restlessness, SOB, orthopnea)--head propped up or use extra pillows, Wheezing
What will u find in Assessment for pulmonary edema? Lungs? Heart-sounds/rate? Skin? Resp?, Crackles in the lungs, called rales, Abnormal heart sounds, tachycardia, pallor or cyanosis, tachypnea
Possible Medications for pulmonary edema? Administer Oxygen: Start with nasal cannula and titrate to venturi mask or non-rebreather face mask to keep oxygen saturation above 90%, Determine cause of edema, Treat underlying cause of edema.
Pulmonary Embolism is what? A collection of particulate matter—solids, liquids, or air—enters venous circulation and lodges in the pulmonary vessels, In most people with pulmonary embolism, a blood clot from a dvt breaks loose from one of the veins in the legs or the pelvis
Pulmonary Embolus: Etiology Prolonged immobilization-airplane rides!!, Central venous catheters-little clots form on the outside edges or not flushed and clot forms at tip, Surgery,Obesity,Advancing age, Conditions that increase blood clotting, History of thromboembolism
Pulmonary Embolus: Clinical Manifestations respiratory? Cardiac? Respiratory manifestations—dyspnea, tachypnea, tachycardia, pleuritic chest pain, dry cough, hemoptysis, Cardiac —distended neck veins, syncope, cyanosis, hypotension, ab heart sounds, abnormal ekg findings, Low-grade fever, petechiae, symptoms of flu
Pulmonary Embolus: Labs/expected results? ABGs-acidotic, Pulse oximetry, Chest X-ray, ventilation/perfusion lung scan: (Also called V-Q Scan)
PE: Nonsurgical Management includes Oxygen therapy, Continual patient monitoring,
Drug therapy
PE: Surgical Management RARELY USED!!!!, Embolectomy, Inferior vena cava interruption
Pulmonary edema labs to check/results CBC-anemia, ↓ RBC count, blood chem/kidney funct, Blood O2 levels (ox/ABG)-↓ in pts w/pulm edema, Chest x-ray-fluid in/around lung or enlarged heart, ECG-ab rhythm,evidence of MI, US aka (echo) weak heart muscle, leakynarrow heart valves, fluid surroundin
Pts who need oxygen, get oxygen. Regardless of whether or not they have COPD. Why?? If we knock out their respiratory drive, we can fix that with intubation. If we allow them to stay hypoxic, we can’t fix the dead cells.
Lasix check what lab? Mg per/min. max?? Potassium, always check potassium.No more than 10 mg lasix/ minute. 10 mg/min(1ml/min) IV push MAX!!!
Heparin prevents clot from growing bigger and prevents new clots from forming. But doesn’t? IT DOES NOT BREAK UP CLOT!!!
Pts will generally refer to their PT/INR as their what level? “Coumadin” level, Always ask people their dosage as some people are on different doses different days.
Ventilator Just makes your lungs expand. No what? gas exchange from this machine.
A ventilator is not a respirator. A respirator is awhat? heart-lung bypass machine. Such as is used during Bypass surgery.
Volume vent and pressure vent-Know difference between these two types.
If lungs are noncompliant, with vol vent, if vol too high for lungs, can blow a bleb. A bleb is a weakned area in the wall of the lung.
FiO2– Fraction of inspired oxygen. This is how much oxygen you are giving. Ventilation is the only way to give what? 100% pure oxygen.
Barotrauma too much pressure against lungs. Can cause alveoli to harden (Fibrolytic)(Scarring of lungs).
CMV Most rarely used
A/C– Machine assist getting volume into lungs when patient does not take a breath
SIMV The most common form of ventilation. If programmed for 10, pt is breathing 30, only 10 are delivered .
PSV spontaneous ventilations. No set number. Takes what pt does and assists them. Pt breathing 20, it sets at 20.
PEEP If you increase expiratory pressure, you can force fluid out of the lungs. Pulmonary edema, pneumonia.
CPAP Keeps the airway open. Pts breathe on their own. Often used at the end of ventilator use. Apnea pts.
HFV Used mostly with premies.
ECMO For babies. Take the blood out, oxygenate it, put it back in.
BiPA – Noninvasive bi-level positive airway pressure. COPD pts. Intubation prevention Because the pressure is so high, these really need to be secure to the face.
Volutrauma Too much volume, blow a bleb that busts. Which can lead to a pneumothorax.
VAP-- #1 pulmonary complication of ventilators. Pneumonia we caused.
PEEP causes Cardiovascular problems IF PEEP is too high, the increased intrathoracic pressure prevent ventricles from filling properly. Output decreases, dec. BP. If drop noted, call respiratory therapy, don’t think pt is tolerating PEEP. TEST!!!
Can’t sedate vent pt completely b/c they need to breathe on their own.
Monitor what v/s for vent pt BP
What hygiene for vent pt MOUTH CARE FOR VAP!!! Test
H2 Pump inhibitors (Test) Look it up!!!
Closed pneumothorax Means there is no opening to the outside air (chest is intact)
body type-tall thin b-ball players tend to get this pneumothorax? closed
Open pneumothorax Means pleural space is open to outside air (puncture wound in chest, such as a stab wound).
What type of pneumothorax is a medical emergency and what is the telltale sign? And what is happening? tension, deviated trachea toward the unaffected side, air accumulation on effected side is compressing the heart.it’s pushing everything to the other side
Tx for pneumothorax is what? needle decompression until chest tube.
Where would chest tube for pneumothorax be placed? As opposed to needle decompression? midauxillary 5th intercostal vs 2nd mid-clavicular intercosttal space
What auscultation & percussion sounds will you hear w/ pneumothorax? Hemothorax? pneumo-ausculation diminished/absent affected side, HYPERresonnace. Hemo-disminshed/absent, HYPO-dull
Difference between pneumothorax and pleural effusion? dull instead of hyperrsonance, pain when they breathe in.
What is a thoracentesis used for? to remove fluid/pleural effusion
What is pleurisy? And what is it’s cardinal sign? How is it tx? pleural inflammation, pain on inspiration. Anti-inflammatories and analgecics.
What is empyema? What could cause it? pus in the pleural space.pneumonia, trauma, surgery/infection.
What is atelectasis and how does it present? Ie breath sounds/percussion? What is tx? collapse of alveoli 2nd to retained secretions. SOB, dyspnea, ↓ breath sounds, dull. TCDB, ambulate/mobilize. Hydration, mucomyst. Humidified O2
Potential complications of thoracentesis? Volume shift (if u take out a lot of fluid/quickly)- hypotension, pulmonary edema, Pneumo/hemo thorax
Created by: kerinska