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49 Cards in this Set
- Front
- Back
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mechanical ventilation is needed for patients that...
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1. present with severe issues with gas exchange
2. patients with hypoxemia, progressive alveloar hypoventilation with resp acidosis |
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purpose/goal of mechanical ventilation
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support and maintain resp function, improve oxygenation and ventilation, decrease need for effective breathing (COPD, severe pneumonia), used to support patients lung fx until either acute episode has passed or lung fx improves
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negative pressure vents
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non-invasive, these encase body trunk in patients with neuromuscular disease, CNS, SCI and COPD and changes the pressure of the chest cavity.
-can be used at home -patient needs to be able to clear own secretions -compliant lungs -cuirass -ponchos -body wrap |
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positive pressure vents
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main purpose is to end inspiration and initiation of expiration, done by pressure cycled ventilation, timed-cycled ventilation or volume-cycled ventilation
-upon inspiration pressure is pushed into the lungs -used in acute care settings |
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Does the ventilator cure the diseased lungs?
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no - supports and maintains resp fx and decreases need for effective breathing, supports patients lung fx until acute episode has passed
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Goal of mechanical ventilation?
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support respiratory function until acute episode has passed, nurse must FOCUS on correcting cause of resp failure (ex. sepsis)
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some nursing dx r/t mechanical ventilation
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1. impaired verbal communication r/t sedation and physical barrier
2. disturbed sleep pattern r/t interruptions for monitoring, nosiy environment 3. death anxiety r/t loss of indep breathing ability 4. impaired oral mm r/t presence of endotracheal tube *5. potential for ventilator-assisted pneumonia |
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sedation medications used for intubation.
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propofol, etomidate, dipro
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common cause for complications with vent patients?
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poor handwashing, poor oral care, improper repositioning,
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sign of propofol toxicity?
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green urine
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regarding intubation....sedate or parlayze first?
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sedate 1st then paralyze
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each attempt of intubation should not last longer than?
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30 seconds OR patient has decrease in saturation
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intubation and ______ placement should go hand in hand.
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Oral gastric tube placement - exit for vomitus if needed
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sedation used post intubation
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versed, vecurronium
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prior to intubation what must nurse monitor?
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vital signs: bp, pulse, hr, o2 saturation
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paralytic used for intubation
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succinlycholine
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how is ET tube placement verifed?
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lung sounds (1)anterior, (2)posterior and(3) belly, xray is most definitive
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purpose of OG tube with intubation?
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decompress stomach contents - air - prevent vomiting (aspiration)
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explain pressure-cycle vents
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pushes air into lungs until preset pressure is reached
-tidal volume and inspiration time vary -not used often, short term vents ~s/p surgery or resp therapy ~bi-pap is example - provides preset inspiratory and expiratory pressure |
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explain time-cycle vents
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push air into lungs until preset time has elapsed
- tidal volume and pressure vary |
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explain volume cycle vents
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push air into lungs according to the preset volume to be delivered
-micropressors vent -computer managed, positive pressure vents - more responsive to severe lung diseases |
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assist control (AC) ventilation
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used most often, resting mode
ventilator takes over breathing -tidal volume and vent rate is preset -a minimal breathing pattern will be established if patient is not spontaneously breathing -the patient controls the rate of breathing |
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potential complications of AC ventilation?
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hyperventilation, if patient is breathing faster then the vent
respiratory alkalosis |
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respiratory alkalosis
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signs: a lot of coughing, a lot of noise from vent |
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respiratory acidosis
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low ph, high pco2
aveloar hypovention leads to hypercapnia Acute respiratory acidosis is present when an abrupt failure of ventilation occurs. This failure in ventilation may be caused by depression of the central respiratory center by cerebral disease or drugs, an inability to ventilate adequately owing to a neuromuscular disease (eg, myasthenia gravis, amyotrophic lateral sclerosis, Guillain-Barré syndrome, muscular dystrophy), or airway obstruction related to asthma or chronic obstructive pulmonary disease (COPD). |
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(SIMV) synchronized intermittent mandatory ventilation
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tidal volume and rate is preset
with lack of spontaneous breathing a minimal rate is set allows for spontaneous breathing can be used as main vent or for weaning weaning process allows for synchroization of vent & patient |
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bi-pap - why used?
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bi level positive airway pressure
-allows for non-invasive support for ventilation - nasal or face mask - most commonly used for sleep apnea and ventilatory muscle fatigue -pressure support and blow by decrease the work of breathing used to wean off vent |
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pressure support and continous flow (flow-by)
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decrease the work of breathing
used for weaning |
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tidal volume (Vt)
range? rate? |
volume of air in each breath
-measured either on insp or expir ranges btw 7-10 ml/kg rate of breaths 10-14 |
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fiO2
fraction of inspired oxygen |
oxygen delivered to patient
setting is dependant on ABGs 100% humdified air is provided |
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Arterial Blood Gases
ranges? |
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Peak airway - inspiratory pressure PIP
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pressure needed by vent to deliver set tidal volume and given compliance
peak prssure is the HIGHEST pressure reached during inspiration - an increase in pressure means there is an increase in resistance, either by equipment or lungs (mucous, own breathing, bronchospams) |
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CPAP - continous positive airway pressure
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positive airway pressure throughout the resp cycle upon spontaneous breathing
sedation is not always used if ever - due to need for patient to spontaneously breathe -keeps alveoli open during inspiration -prevents collapse during expiration -assist with the weaning process delivers oxygen and monitoring |
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**positive end expiratory pressure PEEP
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positive pressure is exerted during expiration
-improves oxygenation by enhancing gas exchange and prevention of atelactasis -used to treat persistent hypoxemia -added at times when PaO2 remains low and FiO2 is 50-70% or greater - prevents collapse of alveoli by keeping them partially inflated - there should be an increase in arterial blood oxygenation and decrease in FiO2 |
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hypoxia
hypoxemia |
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nursing considerations for patient with vent
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assess VS and breath sounds every 30-60 minutes at the minimum
saturation ABGs tube placement p each movement assess endotube area at least q 4 hours for color, drainage, tenderness, skin irritation evaluate and implement care for anxiety in the family and patient GOOD HANDWASHING |
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NURSING CARE FOR VENT PATIENT
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assess a means for communication with patient
attempt to anticipate the needs of patient freq vent checks - looking at settings, water for humidifcation, secretions in tube and mouth, kinks in tubing, alarms are ON - always assess patient when alarm signals causes 1. high pressure causes 2. low exhaled volume |
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care of ET tube
indications for suctioning? |
secretions
increased PIP (peak airway pressure) presence of rhonchi (wheezes) decreased breath sounds frequent mouth care position of ET tube at least q 4 hrs to prevent skin breakdown at site of insertion |
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what is purpose of frequent mouth care of vent patients?
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to prevent ventilated assisted pneumonia
handwashing!!!!!!!!!!! |
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cardiac complications with vent patients
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hypotension & fluid retention
hypotension: causes increase pressure in thorax and prevents blood return to heart which decreases cardiac output hypotension seen more with dehydration and need for higher PIP (peak airway pressure) fluid retention: due to decreased CO, kidneys receive LESS blood flow which stimulates RAS system -humidified air can play part in fluid retention -airway dry, secretions solidfy |
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RAS system
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baratrauma
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resp complication:
damage to lungs from positve pressure examples:pneumothorax, subcutaneous emphysema and pneumomedisatium |
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pneumonthorax
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collapsed lung
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subcutaneous emphysema
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pneumomediastium
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which patients are at risk for baratrauma?
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chronic airflow limitation, blebs, hyperinflation, require high pressure settiings on vent like in ARDs
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volutrauma
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damage to lungs due to excessive volume delivered to one lung over the other
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GI and nutritional complications in vent patients
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stress ulcers - 25% pts
tx c antacids, sucralfate (carafate, sulcrate) histamine blockers - zantac, ranitidine proton pump inhibitors-nexium, esomeprozole SHOULD BE RX SOON AFTER INTUBATION!!!! changes in thoracic and abd cavity can cause paralytic ilieus affecting absorption of nutrients through the GI system |
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ways to treat malnutrition in vent patients
*common problem* |
feed thru NG tube - directly to stomach (GUT IS BEST)
TPN and lipids via IV -cause problems weaning off vent (not enough energy) -need protein and CHO to heal and for E -loss of resp muscle tone and strength -ineffective breathing occurs -fatigue results electrolyte replacment important -monitor potassium, calicum (cardiac) -mag and phosphate (muscle) pt in acute resp failure, smooth muscle relaxers |
