Mechanical Ventilation (Med-Surg Iii)

Front 1

Control Ventilation (VC)

Back 1

Delivers gas @ preset rate and tidal volume or pressure, regardless of clients inspiratory efforts.

Clinical Application: CV is used as the primary ventilatory mode in clients who are apneic

Nsg. Implications: used in clients unable to initiate a breath; spontaneously berathing clients must be sedated and/or paralyzed

Front 2

Assist-Control (AC):

Back 2

Delivers gas @ preset tidal volume or pressure in response to clients inspiratory efforts and will initiate breath if client fails to do so w/in preset time.

Clinical Application: is used as the primary mode of ventilation in spontaneous breathing clients w/ weak respiratory muscles

Nsg. Implications: Hyperventilation can occur in clients w/ increased respiratory rates. Sedation may be necessary to limit the number of spontaneous breaths.

Front 3

Synchronous Intermittent Mandatory Ventilation (SIMV)

Back 3

Delivered gas @ preset TV or pressure and rate while allowing client to breathe spontaneously; ventilator breaths are synchronized to clients respiratory effort.

Clinical Application: is used both as a primary mode of ventilation in a wide variety of clinical situations and as a weaning mode


Nsg. Implications: May increase the work of breathing and promote respiratory muscle fatigue

Front 4

Positive End Expiratory Pressure (PEEP)

Back 4

Positive pressure applied @ the end of expiration of ventilator breaths

Nsg. Implications: S/E include decreased cardiac output, volutrauma, and increased ICP. No ventilator breaths are delivered in PEEP and CPAP mode unless used w/ CV, A/C or SIMV

Clinical Application: used in clients w/ hypoxemia refractory to oxygen therapy; they increase functional residual capacity and improve oxygenation by opening collapsed alveoli @ end of expiration

Front 5

Constant Positive Airway Pressure (CPAP)

Back 5

Clinical applications: used in clients w/ hypoxemia refractory to oxygen therapy; they increase functional residual capacity and improve oxygenation by opening collapsed alveoli @ end of expiration

Nsg. Implications: S/E include decreased CO, volutrauma and ICP. No ventilator breaths are delivered in CPAP mode unless used w/ CV, A/C, SIMV

Front 6

Pressure Support Ventilation (PSV)

Back 6

Preset positive pressure used to augment clients inspiratory efforts; patient controls rate, inspiratory flow, and TV

Clinical application: used at the primary mode of ventilation in clients w/ stable respiratory drive, is used w/ SIMV to support spontaneous breaths, and is used as a weaning mode in patients who are difficult to wean

Nsg. Implications: Adventages include increased client comfort, decreased work of breathing and decreased respiratory muscle fatigue, and promotion of respiratory muscle conditioning.

Front 7

Constant Positive Airway Pressure (CPAP)

Back 7

Clinical applications: used in clients w/ hypoxemia refractory to oxygen therapy; they increase functional residual capacity and improve oxygenation by opening collapsed alveoli @ end of expiration

Nsg. Implications: S/E include decreased CO, volutrauma and ICP. No ventilator breaths are delivered in CPAP mode unless used w/ CV, A/C, SIMV

Front 8

Pressure Support Ventilation (PSV)

Back 8

Preset positive pressure used to augment clients inspiratory efforts; patient controls rate, inspiratory flow, and TV

Clinical application: used at the primary mode of ventilation in clients w/ stable respiratory drive, is used w/ SIMV to support spontaneous breaths, and is used as a weaning mode in patients who are difficult to wean

Nsg. Implications: Adventages include increased client comfort, decreased work of breathing and decreased respiratory muscle fatigue, and promotion of respiratory muscle conditioning.

Front 9

Complicatioins of PPV

Back 9

Hypotension, decreased CO, decreased preload

S/T increased thoracic pressure can put pressure on superior vena cava and lowers BP as it decreased CO so less blood to body

Higher PEEP (air that stays in the lungs) the lower the BP as there is less room for expansion

Front 10

Complication of - list them

Back 10

Hypotension, dec. CO, dec. preload

Fluid imbalance

Stress response

Alveoli rupture

Alveolar HYPOventilation

Alveolar HYPERventilation

Ventilatory associated pneumonia

Front 11

Complication of PPV

Back 11

Fluid imbalance = Na and H2O retention

S/T decreased renal perfusion causing Na retention secondary to rennin secretion

From decreased CO adn kidney output

Front 12

Complication of PPV

Back 12

Stress Response: S/T increased cortisol release, and increase in ADH release

Front 13

Complication of PPV

Back 13

Alveoli rupture:

S/T volu-pressure trauma
PS (amount of air blown in)
When they rupture, cavity fills w/ air, pneumothoraz that can lead to trachial deviation

Front 14

Complication of PPV

Back 14

Alveolar HYPOventilation

- caused by cuff leak, obstrution, incorrect vent setting, immobility that can lead to hypoxia so adjust FiO2

Front 15

Complication of PPV

Back 15

Alveolar HYPERventilation:

COPD clients @ risk, spontaneous hyperventilation

Front 16

Compication of PPV

Back 16

Ventilator assoicated pneumonia:
- all of antibiotoics if vented
- clients are more prone to infections
- contaminated areas
- lack of hand washing
- colonization in the oropharynx tract

Front 17

What are the ventilator modes

Back 17

CMV, A/C, SIMV, PSV, PEEP, CPAP

Front 18

High pressure limit alarm sounds, what do you do and what does it mean

Back 18

High pressure limit alarm = high pressure in the lungs

Secretion in ETT/airway or condensation in tubing so suction

Kink in venting tube

Anxiety/adgitation may need more sedation

Patient biting on ETT so may need to increase sedation and add bite block

Patient coughing, gagging, or trying to talk so may need to increase sedation via Verset

Increased airway pressure from bronchospasm or pheumothorax so may need albuterol tx and MUST asculate lungs

Front 19

What is the Low Pressure alarm and what do you do if it sounds

Back 19

Low Pressure alarm = low pressure in the lungs so no air getting to the lungs

Vent tubing not connected

Displaced ETT or trach tube

Front 20

What is the High Respiratory Rate alarm and what do you do

Back 20

High Respiratory Rate alarm = breathing > 20-28 breaths per min.

Patient anxiety/pain is #1 cause

Secretions in ETT/airway so suction

Hypoxia

Hypercapnia (breathing too fast)

Front 21

What is the Low Exhaled Volume alarm and what should you do

Back 21

Nothing is being exhaled

Vent tube not connected

Leak in cuff or inadequate cuff seal

Occurence of another alarm preventing full delivery of breath

Front 22

What is PS

Back 22

THe amount of air pushed into the lungs via a ETT

Front 23

What is FiO2

Back 23

The percent of oxygen to be delivered

Front 24

What do you assess for weaning from ventilator

Back 24

Clients ability to breath over the vent

Volume pulled

Pulse Ox, ABG, VS, CXR

Has gone thru the MODES

Mentation - start weaning off sedative

T-piece that takes client off the vent and puts on wall oxygen so no PEEP adn no PS

Normal ABG, TV > 350, breathing > 30, supplemental oxygen, Drs order

Front 25

What is ARDS

Back 25

Adult (acute) Respiratory Distress Syndrome:

It is a lung inflammatory response as it attracts neutrophils to the pulmonday interstitium and INCREASES the permeability of the alveolar THUS fluid moves into the interstitial and alveolar spaces. (pulmonary edema)

Alveoli fills w/ fluid/ hypoxia b/c no exchange.

Front 26

Causes of ARDS

Back 26

Sepsis, SIRS, MODS, pneumonia, apiration, chest trauma

Front 27

Clinical manifestations fo ARDS

Back 27

Increased respiratory rate, dyspnea, respiratory alkalosis, "white out" on CXR, rales, refractory hypoxia (hypoxia dispite oxygen supplementation), hypoxemia on ABG, decreased mentation b/c no oxygen

Front 28

Collaborative care for ARDS

Back 28

Ventilatory support, mechanical

Increased PEEP support

Positive pressure ventilation

Permissive hypercapnea = low TV b/c want to give highere PEEPS

Prone positioning as it allows fluid movement to other parts of the lung and allow ventilation of that part of the lung -use special bed to turn

Lateral rotation - bed can rotate client side to side

Chest vibration therapy - chest therapy done by bed

Front 29

Complication of ARDS

Back 29

Prone to oxygen toxicity as it is deliverd at such a high rate (aka - respiratory lung syndrome)

This will eventually damage lung cells so must wean FiO2

Front 30

Complications of chest trauma

Back 30

Closed, open, tension pneumothorax

Closed pheumothorax = spontaneous, no known reason, dmage to lung allows air to escape
CAUSED BY: esophageal rupture, broken ribs, mechanical ventilation damage

Open pneumo = air from OUTSIDE gets inside CAUSED BY: gunshot, post procedures such as a tripple lumen insertion, lung biopsy

Tension pneumo = caused by open or closed and it creates tension in the chest CAUSED BY: CPR, sucking chest wound as air in but not out

Front 31

What can be done for a possible sucking chest wound

Back 31

Sucking chest wound = air is getting in but not getting out. Use needle w/ 1 way valve to allow air out OR take a deep breath, pinch nose and mouth, blow out and pressure should expell the air and then seal it.

Front 32

What is Flail chest

Back 32

multiple rib fractures that are free floating so on inspiration, the flail segment of ribs is sucked inward. This compromises the amount of inspired air in the unaffected lung; On expiration, the flail segment of ribs bellows outward, creating more space on the affected side so some air is shunted back and forth vs passing thru the upper airway.

Front 33

How can you decrease the pressure in the PA if have pulmonary hypertension

Back 33

Decrease preload, diuretics, calcium channel blockers, a drip of Epoprostenol as it decreased PVR with a very short half life, lung transplant, vasodilators, anticoagulation