N240 Olol - Test 1 - Ventilator Seminar

Front 1

Contents of Ventilator Seminar

Back 1

-Pulse oximetry
-Manual ventilation with ambu
-Oxygen delivery systems
-Artificial airways

Front 2

Pulse Oximetry

Back 2

-Noninvasive measurement of oxygen saturation (SAO2).
-Measures the percent of hemoglobin that is bound.
-Can be used for continuous monitoring or spot check.
-Can reduce the need for frequent ABGs
-Can it completely replace ABGs?

Front 3

Pulse Oximetry (con't)

Back 3

-How do you know that your readings are accurate?

-What conditions could interfere with accuracy of measurements?

Front 4

Manual Ventilation with Ambu Bag

Back 4

-Proper position make a “C” with the hand.
-Thumb holds mask firmly over the nose to make a seal, 1-2 fingers hold the lower part of the mask firmly over the chin, 4-5 finger reach under the chin and lift opening the airway with a chin lift.
-Compress the bag with your dominate hand.

Front 5

Ambu Bag

Back 5

-Avoid overinflation, normal tidal volume 700 ml, ambu bag holds 1500 ml.
-Don’t forget to allow patient to exhale.
-Bag in synchrony with spontaneous breaths.
-Keep at bedside of all ventilated patients
-Connect to oxygen and turn the oxygen up to 15 l/min.

Front 6

Ambu Bag (con't)

Back 6

-When the ventilator malfunctions, why is the ambu bag your best friend?

Front 7

Review oxygen delivery systems

Back 7

-Great chart on p 602.
-Room air oxygen 21%. If patient develops hypoxemia, supplemental oxygen is needed.
-Some common choices are nasal cannula, face mask, nonrebreather, Venturi mask, trach collar.

Front 8

Nasal Cannula

Back 8

-Nasal cannula: flow is measured in l/min. not very precise delivery method.
-Affected by mouth breathing, obstructed nose.
-Advantages simple, patient can mobilize, eat, speak.
-Humidify for flow rates over 3 l/min.
- 1-2 l/min=23-30%
- 3-5 l/min=30-40%
- 6 l/min=42%

Front 9

Face mask

Back 9

-Oxygen is collected and stored in the mask.
---Patient breaths oxygen rich environment and exhales CO2 through openings in the sides of the mask.
- 6-8 l/min=40-60%

Front 10

Nonrebreather mask

Back 10

-Mask is attached to a reservoir bag. Oxygen enters the mask and bag.
-Patient breaths in oxygen rich environment and one way valves keep CO2 from entering the reservoir on exhalation. CO2 exits through flaps in the side of the mask.
- 12 l/min = 80-100%
-Usually used when high concentrations of oxygen are needed.

Front 11

Venturi Mask

Back 11

-High flow system provides most precise oxygen concentrations.
-Nurse dials in the oxygen required and as the dial turns openings in the mask are opened or closed to allow more or less room air to mix.
-Advantage is the accuracy of oxygen flow.
- 4-6 l/min = 24-28%
- 6-8 l/min = 30-40%

Front 12

Tracheostomy Collar

Back 12

-Provides humidified oxygen to a tracheostomy tube.
---Plastic collar lies over the tracheostomy opening and is fastened around the neck with elastic ties.
- 8-10 l/min=30-100%

Front 13

Artificial Airways

Back 13

-Endotracheal tubes
-Assessing position
--Auscultate equal bilateral breath sounds
--Apply CO2 detector between the endo tube and ambu bag
--Chest x ray to visualize tip 2cm above the carina
--Any others?

Front 14

Artificial Airways
--Any others?

Back 14

-

Front 15

Artificial Airways
(Respiratory Therapist)

Back 15

-Respiratory therapy will secure the endotracheal tube with tape or ties.
-Document placement by recording the cm mark on the tube at the level of the lips.
-Maintain cuff pressure to prevent aspiration or tissue necrosis on tracheal mucosa.

Front 16

Artificial airway
(con't)

Back 16

-Tracheostomy tubes, long term airway needs.
-Fenestrated tubes used for weaning and speech
-Outer cannula has a hole that when the inner cannula is removed and the trach is plugged at the opening in the neck the patient is able to move air through their upper airway.
-Allows air to pass through the vocal cords and speech to be resumed.
-When trach is plugged deflate the cuff and remove the inner cannula.
-Can you plug a nonfenestrated trach?

Front 17

Advantages to Tracheostomy tube

Back 17

-

Front 18

(PART II)
Mechanical Ventilation

Back 18

-Physiology of normal breathing
-Volume cycled-pressure limited ventilators
-Ventilator settings
-Modes of ventilation
-Troubleshooting alarms

Front 19

Normal Breathing

Back 19

-Normally people negative pressure breathe. Our diaphram contracts and pressure inside the chest becomes more negative. Gases move from areas of higher pressure to lower pressure and air rushes into our lungs.
-Exhalation is passive with the diaphram muscle relaxing and elastic properties of the lungs pushing air out of the lungs.
-Placing a patient on a ventilator changes all of the normal dynamics. All of a sudden a machine is forcing air into the lungs.
-Pressure in the ventilator has to be greater than the pressure in a patient’s lungs to cause air to enter.
-Mechanical ventilation is positive pressure breathing.

Front 20

Volume cycled
- Pressure limited ventilation

Back 20

-Volume cycled – each breath delivered to the patient has a predetermined volume. For example a Tidal volume of 700 ml means that with each ventilator breath the machine delivers 700 ml.
-Pressure limited – a safety feature that stops a breath if a certain pressure is reached.
-Peak inspiratory pressure - Amount of pressure needed to give a ventilator breath.

Front 21

Ventilator settings

Back 21

-Tidal volume – amount of air delivered to the lung with each breath.
-Rate- the number of breaths delivered by the ventilator each minute.
-Oxygen percentage – Percent of oxygen delivered with each breath. Referred to as the Fraction of inspired oxygen (FIO2).
-Peak inspiratory pressure – amount of pressure required to deliver a breath.

Front 22

Modes of ventilation

Back 22

-Control mode or assist control - CMV
-Synchronized intermittent mandatory ventilation (SIMV)
-Continuous Positive airway Pressure (CPAP)
-Positive end expiratory pressure (PEEP)
-Pressure support (PS)

Front 23

Control mode ventilationor assist control

CMV

Back 23

-Preset tidal volume is delivered at a preset rate.
-If the patient attempts to breath between breaths the ventilator will give a ventilator breath.
-Generally used on patients with most severe oxygenation problems.
-Should only be used for a short time due to potential respiratory muscle atrophy.
-Cannot wean in this mode.

Front 24

Synchronized IntermittentMandatory Ventilation (SIMV)

Back 24

-Ventilator delivers a preset volume at a preset rate.
-If the patient tries to breathe between ventilator breaths the ventilator allows them to take as many additional breaths as they like.
-Best weaning mode, rate can be reduced gradually allowing the patient to breathe more on their own.
-Patient retains respiratory muscle strength.

Front 25

Continuous positive airway pressure (CPAP)

Back 25

-No preset mechanical breaths
-Patient must have spontaneous respirations.
-Can apply PEEP to this mode to help prevent atelectasis.
-CPAP trial – short test before extubation
-Different than CPAP machines for sleep apnea.

Front 26

Positive end expiratoryPressure (PEEP)

Back 26

-Improves oxygenation by providing some resistance to alveoli at the end of expiration. This maintains alveoli in slightly open position.
-Added to other modes of ventilation in increments of 3 cm of water to improve oxygenation.
-Optimum PEEP increasing PEEP improves oxygenation only to a point. At a certain point alveolar distention may compress capillary bed impairing perfusion, and oxygenation deteriorates.
-Side effects of PEEP, increased intrathoracic pressure, decreased venous return, decreased cardiac output.
-Increases cardiac workload
-Detrimental in hypovolemic shock

Front 27

Purpose of adding PEEP

Back 27

-Improve oxygen level

Front 28

Pressure support (PS)

Back 28

-Augments patient’s spontaneous respirations.
-Pressure is increased on inspiration to boost patient’s efforts.
-Used with other ventilator modes like SIMV and CPAP

Front 29

Troubleshooting alarms

Back 29

-High pressure alarms
-Low pressure alarms

Front 30

High Pressure Alarms

Back 30

Patient coughing
-Needs suctioning
-Circuit kinked
-Patient biting on tube
-Tension pneumothorax

Front 31

Low Pressure Alarms

Back 31

-Disconnected circuit
-Leak in circuit or cuff
-Underinflated cuff
-Patient extubated

Front 32

Can pulse ox completely replace ABG's

Back 32

-

Front 33

How do you know that your readings with a pulse ox are accurate?

Back 33

-

Front 34

What conditions could interfere with accuracy of measurements?

Back 34

-

Front 35

A nurse is explaining to a student how to ventilate with an Ambu bag. What does she say?

Back 35

make a C with your hand
thumb holds mask firmly over the nose
1 &2 fingers hold the mask over the chin and the other fingers lift the chin to open the airway
compress the airbag with dominant hand
allow the patient to exhale
bag with spontaneous breaths
keep at bedside of all ventilate ptes
then connect pt to O2 up to 15 L/min

Front 36

When the ventilator malfunctions, why is the ambu bag your best friend?

Back 36

-

Front 37

What are the flow rates and percentages for nasal cannula?

Back 37

room air is 21% so...
1-2 L/min = 23-30%
3-5 L/min = 30-40%
6L/min = 42%

Front 38

What is the flow rate and percentage for a face mask?

Back 38

6-8 L/min = 40-60%

Front 39

What is the flow rate and percentage for a non-rebreather mask?

Back 39

12 L/min = 80-100%
mask and reservior bag

Front 40

What is the flow rate and percentage for a Venturi mask?

Back 40

4-6 L/min = 24-28%
6-8 L/min = 30-40%

Front 41

Which type of ventilation method delivers the most accuracy of O2 flow?

Back 41

Venturi mask- most precise O2 concentrations

Front 42

What type of ventilator is used on a trach patient?

Back 42

Trach collar

Front 43

What is the rate and percentage for a trach collar?

Back 43

8-10 L/min = 30% -100%

Front 44

What is the major difference between normal breathing and ventilator breathing?

Back 44

normal breathing is negative pressure and ventilation is positive pressure

Front 45

A pt is recieving Volume cycled ventilation. The nurse knows this means?

Back 45

that each breath delivered to the pt has a predetermined volume

Front 46

How can the nurse be sure that a Volume cycled ventalater is not going to deliver over the tidal volume required?

Back 46

these are Pressure limited- a safety feature that stops the breath when a certain pressure is reached

Front 47

When is a CMV ventilator used?

Can you wean a pt off of a CMV?

Back 47

on the most severe O2 problems
and should be used for only a short time-

no

Front 48

Explain to a pt what a CPAP is?

Back 48

no preset mechanical breaths

pt must be able to breath on own

Can be used with PEEP (prevents atelectasis)

not same machine used for apnea

Front 49

When should PEEP not be used?

Back 49

for a pt in hypovolemic shock

Front 50

The nurse knows that side effects of PEEP are?

Back 50

decreased venous return (supine, legs up?) decreased cardiac output, increased cardiac workload, increased intrathoraic pressure

Front 51

When does PEEP quit being an improvement on oxygenation?

Back 51

at a certain point alveolar distention may compress capillary beds impairing perfusion and oxygenation deteriotes

Front 52

A pt is put on PEEP. The nurse knows this is to?

Back 52

improve oxygen levels

Front 53

A pt is put on PS support. The nurse explains to the pt that this will?

Back 53

augument the pt's spontaneous respirations. It is sometimes used with SIMV and CPAP

Front 54

What will set off a highpressure alarm?

Back 54

pt coughing
needs suctioning
kink in circuit
pt biting on tube
tension pneumothorax

anything that occuldes the tube

Front 55

What will set off a low pressure alarm?

Back 55

anything disconnected
or leaking or underinflated cuff