Term
| Order Least O2 Support to Most O2 support |
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Definition
1. NC: up to 6L
2. Venti mask: provides up to 50% FiO2
3. Non rebreather: provides 100% FiO2
4. BiPap: 100% FiO2 and positive pressure
5. Intubation |
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Term
| What does IS stand for? Purpose? How often should it be done? |
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Definition
| Incentive Spirometry helps pt to fully expand lungs in post op patients, helps prevent atelectasis. Should be done 10 X Q 1-2 hours while awake (try for every hour). Instruct the patient to suck in through the mouthpiece as hard as they can, try to meet or exceed goal tidal volume. |
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Term
| HIgh level PEEP may cause: |
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Definition
Barotrauma, hypotension, and decreased CO
Pt with increased PEEP will have SBP lowered by 5-10 |
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Term
| T/F Albuterol is a beta 2 specific drug and has no HR effect |
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Definition
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Term
Patient's ABG is:
pH: 7.3
CO2: 60
PO2: 80
HCO3: 24
SaO2: 92%
RR: 30
on NC 5L
What can you do? What orders do you expect? |
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Definition
Respiratory Acidosis, patient is not breathing deep enough to oxygenate well. Encourage pt to take deeper breathes. If they can't because of pain, may expect more effective pain management from MD. If not pain related, MD may order BiPap to increase time alveoli is open to increase gas exchange; bipap will give positive pressure and force deeper breathes
If patient doesn't breathe, may turn into PEA and a code |
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Term
| ARDS is? Primary or secondary? Causes? |
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Definition
Acute REspiratory Distress Syndrome
Secondary
Barotrauma, inhaled toxins, pneumonia, sepsis, influenza, aspiration, trauma |
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Term
| DIffrence between hypoxia and hypoxemia |
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Definition
Hypoxemia: decreased O2 in blood; widespread
Hypoxia: decreased O2 in tissue; specific to area (anoxic brain) |
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Term
| What could cause high peak pressure alarm? |
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Definition
| Patient biting ET tube, Kinked tubing, mucous plug, water condensation in tubing (causes high pressures; sloshing of water in tubing can trick vent into thinking the pt is trying to breathe spontaneously, will force another breath if on A/C) |
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Term
| Can you draw ABG while inline breathing treatment is running in ETT? |
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Definition
| No, PO2 will be falsely elevated because inline treatment is pushed in with additional L of O2 |
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Term
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Definition
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Term
| Cpaping pt to attempt Extubation, what 3 parameters are provided? |
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Definition
| PEEP, FiO2, Pressure support |
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Term
| Silence button on Vent lasts how long? |
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Definition
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Term
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Definition
| Hgb (most important), CO, SaO2 |
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Term
| O2 Protocol is what and what does it cover up to? |
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Definition
Do what you need to do to titrate to 94% is our standing order. May use nonrebreather, venti, but should be communicating with MD while doing so.
Can give Venti and NC at once |
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Term
| WHere can you find venti masks and NC? Intubation box? |
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Definition
Venti mask and NC: by the bathroom
intubation box on crash cart, never more than 20 feet from any room |
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Term
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Definition
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Term
| What do you need to ask the MD for when you call to get intubation orders? |
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Definition
1. Vent settings (Mode, FiO2, set rate, PEEP, Inspiratory pressure, PS, Tidal volume, goal SaO2)
2. Sedative
3. Pressors
4. ABG for 30 minutes after
5. CXR |
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Term
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Definition
No reliable clinical S/S for arterial oxygenation
Pallor/cyanosis is sign og hypoxia, not hypoxemia |
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Term
| When does organ failure begin? |
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Definition
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Term
| SpO2, aka oxygen saturation |
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Definition
Fraction of oxygen-sat Hgb relative to total Hgb in blood
Indirect measurement of SaO2
Low SaO2 (ABG), low SpO2 (pulse ox) - hypoxemia
Hypoxia: specific body part, clinical S/S |
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Term
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Definition
Partial pressure of arterial oxygen in the blood
Normal is 70-105
Supplemental O2 makes you PO2 higher! ROom air is only 21%; more will increase PO2 |
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Term
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Definition
Your FiO2 multiplied by three is roughly your PaO2
50% FiO2 will make your PO2 roughly 150
If not, there is an oxygenation problem, some obstacle to effective ventilation |
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Term
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Definition
Low levels of O2 in arterial blood, can cause tissue hypoxia
measured by PaO2 nd SaO2 and indirectly by SpO2 |
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Term
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Definition
Body is deprived of adequate O2 supply
Can be generalized or local
May use nitroglycerin paste to the toes |
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Term
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Definition
Ventilation is not adequate enough to perform needed gas exchange
Results:
increased concentration of CO2
decreased O2
leads to respiratory acidoses |
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Term
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Definition
RR x TV = ventilation
(Rate x depth) |
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Term
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Definition
Total amount of air moved ina dn out of lungs via inhalation and exhalation
Evaluation:
Tidal volume
Repiratory Rate
Chest Rise
Compliance |
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Term
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Definition
amount of gas expired per breath
normal 4-6 ml/kg
too hight= trauma to lungs |
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Term
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Definition
Ventilation per minute
Normal is 5-10 /min
Inversely affects CO2 (higher ventilation - low CO2, lower ventilation - high CO2) |
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Term
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Definition
Represents total pressure needed to push a volume of gas int lungs and is composed by
1. pressured resulting from inspiratory flow resistance
2. elasticity of lungs
3. alveolar pressure present (PEEP)
PEAK pressures - inspiratory pressure + PEEP
Constrictive lung disease will have high peak airway pressures |
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Term
| Postive End Expiratory Pressure |
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Definition
PEEP helps keep your alveoli from collapsing during exhalation
High PEEP can cause:
decreased CO
Hypotension
Barotrauma |
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Term
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Definition
Inspiratory to expiratory Ratio
Normal is 1:2, 1:3, 1:4
Inspiration is active, expiration is passive, takes longer |
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Term
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Definition
Expiration is shorter than inspiration
2:1, 3:1, 8:1
Ensures recruitment, constant inflation of the lungs give gas exchange longer to occur, helpful in damaged lungs
Hypercapnia due to low expiration times (permissive hypercapnia, e allow it because it is a smaller problem than desatting)
If patient becomes disconnected from vent, all the alveoli will collapse and desat
PT must be fully sedated because this is very uncomfortable adn unnatural, will fight the vent |
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Term
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Definition
Assist/Control: Pressure and volume
May receive controlled or assisted breaths
If pt triggers a breath, will receive the full volume and duration of the mandatory set breath
Pt can breathe if they want, but dont have to work for it
No weaning component
Causes hyperventilation as they awake and over breath the ventilator
Volume Control: rarely used in CVICU
Pressure control: set RR, Pi, PEEP, FiO2
Tidal volume is determined by the preset pressure limit |
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Term
| What is the difference between pressure setting and volume setting? |
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Definition
Pressure: Pi, fills lungs until set pressure is met
Volume: Forces the same tidal volume of air in each breath
Waveforms of set breaths will appear as green on monitor |
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Term
SIMV
Synchronized Intermittent Mandatory Ventilation |
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Definition
Early Weaning Mode for weak, chronic patients (rate of 8 or more)
More comfortable for awake patients overbreathing the set ventilator RR
The patient can breathe spontaneously while also receiving mandatory breaths
RR, Inspiratory pressure or tidal volume, pressure support, PEEP, FiO2
Red Waveforms represent spontaneous breaths with no assistance, only PS. Will usually be smaller, shallower |
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Term
CPAP
Continuous Positive Airway Pressure |
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Definition
FULL weaning mode
THe patient controls all parts of the breaht except pressure limit
The patient triggers the ventilator; there are NO set RR
THe ventilator delivers a flow up to a set present pressure limit depending on the desired minute ventilation
Tidal volumes may vary
Pressure support is a method of assisting spontaneous breating in a ventilated patient
Has set PS, PEEP, FiO2 |
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Term
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Definition
Needs to meet the following criteria:
1. Hemodynamically stable (MAP 65, HR less than 120, minimal drips, RR 6-28
2. SpO2 greater than 94% on FiO2 50% or lower
3. Patient is awake, and follows commands
CPAP = Pressure Support 5, FiO2 50%, PEEP 5 for 30 minutes, get ABG. If satisfactory, EXTUBATE
-If patient becomes unstable, return to vent to previous settings
-Extubate to 5 LNC; let MD know, and have RT bedside (they will be the one to do it)
As pressure support is weaned down, the TV and MV will go down naturally beacuase the support is going away; pt is doing it alone |
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Term
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Definition
Similar to PCV (Pressure control ventilation)
Ideal mode for APRV (Inverse I:E ratio)
-more comfortable than PC-IRV
FOr patients who have hypoxemia
-Improved PaO2 due to alveolar recruitment
-Allows for lower FiO2 due to better gas exchange in alveoli (due to longer open time)
Set RR, PS, High PEEP, Low PEEP, FiO2
This is good for patients who need higher PEEP but are overbreathing the vent; this setting keeps the alveoli open for a longer time |
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Term
| Volutrauma vs. Barotrauma |
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Definition
Volutrauma: damage to the lung caused by over distension by a mechanical vent set for an excessively high tidal volume
Barotrauma: mechanism of injury is excessive pressure
-High pressures needed to ventilate non-compliant lungs (ie: cystic fibrosis, pulmonary fibrosis)
-Scar tissue forms, function is forever impaired in that particular alveoli |
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Term
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Definition
No machine, patient, or operator trigered breath detected
ACTION: Ventilate the patient |
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Term
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Definition
Disconnection in the circuit
ACTION: Reconnect patient. Assess patient extubated, circuit tubing disconnect, displace ETT (ie, back of throat) |
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Term
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Definition
Patient circuit secverely occluded
ACTION: identify and resolve source of complete circuit occlusion
Assess crimped/occluded tubing, patient biting tube, mucus plug |
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Term
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Definition
Measured peak airway pressure high limit violated
ACTION: assess patien/vent cause for impeded air flow
Assess need for sucitoning, gag/cough, bronchoconstrictin/spasm, pneumothorax, condescation in tubing, compressed circuit tubing, patient trying to talk, tube advancement, decreased lung compliance |
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Term
| Increased total respiration rate |
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Definition
Machine plus patient breaths (total) limit exceeded
Action: evaluate patient and or vent for high RR
Assess: vent rate set too high, patient has anxiety, pain increased PCO2, secretions
Risk for air trapping creating auto-peep |
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Term
| Decreased mandatory tidal volume |
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Definition
Low exhaled mandatory breath tidal volume
ACTION: check source of air loss in circuit
Assess: loose crcuit connection, underinflated or incompetent cuff, pnuemothorax |
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Term
| Decreased spontatneous breath volume |
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Definition
Low exhaled spontaneous breath tidal volume
ACTION: assess patient's deapth and rate of respiration
Assess: patient for hypoventilation |
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Term
| Creating a safe environment with Ventilator |
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Definition
Vent and humidification alarms on
Never leave a pt once alarms are in silence mode (2 minutes)
Essential equipment bedside: ambu bag, extra O2 flowmeter, reintubation/retrach supplies, trach obturator
Suction set up, in working order
Pre/post oxygenate ptient when suctioning
When in doubt, ambu bag and call RT
Implemetn oral care interventions
implement ventilator bundle order set
Have plan to effectively ventliate patient regardless of trach type |
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Term
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Definition
Recruits Alveoli to increase lung volume and enchance gas exchange/oxygenation
may allow for decreased FiO2 due to alveiolar recruitment
Increases intrathoracic pressure = decreased preload, decreased CO, decreased BP, Increased PA pressure, increased ICP, decreased UP, increased ADH
May aid in decreasing pulmonary edema due to further decreased preload; may rebound effect when weaning = risk for pulmonary edema
Heart tones and BS more distant
DUe to high pressures, more at risk for subQ emphysema and alveolar rupture resulting in pneumothorac or tension pneumothorax |
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Term
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Definition
Increased peak pressures
Increased HR and RR
Decreased BP
Decreased breath sounds on affected sides
Tracheal deviation to non affected side
Sudden SOB
Chest pain
Cyanosis
Prepare for needle aspiration/CT insertion |
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Term
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Definition
HOB 3-45 degrees
Oral Care: may include chlorhexidine (toothbrushing more effective than sponge toothettes)
Suction subglottic secretions |
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Term
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Definition
Pre oxygenate 100% at least 30 seconds before, suction less than 10 seconds
Monitor rhythm, and SP02 while suctioning
Dont draw ABGS for 30 minutes after suctioning |
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Term
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Definition
Daily readiness assessment
1. underlying disease improved enough
2. oxygenation is adequate
3. inspiratory effort is afequate
4. hemodynamics stable
5. patient attempts spontaneously breathing
Weaning readiness criteria
1. underlying cause resolving
2. Adequate oxygenation: PEEP 5-8, FiO2 40-50%
3. pH >7.25
4. Hemodynamically stable
5. NIF <=-20
Respiratory <=30
MV <10 L
TV > 5 L
LOC
Hgb
patient emotionally ready
Usually takes 24 hours to recover from weaning induced respiratory muscle fatigue |
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Term
| Focal assessment of ventilated patient: |
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Definition
Breath sounds
Respiratory effort
Resp. intolerance
Chest movement equal
interatction with vent
suctioning effect
secretion character
s/S infection
GI bleed
pain management
Hemodynamics
Weight gains
Condition of mucosa |
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Term
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Definition
Devloping strength plus endurance
Physiologic/hemodynamics stability
A-A gradient
pCO2
pO2
VT
NIF
MV |
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