Modes
What is the least invasive mode of ventilation and what routes is the pressure delivered?
Bipap, and it is delivered via oral or nasal masks.
What setting refers to the percentage of oxygen being delivered to the patient?
FiO2
The head of the bed should be elevated at least this much to help prevent VAP?
30 degrees
What vent mode is used for weaning trial?
SIMV!
A mechanically ventilated patient’s high-pressure alarm sounds. The nurse should take this action first.
Assess the patient’s airway and respiratory status
Possibly be ready to manually bag the patient and call RT if we dont know why its sounding.
What vent mode is most commonly used and how does it work?
Assist Control and it works by giving the patient the full preset breath when they initiate one.
What does PEEP mean? What does it do?
Positive end expiratory pressure, Positive pressure maintained at the end of exhalation to increase functional residual capacity and open collapsed alveoli
What is the sedation vacation or the weaning trials?
This is done to help assess readiness for extubation and loweres time on the vent but we need a doctors orders.
What oxygen saturation suggests the patient may not be tolerating the weaning process?
about 90% or less.
What are a few vent complications that can happen?
Hypotension
Respiratory complications
GI alterations
Malnutrition
Infections
Muscular deconditining
Ventilator Dependence
What mode is used for the weaning process and how does it work? (the machine not the weaning process)
SIMV is used for the weaning process and its when a patient can take a breath during the machine however, they can only take the full extent of their breath and aren't given more to support them.
What setting helps assist a pateint with spontaneous breaths and helpful during weaning?
Pressure Support
What should always be done first before repositioning the patient to help reduce the risk of aspiration?
Oral suctioning should always be done first.
Name all 3 neurological signs that the patient is not tolerating the weaning process?
Anxiety and agitation
Decreased LOC
Subjective discomfort
What are proprity assessments for a patient who is ventilated?
VS, lung sounds, respiratory status, chest expansion, pulse ox, ABGs, need for suctioning, vent settings, alarm sounds on.
True or false
Assist control and SIMV both can be used during the weaning process to allow for the patient to come off of the ventilator
What are ALL the different settings on a ventilator?
Tidal volume, rate, FiO2, Peep, pressure support (PS)
What are at least two ways to prevent peptic ulcer disease? and at least two ways to prevent DVT?
Peptic Ulcer: Protonix and Pepcid
DVTs: SCDs, Heparin, Lovenox
Name two cardiovascular signs tht means the weaning process should be stopped?
HR or BP changes greater than 20% than baseline
Dysrhythmias
ST changes
Diaphoresis
What are interventions that are needed for a patient on a ventilator?
Keep alarms on, ambu bag at bedside, suction as needed, emptying the tubing, bagging the patient if the vent fails
Which vent setting can a patient start to hyperventilate if not being monitored?
Assist-Control
What is Tidal Volume? How is it calculated?
Volume of air inspired and expired with each breath during normal breathing (defintion from the book in chapter 17)
Volume of air a client received with each breath. Calculated by height x weight
Name everything we do for VAP prevention!
30 degree head of bed
Sedation vacation/weaning trials
Oral care or practicing their ADLs
Suction orally before repositioning
Peptic ulcer prophylaxis
DVT prophylaxis
Good hand hygiene
Name at least 3 things we would see in the respiratory system that would make us stop the weaning process?
RR greater than 35 or less than 8
Labored resperations
Accessory muscle use
Abnormal breathing pattern
O2 stats less than 90%
A nurse enters the room and finds the ventilator disconnected from the ET tube and the patient's oxygen saturations dropping. What is the priority action?
Reconnect if immediate and safe or manually bag the patient with the ambu bag as you call for help