Mechanical Ventilation Overview
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What is the primary purpose of assist control mode in mechanical ventilation?

  • Decreases the risk of respiratory alkadosis by limiting machine breaths
  • Delivers a preset number of breaths and maintains a preset tidal volume (correct)
  • Allows patient-initiated breaths without any preset tidal volume
  • Reduces the frequency of breathing assistance over time

In synchronized intermittent mandatory ventilation (SIMV), what occurs between the ventilator's breaths?

  • The patient receives no support and must initiate all breaths.
  • The machine allows the patient to breathe spontaneously with limited assistance. (correct)
  • The ventilator delivers a higher tidal volume than preset.
  • The patient can take spontaneous breaths with no pressure support.

What does positive end-expiratory pressure (PEEP) do during exhalation?

  • Enables exhalation past a baseline pressure to improve tidal volume
  • Prevents exhalation below a preset pressure to maintain airway patency (correct)
  • Allows complete liberation of airways for exhalation
  • Increases the oxygen concentration in the air delivered to the patient

How does continuous positive airway pressure (CPAP) function?

<p>Administers positive pressure throughout the respiratory cycle for spontaneously breathing patients (B)</p> Signup and view all the answers

What is the main benefit of pressure support ventilation (PSV)?

<p>It provides positive pressure on inspiration to enhance oxygenation without full mechanical ventilation. (D)</p> Signup and view all the answers

What is the goal for tidal volume during mechanical ventilation?

<p>To achieve a tidal volume of 5-8 mL/kg (A)</p> Signup and view all the answers

What does the I:E ratio compare in mechanical ventilation?

<p>Inspiratory time to expiratory time (C)</p> Signup and view all the answers

What primary goal does FiO2 aim to achieve during mechanical ventilation?

<p>Deliver oxygen concentrations no greater than 40% while ensuring the patient remains above 60 mmHg (D)</p> Signup and view all the answers

What is NOT a primary indication for mechanical ventilation?

<p>Enhancing patient comfort during minor procedures (B)</p> Signup and view all the answers

Which type of mechanical ventilation is primarily utilized in acute care?

<p>Positive pressure ventilation (D)</p> Signup and view all the answers

What phase of positive pressure ventilation comes after inspiration?

<p>Change from inspiration to exhalation (D)</p> Signup and view all the answers

Which variable is responsible for initiating the change from exhalation to inspiration in positive pressure ventilation?

<p>Trigger variable (D)</p> Signup and view all the answers

In positive pressure ventilation, what does the cycle variable do?

<p>Ends inspiration (D)</p> Signup and view all the answers

Which classification of ventilator delivers a breath until a preset volume is reached?

<p>Volume-cycled ventilator (C)</p> Signup and view all the answers

Positive pressure ventilation can be maintained by which of the following variables?

<p>Baseline (C)</p> Signup and view all the answers

Which type of ventilation is NOT suitable for use in a critical care setting?

<p>Negative pressure ventilation (C)</p> Signup and view all the answers

What is a major sign of acute kidney failure?

<p>Decreased urine output (C)</p> Signup and view all the answers

Which of the following is a common first step to address a low pressure alarm in a dialysis unit?

<p>Check the connection and assess cuff pressure (B)</p> Signup and view all the answers

What is the average rate of blood flow through a fully matured fistula in hemodialysis?

<p>600-1200 ml/min (B)</p> Signup and view all the answers

What is the primary advantage of using a graft for vascular access in hemodialysis?

<p>It is suitable for patients whose blood vessels are fragile. (D)</p> Signup and view all the answers

Which statement is true regarding the care of a fistula?

<p>A sign should be posted above the patient's bed indicating the access type. (B)</p> Signup and view all the answers

In which condition is a patient likely to require dialysis for a short period?

<p>Acute Kidney Failure (D)</p> Signup and view all the answers

Which complication is associated with subclavian catheters used for dialysis?

<p>Pneumothorax (C)</p> Signup and view all the answers

What is the maximum weight a patient should gain between dialysis sessions to avoid hypotension?

<p>1.5 kg (C)</p> Signup and view all the answers

What medical condition is least likely to lead to acute kidney failure?

<p>Chronic Hypertension (A)</p> Signup and view all the answers

What should be done if the endotracheal tube is obstructed?

<p>Remove the obstruction (A)</p> Signup and view all the answers

What is sensitivity in the context of mechanical ventilation?

<p>The inspiratory effort required to trigger a mechanical breath. (B)</p> Signup and view all the answers

Which of the following is NOT a complication associated with mechanical ventilation?

<p>Muscular hypertrophy (B)</p> Signup and view all the answers

Which nursing care intervention is essential for clients on mechanical ventilation?

<p>Conducting regular respiratory assessments. (A)</p> Signup and view all the answers

How can ventilator-associated pneumonia (VAP) be effectively prevented?

<p>Elevating the HOB to 30 degrees. (A)</p> Signup and view all the answers

What is a sign that a patient may be ready for weaning from mechanical ventilation?

<p>Spontaneous breathing capability. (A)</p> Signup and view all the answers

What does bucking the ventilator refer to?

<p>The patient is fighting the ventilator, causing asynchrony. (D)</p> Signup and view all the answers

Which action should be taken if a ventilator alarm occurs and cannot be resolved immediately?

<p>Manually ventilate the patient with a bag until the issue is resolved. (D)</p> Signup and view all the answers

What physiological factors are evaluated to determine a patient's ability to be weaned from mechanical ventilation?

<p>Hemodynamic stability, oxygenation, and respiratory rate. (B)</p> Signup and view all the answers

What should be closely monitored to assess the maturity of a fistula?

<p>Feeling for thrill (D)</p> Signup and view all the answers

Which of the following is discouraged during dialysis treatment?

<p>Eating meals (B)</p> Signup and view all the answers

What is the expected duration of a typical dialysis session?

<p>3-5 hours (D)</p> Signup and view all the answers

What symptom may indicate the development of disequilibrium syndrome post-dialysis?

<p>Jerking or confusion (B)</p> Signup and view all the answers

Which medication is used to stimulate red blood cell production in dialysis patients?

<p>Erythropoietin (D)</p> Signup and view all the answers

What is the maximum amount of IV fluids that should be administered in 24 hours to prevent electrolyte disturbance?

<p>1000 mls (D)</p> Signup and view all the answers

What is a common dietary restriction for patients on dialysis regarding sodium intake?

<p>No added salt (A)</p> Signup and view all the answers

What should be done to control bleeding from a fistula post-dialysis?

<p>Apply firm direct pressure for at least 10 minutes (A)</p> Signup and view all the answers

What is the primary goal in the care of Central Venous Catheters (CVCs)?

<p>Maintain catheter patency and prevent infection (B)</p> Signup and view all the answers

What must be avoided during dialysis if the patient has been heparinized?

<p>Intramuscular injections (B)</p> Signup and view all the answers

Which electrolyte imbalance is critical to monitor in dialysis patients due to its risk of cardiac complications?

<p>Potassium (B)</p> Signup and view all the answers

What can result from rapid fluid removal during dialysis?

<p>Hypotension (D)</p> Signup and view all the answers

Why is communication with physicians regarding blood work important on dialysis days?

<p>To avoid unnecessary needle sticks (A)</p> Signup and view all the answers

How should a diet for a dialysis patient be structured concerning protein?

<p>High protein intake (D)</p> Signup and view all the answers

Flashcards

Mechanical Ventilation Indication

Supports cardiopulmonary gas exchange by increasing lung volume and reducing work of breathing. It also reverses hypoxemia, respiratory acidosis, distress, or atelectasis; reverses muscle fatigue; and allows for sedation/neuromuscular blockade, decreasing systemic and myocardial oxygen use, and intracranial pressure, stabilizing the chest wall.

Positive Pressure Ventilation

A critical care method using a mechanical device to force air into the lungs, usually via an endotracheal or tracheostomy tube. Non-invasive methods use masks.

Positive Pressure Ventilation Cycle

The variable controlling the end of inspiration; it can be pressure-, flow-, or volume-limited, determined by ventilator settings and client effort.

Volume-Cycled Ventilator

A ventilator that delivers a breath until a preset volume is reached.

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Pressure-Cycled Ventilator

A ventilator that delivers a breath until a preset pressure is reached in the client's airways.

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Flow-Triggered Breath

A breath initiated by the sensitivity setting of the ventilator and patient inspiratory effort, based on inspiratory flow.

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Ventilator Trigger

The phase variable that initiates the change from exhalation to inspiration.

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Ventilator Variables

Volume, pressure, flow, time are variables that are used to start, maintain and end each phase of inspiration.

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Time-cycled ventilator

Delivers a breath over a preset time interval.

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Assist-control ventilation

Ventilator provides full ventilation. Tidal volume and rate are preset. Delivers breaths if the patient doesn't initiate one; if patient initiates a breath, machine provides the preset tidal volume.

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Synchronized intermittent mandatory ventilation (SIMV)

Preset tidal volume and rate, but patient can take spontaneous breaths between ventilator breaths.

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Positive end-expiratory pressure (PEEP)

Preset pressure keeps airways open at the end of exhalation, preventing atelectasis and improving oxygenation.

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Continuous positive airway pressure (CPAP)

Positive pressure during the respiratory cycle for spontaneously breathing patients; Non-invasive (mask) or invasive (tube).

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FiO2

Fraction of inspired oxygen; concentration of oxygen delivered to patient.

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Tidal Volume

Volume of air received per breath; Goal 5-8 mL/kg.

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Respiratory Rate

Number of breaths per minute; Goal 10-12.

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Mechanical Ventilation Complications

Potential problems caused by mechanical ventilation, including barotrauma, pneumothorax, and ventilator-associated pneumonia (VAP).

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Ventilator-Associated Pneumonia (VAP)

Lung infection caused by mechanical ventilation; often triggered by contaminated equipment or procedures.

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Nursing Care for Ventilation

Ongoing care for patients on mechanical ventilation including respiratory assessment, nutritional support, and pain management.

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Preventing VAP

Strategies to reduce the risk of ventilator-associated pneumonia, such as elevating the head of the bed and maintaining good oral hygiene.

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Ventilator Weaning

Gradual process of removing a patient from a ventilator based on assessed readiness.

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Weaning Assessment

Evaluating the patient's stability and respiratory function to determine readiness for a weaning trial.

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Ventilator Bucking

Patient actively resisting the ventilator, causing a mismatch in respiratory effort.

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Common Ventilator Alarms

Warnings that indicate problems with the ventilator's function or patient issues.

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High pressure alarm

Indicates a problem with the airway or breathing circuit during mechanical ventilation.

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Low pressure alarm

Signals a disconnection or leak in the breathing tube.

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Acute Kidney Failure

Rapid onset of kidney failure.

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Hemodialysis

A treatment used to remove waste products from the blood when the kidneys fail.

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Vascular Access (Fistula)

A surgically-created connection between an artery and vein for dialysis.

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Graft

Tube connection for dialysis when a Fistula is not possible.

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Central Venous Catheters

Temporary or permanent catheters used for dialysis access in the veins.

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Fistula Care

Daily assessment and precautions to prevent complications and infection of the access.

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Causes of Acute Kidney Failure

Conditions that lead to rapid loss of kidney function.

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Hemodialysis frequency

Usually performed three times a week to treat kidney failure.

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Dialysis Bruit

A whooshing or pulsating sound heard with a stethoscope, signifying adequate blood flow through the fistula.

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Fistula Thrill

A vibration or pulsation felt, indicating high blood flow through a fistula. Stronger thrill=more mature fistula.

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Infection Risk in Dialysis

Watch for redness, swelling and drainage around fistula site and decreased circulation (pallor, slow capillary refill).

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Pre-Dialysis Report

Communicate any changes in patient's condition, medications, procedures or surgeries to dialysis nurse.

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Dialysis Diet

Restricted potassium, phosphorus, and salt. High protein, and diabetic diet if applicable.

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Weight-Fluid Correlation

1 kg weight loss= 1 L of fluid loss.

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Post-Dialysis Bleeding

Check for bleeding after dialysis, possibly from the fistula site or puncture sites from blood draws.

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Disequilibrium Syndrome

A dangerous condition caused by too rapid fluid removal during dialysis, leading to symptoms like restlessness, headache, and seizures.

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Post-Dialysis Hypotension

A sudden drop in blood pressure

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Fistula Care Post-Treatment

Apply firm pressure for 10 minutes, using tipstop bandages then gauze and cling film until the bleeding stops.

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Bleeding from Fistula

Apply firm pressure at the site until bleeding stops.

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CVC Care

Maintain the catheter (CVC) in a clean, secure, and infection-free state.

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Fluid Restriction

Limit intake to amounts as specified by the physician or dietitian.

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Dialysis Blood Work

Monitor for increased creatinine and urea, potassium, sodium and phosphorus as well as decreased calcium levels.

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Renal Diet

A diet specifically designed for patients with kidney disease, to manage fluid and various mineral(potassium, phosphorus) levels in the blood.

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Anticoagulation

Medications like heparin may be used during dialysis to prevent blood clots.

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Study Notes

Mechanical Ventilation

  • Indications: Supporting cardiopulmonary gas exchange, increasing lung volume, reducing work of breathing, reversing hypoxemia and acute respiratory acidosis, relieving respiratory distress, preventing/reversing atelectasis, reversing ventilatory muscle fatigue, permitting sedation/neuromuscular blockade, decreasing systemic/myocardial oxygen consumption, reducing intracranial pressure, stabilizing chest wall

  • Types of Ventilation:

    • Negative pressure: Applied externally to decrease atmospheric pressure around the thorax to initiate inspiration; not used in critical care.
    • Positive pressure: Acute care setting; uses a mechanical drive to force air into the lungs (usually through an ETT or tracheostomy tube). Non-invasive methods use masks (nasal or facial) and a ventilator/BiPAP machine for both inspiration and expiration.

  • Phases of Positive Pressure Ventilation:

    • Change from exhalation to inspiration
    • Inspiration
    • Change from inspiration to expiration
    • Exhalation

  • Variables of Positive Pressure:

    • Volume
    • Pressure
    • Flow
    • Time

  • Trigger: The phase variable that initiates the change from exhalation to inspiration. Breaths can be pressure-triggered or flow-triggered, based on the ventilator's sensitivity setting and the client's inspiratory effort.

Positive Pressure Ventilator Classifications

  • Volume-cycled: Delivers a breath until a preset volume is delivered.
  • Pressure-cycled: Delivers a breath until a preset pressure is reached in the client's airways.
  • Flow-cycled: Delivers a breath until a preset inspiratory flow rate is achieved.
  • Time-cycled: Delivers a breath over a preset time interval.

Ventilation Modes

  • Assist Control: Ventilator provides full ventilation for the client; tidal volume and ventilation rate are preset. Delivers preset breaths if the client doesn't initiate a breath; enables client to control some breaths if they do initiate a breath. May cause hyperventilation and respiratory alkalosis.
  • Synchronized Intermittent Mandatory Ventilation (SIMV): Tidal volume and ventilation rate are preset. Client can take spontaneous breaths between ventilator breaths; helps in weaning off the ventilator.

Modes of Mechanical Ventilation

  • Continuous Positive Airway Pressure (CPAP): Application of positive pressure during the respiratory cycle for spontaneously breathing clients. Non-invasive (face mask or nasal mask) or invasive (endotracheal tube or tracheostomy tube). Used for obstructive sleep apnea.
  • Pressure Support Ventilation (PSV): Positive pressure is delivered to the client on inspiration; helps alleviate work of breathing, increases oxygenation, and helps avoid atelectasis.
    • Lower oxygen concentrations may be required.

Additional Variables Affecting Ventilation

  • FiO2: Oxygen concentration delivered to the client (goal is to maintain PaO2 >60 mmHg using FiO2 of 40% or less).
  • Tidal Volume: Volume of air a client receives with each breath (goal 5-8 mL/kg).
  • Respiratory Rate: Number of breaths each minute (goal is 10-12).
  • Positive End-Expiratory Pressure (PEEP): Adds positive pressure on expiration; improves oxygenation by enhancing gas exchange and preventing atelectasis.
  • I:E Ratio: Comparison of inspiratory to expiratory time.
  • Peak Airway Pressure: Maximal pressure level achieved during a breath.
  • Sensitivity: The inspiratory effort required to trigger a mechanical breath.

Complications of Mechanical Ventilation

  • Barotrauma, pneumothorax, subcutaneous emphysema, malnutrition, muscular deconditioning, hypotension, alterations in cardiac function, fluid retention.

Nursing Care for Clients on Mechanical Ventilation

  • Respiratory assessment
  • Arterial blood gas analysis
  • Placement of ETT and monitoring
  • Airway clearance
  • Nutritional support
  • Eye care, oral care
  • Pain management & communication
  • Troubleshooting ventilator & weaning client
  • Preventing VAP: Elevating HOB and providing oral care.

Preventing VAP (Ventilator-Associated Pneumonia)

  • Elevating head of bed (30 degrees)
  • Interrupting sedation for spontaneous breathing trials (daily)
  • Preventing pain.
  • Assessing delirium and other complications from the ventilator.
  • Using oral care versus nasal care (consider patient swallowing and ability).

Ventilator Alarms

  • High Pressure Alarm: Occurs if secretions, a plugged tube, bronchospasm, dislodged tube, kinked/obstructed/removed tubes/obstructions, or coughing, gagging, biting tubes, anxiety, or inappropriate alarms.
  • Low Pressure Alarm: Occurs if a disconnection, leak in the tube, or cuff issues or inappropriate alarms.

Other Important Considerations

  • Vascular access (for dialysis): Avoiding cephalic veins; using radial or brachiocephalic sites.
    • Fistulas and grafts: care of fistula & monitoring for complications, such as stenosis.
  • Diet Restrictions: Diabetic patients or those with renal failure; protein, potassium, phosphorus, and fluid restrictions. Diets for those who will be on dialysis.
  • Medications: Managing pain control (morphine, codeine, acetaminophen). Avoid demerol in circumstances causing seizure risks and other specific needs related to dialysis.
  • Post-dialysis care: Bleeding from the fistula, monitoring blood pressure and for hypotension.
  • Analgesics: Morphine/Codeine, Acetaminophen; Acetylsalicylic Acid avoidance (due to gastric ulcers potential).
  • Vitamins: Specific vitamin B and C preparations are often readily available.

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CNA Presentation: Mechanical Ventilation PDF

Description

This quiz explores the essential concepts of mechanical ventilation, including its indications, types, and phases. Test your knowledge on how mechanical ventilation supports respiratory function in patients. Ideal for healthcare professionals and students specializing in respiratory care.

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