Podcast
Questions and Answers
What is the primary purpose of assist control mode in mechanical ventilation?
What is the primary purpose of assist control mode in mechanical ventilation?
In synchronized intermittent mandatory ventilation (SIMV), what occurs between the ventilator's breaths?
In synchronized intermittent mandatory ventilation (SIMV), what occurs between the ventilator's breaths?
What does positive end-expiratory pressure (PEEP) do during exhalation?
What does positive end-expiratory pressure (PEEP) do during exhalation?
How does continuous positive airway pressure (CPAP) function?
How does continuous positive airway pressure (CPAP) function?
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What is the main benefit of pressure support ventilation (PSV)?
What is the main benefit of pressure support ventilation (PSV)?
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What is the goal for tidal volume during mechanical ventilation?
What is the goal for tidal volume during mechanical ventilation?
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What does the I:E ratio compare in mechanical ventilation?
What does the I:E ratio compare in mechanical ventilation?
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What primary goal does FiO2 aim to achieve during mechanical ventilation?
What primary goal does FiO2 aim to achieve during mechanical ventilation?
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What is NOT a primary indication for mechanical ventilation?
What is NOT a primary indication for mechanical ventilation?
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Which type of mechanical ventilation is primarily utilized in acute care?
Which type of mechanical ventilation is primarily utilized in acute care?
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What phase of positive pressure ventilation comes after inspiration?
What phase of positive pressure ventilation comes after inspiration?
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Which variable is responsible for initiating the change from exhalation to inspiration in positive pressure ventilation?
Which variable is responsible for initiating the change from exhalation to inspiration in positive pressure ventilation?
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In positive pressure ventilation, what does the cycle variable do?
In positive pressure ventilation, what does the cycle variable do?
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Which classification of ventilator delivers a breath until a preset volume is reached?
Which classification of ventilator delivers a breath until a preset volume is reached?
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Positive pressure ventilation can be maintained by which of the following variables?
Positive pressure ventilation can be maintained by which of the following variables?
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Which type of ventilation is NOT suitable for use in a critical care setting?
Which type of ventilation is NOT suitable for use in a critical care setting?
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What is a major sign of acute kidney failure?
What is a major sign of acute kidney failure?
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Which of the following is a common first step to address a low pressure alarm in a dialysis unit?
Which of the following is a common first step to address a low pressure alarm in a dialysis unit?
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What is the average rate of blood flow through a fully matured fistula in hemodialysis?
What is the average rate of blood flow through a fully matured fistula in hemodialysis?
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What is the primary advantage of using a graft for vascular access in hemodialysis?
What is the primary advantage of using a graft for vascular access in hemodialysis?
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Which statement is true regarding the care of a fistula?
Which statement is true regarding the care of a fistula?
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In which condition is a patient likely to require dialysis for a short period?
In which condition is a patient likely to require dialysis for a short period?
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Which complication is associated with subclavian catheters used for dialysis?
Which complication is associated with subclavian catheters used for dialysis?
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What is the maximum weight a patient should gain between dialysis sessions to avoid hypotension?
What is the maximum weight a patient should gain between dialysis sessions to avoid hypotension?
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What medical condition is least likely to lead to acute kidney failure?
What medical condition is least likely to lead to acute kidney failure?
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What should be done if the endotracheal tube is obstructed?
What should be done if the endotracheal tube is obstructed?
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What is sensitivity in the context of mechanical ventilation?
What is sensitivity in the context of mechanical ventilation?
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Which of the following is NOT a complication associated with mechanical ventilation?
Which of the following is NOT a complication associated with mechanical ventilation?
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Which nursing care intervention is essential for clients on mechanical ventilation?
Which nursing care intervention is essential for clients on mechanical ventilation?
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How can ventilator-associated pneumonia (VAP) be effectively prevented?
How can ventilator-associated pneumonia (VAP) be effectively prevented?
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What is a sign that a patient may be ready for weaning from mechanical ventilation?
What is a sign that a patient may be ready for weaning from mechanical ventilation?
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What does bucking the ventilator refer to?
What does bucking the ventilator refer to?
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Which action should be taken if a ventilator alarm occurs and cannot be resolved immediately?
Which action should be taken if a ventilator alarm occurs and cannot be resolved immediately?
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What physiological factors are evaluated to determine a patient's ability to be weaned from mechanical ventilation?
What physiological factors are evaluated to determine a patient's ability to be weaned from mechanical ventilation?
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What should be closely monitored to assess the maturity of a fistula?
What should be closely monitored to assess the maturity of a fistula?
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Which of the following is discouraged during dialysis treatment?
Which of the following is discouraged during dialysis treatment?
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What is the expected duration of a typical dialysis session?
What is the expected duration of a typical dialysis session?
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What symptom may indicate the development of disequilibrium syndrome post-dialysis?
What symptom may indicate the development of disequilibrium syndrome post-dialysis?
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Which medication is used to stimulate red blood cell production in dialysis patients?
Which medication is used to stimulate red blood cell production in dialysis patients?
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What is the maximum amount of IV fluids that should be administered in 24 hours to prevent electrolyte disturbance?
What is the maximum amount of IV fluids that should be administered in 24 hours to prevent electrolyte disturbance?
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What is a common dietary restriction for patients on dialysis regarding sodium intake?
What is a common dietary restriction for patients on dialysis regarding sodium intake?
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What should be done to control bleeding from a fistula post-dialysis?
What should be done to control bleeding from a fistula post-dialysis?
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What is the primary goal in the care of Central Venous Catheters (CVCs)?
What is the primary goal in the care of Central Venous Catheters (CVCs)?
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What must be avoided during dialysis if the patient has been heparinized?
What must be avoided during dialysis if the patient has been heparinized?
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Which electrolyte imbalance is critical to monitor in dialysis patients due to its risk of cardiac complications?
Which electrolyte imbalance is critical to monitor in dialysis patients due to its risk of cardiac complications?
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What can result from rapid fluid removal during dialysis?
What can result from rapid fluid removal during dialysis?
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Why is communication with physicians regarding blood work important on dialysis days?
Why is communication with physicians regarding blood work important on dialysis days?
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How should a diet for a dialysis patient be structured concerning protein?
How should a diet for a dialysis patient be structured concerning protein?
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Study Notes
Mechanical Ventilation
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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
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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.
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Phases of Positive Pressure Ventilation:
- Change from exhalation to inspiration
- Inspiration
- Change from inspiration to expiration
- Exhalation
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Variables of Positive Pressure:
- Volume
- Pressure
- Flow
- Time
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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.
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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
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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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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.
