Mechanical Ventilation Quiz
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Questions and Answers

What is the typical respiratory rate for an adult patient on a mechanical ventilator?

  • 10-20 breaths per minute (correct)
  • 30-40 breaths per minute
  • 20-30 breaths per minute
  • 40-50 breaths per minute

    • What is the purpose of PEEP in mechanical ventilation?

  • To deliver a preset tidal volume
  • To synchronize patient breathing with the ventilator
  • To improve ventilation in patients with ARDS
  • To prevent collapse of small airways and alveoli (correct)

    • What is the mode of ventilation used for weaning from the ventilator?

  • Pressure Assist/Control (P-A/C)
  • Synchronized Intermittent Mandatory (SIMV) (correct)
  • Volume Assist/Control (V-A/C)
  • Volume Intermittent Mandatory (V-IMV)

    • What should be done when an alarm sounds during mechanical ventilation?

    <p>Look at the patient and assess for distress</p> Signup and view all the answers

    What is the purpose of pressure support mode in mechanical ventilation?

    <p>To assist patient breathing with a preset amount of inspiratory pressure</p> Signup and view all the answers

    Why is it important to monitor cuff pressure during mechanical ventilation?

    <p>To prevent tracheal necrosis</p> Signup and view all the answers

    What is the purpose of the Ventilator Bundle of Care?

    <p>To improve patient outcomes</p> Signup and view all the answers

    What is the purpose of inverse inspiratory to expiratory ratio in mechanical ventilation?

    <p>To improve oxygenation in patients with non-compliant lungs</p> Signup and view all the answers

    What should be done when a patient is disconnected from the ventilator circuit?

    <p>Manually ventilate the patient with a bag-valve device</p> Signup and view all the answers

    What is the purpose of the SIMV mode in mechanical ventilation?

    <p>To provide assistance with adequate ventilation</p> Signup and view all the answers

    What is the primary purpose of the device attached to the end of the ETT?

    <p>To detect the presence of CO2</p> Signup and view all the answers

    How is the aspiration device used to verify the placement of the ETT?

    <p>It is compressed, deflated, and attached to the ETT to detect CO2</p> Signup and view all the answers

    What should the tip of the ETT be positioned at during intubation?

    <p>3-4 cm above the carina</p> Signup and view all the answers

    Why is the ETT secured with tape or a commercial device?

    <p>To prevent the tube from being dislodged</p> Signup and view all the answers

    What is the preferred method of securing the ETT?

    <p>Using adhesive tape</p> Signup and view all the answers

    What is the purpose of the tracheostomy tube?

    <p>All of the above</p> Signup and view all the answers

    What is the advantage of using a tracheostomy tube over an ETT?

    <p>All of the above</p> Signup and view all the answers

    What should be done with the condensate in the ventilator tubing?

    <p>Drain it into the collection trap and empty</p> Signup and view all the answers

    How often should the ventilator tubing and equipment be changed or cleaned?

    <p>Every 48-72 hours</p> Signup and view all the answers

    Why should the patient be turned from side to side every 1-2 hours?

    <p>To promote circulation and prevent complications</p> Signup and view all the answers

    What is the purpose of inflating the cuff of the endotracheal tube?

    <p>To facilitate ventilation of the patient by sealing the trachea</p> Signup and view all the answers

    What is the purpose of the pilot balloon on the endotracheal tube?

    <p>To inflate and deflate the cuff of the endotracheal tube</p> Signup and view all the answers

    What is the purpose of the laryngoscope in oral endotracheal intubation?

    <p>To facilitate the passage of the endotracheal tube through the oropharynx</p> Signup and view all the answers

    Why is the patient positioned with their head extended and neck flexed during oral endotracheal intubation?

    <p>To improve visualization of the glottis</p> Signup and view all the answers

    What should be done to the outside of the endotracheal tube before insertion?

    <p>It should be lubricated with a water-soluble lubricant</p> Signup and view all the answers

    What is the purpose of using a stylet during oral endotracheal intubation?

    <p>To facilitate the passage of the endotracheal tube</p> Signup and view all the answers

    What is the purpose of verifying the placement of the endotracheal tube?

    <p>To verify that the tube is in the trachea, not the esophagus</p> Signup and view all the answers

    What is the purpose of the radiopaque line on the endotracheal tube?

    <p>To verify the placement of the tube on an x-ray</p> Signup and view all the answers

    Why is it important to check the cuff of the endotracheal tube for leaks?

    <p>To ensure a proper seal is maintained</p> Signup and view all the answers

    What is the purpose of using a minimal leak technique when inflating the cuff of the endotracheal tube?

    <p>To ensure a proper seal is maintained while allowing a minimal amount of air to pass</p> Signup and view all the answers

    Study Notes

    Mechanical Ventilation

    • Inspiratory to Expiratory (I:E) Ratio:
      • In spontaneous ventilation, inspiration is shorter than expiration
      • In mechanical ventilation, I:E ratio is usually set at 1:2 to mimic this pattern
      • Inverse I:E ratio (e.g. 2:1, 3:1) is used to improve oxygenation in patients with non-compliant lungs, such as ARDS
    • Positive End-Expiratory Pressure (PEEP):
      • Addition of positive pressure into the airways at the end of expiration
      • Measured in cm of H2O (typical setting: 5-20 cmH2O)
      • Increases oxygenation by preventing collapse of small airways and maintaining the number of alveoli available for gas exchange
    • Total Respiratory Rate:
      • Equals the number of breaths delivered by the ventilator (set rate) plus the number of breaths initiated by the patient
      • Provides data regarding the patient's contribution to the work of breathing and whether the ventilator is performing all of the work

    Modes of Mechanical Ventilation

    • Volume Controlled Modes:
      • Volume Assist/Control (V-A/C): delivers a preset respiratory rate of a preset tidal volume
      • Volume Intermittent Mandatory Ventilation (V-IMV): delivers a preset number of breaths of a preset tidal volume, with patient-initiated spontaneous breaths in between
    • Pressure Controlled Modes:
      • Continuous Positive Airway Pressure (CPAP): a non-invasive form of PEEP, delivers positive pressure throughout the respiratory cycle
      • Bilevel Positive Airway Pressure (BiPAP): provides positive airway pressure during both inspiration and expiration
      • Pressure Support (PS): a weaning mode, in which the patient's spontaneous respiratory activity is augmented by the delivery of a preset amount of inspiratory positive pressure
      • Pressure Assist/Control (P-A/C): a mode in which there is a set RR and every breath is augmented by a set amount of inspiratory pressure

    Alarm Systems

    • Two important rules:
      • NEVER shut off alarms
      • Manually ventilate the patient with a bag-valve device if unable to troubleshoot alarms quickly or if equipment failure is suspected
    • When an alarm sounds:
      • Look at the patient and assess their condition
      • Take immediate action if the patient is in acute distress
      • Use a bag-valve device to manually ventilate the patient if necessary
    • Alarms:
      • Apnea alarm: no spontaneous breath within a preset time period
      • Low-pressure alarm: indication of low exhaled volume
      • High-pressure alarm: indication of high pressure

    Nursing Interventions

    • Establish a means of communication with the patient
    • Ensure ETT is secured
    • Prevent accidental extubation
    • Suction oral and tracheal secretions as indicated
    • Use caution when moving or turning the patient
    • Have a manual bag-valve resuscitation device readily available
    • Administer medications as prescribed
    • Assess respiratory status and document findings
    • Monitor ventilator alarms and adjust settings as necessary

    Ventilator Bundle of Care

    • Should be implemented on all patients who receive mechanical ventilation to improve outcomes
    • Includes:
      • Maintaining HOB at 30-45 degrees
      • Interrupting sedation at least daily to assess readiness to wean from ventilator and extubated
      • Providing prophylaxis for DVT and peptic ulcer disease
      • Providing daily oral care with chlorhexidine

    Verification of Endotracheal Tube Placement

    • Use of esophageal intubation detector
    • Aspiration device
    • Confirming the position of the ETT tip at 3-4 cm above the carina
    • Recording the centimeter depth marking at the teeth and gums
    • Ensuring the ETT remains in proper position during each assessment

    Securing the Endotracheal Tube

    • Methods:
      • Adhesive tape
      • Harness device
    • Importance of securing the ETT to prevent migration to an unsafe position

    Tracheostomy

    • A tracheostomy tube provides an airway directly into the anterior portion of the neck
    • Indications:
      • Long-term mechanical ventilation
      • Long-term secretion management
      • Protecting the airway from aspiration
      • Bypassing an upper airway obstruction
      • Reducing the work of breathing associated with an ETT
    • Advantages:
      • Better tolerated than the ETT
      • Allows for oral intake and improved communication
      • Allows for easier oral hygiene and careHere are the study notes in markdown format:

    Gas Exchange

    • Work of Breathing (WOB): the amount of effort required for the maintenance of a given level of ventilation
    • Compliance: the measure of the stretchability of the lung and chest wall
    • Resistance: refers to the opposition to the flow of gases in the airways

    Acute Respiratory Failure

    • Definition: an inability of the respiratory system to provide oxygenation and/or remove carbon dioxide from the body
    • Classified into:
      • Oxygenation (Hypoxemic) Failure: PaO2 < 60 mm Hg with a normal or low PaCO2
      • Ventilatory (Hypercapnic) Failure: PaCO2 > 50 mm Hg and pH < 7.35
    • Goals for treatment:
      • Maintaining a patent airway
      • Optimizing O2 delivery
      • Minimizing O2 demand
      • Treating the cause of ARF
      • Preventing complications

    ARDS (Acute Respiratory Distress Syndrome)

    • Definition: acute respiratory failure with features:
      • Acute onset of less than 7 days
      • Hypoxemia that persists when 100% oxygen is provided
      • Decreased pulmonary compliance
      • Dyspnea
      • Pulmonary edema without a cardiac origin
      • Dense pulmonary infiltrates on chest x-ray
    • Etiology:
      • Sepsis
      • Pulmonary infections
      • Shock
      • Cardiopulmonary bypass
      • Inhalation of toxic gases/smoke inhalation
      • Pulmonary aspiration, especially of stomach contents
      • Trauma
      • Drug/alcohol overdose
    • Pathophysiology:
      • Systemic inflammatory response
      • Alveolar-capillary membrane injury
      • Surfactant production reduced
      • Lung fluid accumulation
    • Clinical manifestations:
      • Severe shortness of breath with labored and unusually rapid breathing
      • Hypotension
      • Tachycardia
      • Dysrhythmias
      • Confusion
      • Extreme fatigue
      • Cyanosis/pallor
      • Diaphoresis
    • Diagnostic studies:
      • Arterial blood gases
      • CBC panel
      • Blood culture
      • Urine culture
      • Sputum cultures obtained by bronchoscopy or tracheal aspiration

    Collaborative Care for ARDS

    • Goals:
      • Achieving adequate oxygenation
      • Supporting ventilation
      • Maintaining fluid balance
      • Preventing complications
    • Measures:
      • Non-invasive positive pressure ventilation (NPPV)
      • Mechanical ventilation
      • Fluid restriction
      • Sedatives
      • Electrolyte and acid-base imbalances correction
      • Vasopressors
      • Nutritional support
      • Alternative means of communication
      • Monitoring vital signs and mechanical ventilator settings

    Bronchopulmonary Dysplasia (BPD)

    • Definition: a chronic obstructive pulmonary disease that occurs in newborns who require oxygen and mechanical ventilation
    • Etiology:
      • Premature birth
      • Respiratory infection
      • Oxygen supplementation
      • Mechanical ventilation
    • Pathophysiology:
      • Lung immaturity
      • Pressure of mechanical ventilation damages bronchial epithelium
      • Thickening of alveolar walls
      • Cystic and atelectic areas develop in the lungs
    • Clinical manifestations:
      • Tachycardia/tachypnea
      • Pallor/cyanosis
      • Weight loss/poor weight gain
      • Restlessness/irritability
      • Pursing of the mouth with flaring of the nares
    • Diagnostic studies:
      • Chest x-ray
    • Collaborative care:
      • Weaning oxygen as tolerated
      • Maintaining adequate oxygenation
      • Preventing further lung disease
      • Promoting healing of damaged lungs

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    Test your knowledge on mechanical ventilation, including respiratory rates, PEEP, weaning modes, alarm responses, pressure support, and cuff pressure monitoring.

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