Noninvasive Ventilation Techniques in Nursing
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Questions and Answers

What is the primary function of noninvasive positive pressure ventilation in the treatment of sleep apnea?

  • It serves as a monitoring device for sleep patterns.
  • It reduces the need for sedatives during sleep.
  • It prevents airway collapse by maintaining positive pressure. (correct)
  • It administers medication directly to the lungs.

Which of the following describes the operation of a Bi-level Positive Airway Pressure (BiPAP) device?

  • It cycles between a higher pressure during inspiration and a lower pressure during expiration. (correct)
  • It requires no mask and administers air directly to the lungs.
  • It provides constant pressure throughout both inspiration and expiration.
  • It operates only during sleep and is turned off during wakefulness.

What is an important nursing action when using noninvasive positive pressure ventilation devices?

  • Adjust the mask size if discomfort occurs.
  • Increase the oxygen flow every hour.
  • Keep the patient in an upright position at all times.
  • Check the skin for breakdown around the mask area. (correct)

Why is continuous positive airway pressure (CPAP) considered effective for sleep apnea treatment?

<p>It consistently delivers a set level of positive pressure to keep airways open. (C)</p> Signup and view all the answers

For which patient condition is Bi-level Positive Airway Pressure (BiPAP) most commonly used?

<p>Patients requiring additional ventilation assistance, such as those with COPD. (C)</p> Signup and view all the answers

What is a key advantage of oral intubation over nasal intubation?

<p>It can be performed faster and easier. (B)</p> Signup and view all the answers

What is a critical action to take if intubation attempts exceed 30 seconds?

<p>Reoxygenate the client before attempting another intubation. (B)</p> Signup and view all the answers

How can proper placement of an endotracheal tube be verified?

<p>Through the use of a chest x-ray. (C)</p> Signup and view all the answers

What is the purpose of inflating the cuff on the tracheal end of an ET tube?

<p>To ensure the seal between the cuff and tracheal wall prevents air leak. (A)</p> Signup and view all the answers

Which of the following should be monitored after intubation to ensure patient safety?

<p>End-tidal carbon dioxide levels. (A)</p> Signup and view all the answers

What is the range of FiO2 levels delivered by mechanical ventilation?

<p>21% to 100% (C)</p> Signup and view all the answers

What is a key benefit of mechanical ventilation related to lung function?

<p>Decreased work of breathing (C)</p> Signup and view all the answers

Which device is NOT used to deliver mechanical ventilation?

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

What is the primary method through which positive-pressure ventilators provide air to the lungs?

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

What is a primary indication for noninvasive positive pressure ventilation?

<p>To ensure adequate oxygen saturation of 95% or greater (C)</p> Signup and view all the answers

Which of the following conditions does NOT qualify as a potential diagnosis for noninvasive positive pressure ventilation?

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

What should be established to aid communication with a client undergoing respiratory support?

<p>A method for yes/no questions (B)</p> Signup and view all the answers

Which potential diagnosis is indicated for respiratory support following surgery?

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

In which scenario is noninvasive positive pressure ventilation particularly beneficial?

<p>While managing acute pulmonary edema (A)</p> Signup and view all the answers

What is the primary risk associated with Inverse Ratio Ventilation (IRV)?

<p>Risk of volutrauma and decreased cardiac output (C)</p> Signup and view all the answers

Which mode of ventilation requires the use of two ventilators for a client with unilateral lung disease?

<p>Independent Lung Ventilation (ILV) (D)</p> Signup and view all the answers

What is a key characteristic of Airway Pressure Release Ventilation (APRV)?

<p>Allows alveolar gas to be expelled through natural recoil (A)</p> Signup and view all the answers

Which ventilation mode is associated with delivering small amounts of gas at very high frequencies?

<p>High-Frequency Ventilation (D)</p> Signup and view all the answers

What complication can result from hyperventilation in Assisted Control (AC) mode?

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

What is the purpose of using Positive End Expiratory Pressure (PEEP) in mechanical ventilation?

<p>To enhance gas exchange and prevent atelectasis (A)</p> Signup and view all the answers

What is a frequent sedation requirement for patients under High-Frequency Ventilation?

<p>Sedation and/or neuromuscular blocking agents are usually necessary (B)</p> Signup and view all the answers

Which of the following is a characteristic of Synchronized Intermittent Mandatory Ventilation (SIMV)?

<p>Client-initiated breaths can vary in volume (C)</p> Signup and view all the answers

What is the purpose of maintaining adequate cuff pressure in an endotracheal tube?

<p>To prevent accidental extubation and ensure oxygenation (D)</p> Signup and view all the answers

How often should the cuff pressure of an endotracheal tube be assessed?

<p>Every 8 hours (B)</p> Signup and view all the answers

What does a high-pressure ventilator alarm indicate?

<p>Excess secretions or kinks in the tubing (C)</p> Signup and view all the answers

Which medication is commonly administered to manage anxiety in patients receiving mechanical ventilation?

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

What is the maximum recommended cuff pressure for an endotracheal tube to prevent tracheal necrosis?

<p>20 mm Hg (A)</p> Signup and view all the answers

What is a common indication to use neuromuscular-blocking agents in mechanically ventilated patients?

<p>To ensure complete relaxation of respiratory muscles (A)</p> Signup and view all the answers

What should be done to verify ventilator settings effectively?

<p>Check settings hourly (D)</p> Signup and view all the answers

Which of the following indicates a need for suctioning of the tracheal tube?

<p>The patient exhibits decreased oxygen saturation (C)</p> Signup and view all the answers

What sign indicates potential weaning intolerance in a client during the weaning process?

<p>Heart rate changes exceeding 20% of baseline (B)</p> Signup and view all the answers

Which intervention should be performed immediately if a client shows signs of respiratory distress after extubation?

<p>Prepare to reintubate if necessary (C)</p> Signup and view all the answers

Why is repositioning important for older adult clients during respiratory care?

<p>To promote mobility of secretions (D)</p> Signup and view all the answers

What equipment should be readily available at the bedside of a client undergoing weaning?

<p>Manual resuscitation bag and face mask (B)</p> Signup and view all the answers

What is a common assessment finding in older adults that increases their risk during respiratory weaning?

<p>Decreased respiratory muscle strength (C)</p> Signup and view all the answers

What complication can occur from high concentrations of oxygen during therapy?

<p>Oxygen toxicity (A)</p> Signup and view all the answers

Which nursing action is essential to prevent aspiration in a mechanically ventilated client?

<p>Keep the head of the bed elevated at least 30° (D)</p> Signup and view all the answers

What indicates a potential hemodynamic compromise in a mechanically ventilated patient?

<p>Tachycardia and hypotension (A)</p> Signup and view all the answers

Which condition is related to the damage caused by volume delivered from one lung to another?

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

What is a potential cause of fluid retention in a patient receiving mechanical ventilation?

<p>Activation of renin-angiotensin-aldosterone system (B)</p> Signup and view all the answers

Flashcards

Noninvasive Positive Pressure Ventilation (NPPV)

A method of providing positive pressure to the lungs without an invasive tube.

Continuous Positive Airway Pressure (CPAP)

A type of NPPV that delivers a constant positive pressure to the airway.

Bi-level Positive Airway Pressure (BiPAP)

A type of NPPV that delivers different pressure levels during inspiration and expiration.

Sleep Apnea Treatment

CPAP is highly effective in treating sleep apnea by keeping airways open during sleep.

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COPD Treatment

BiPAP is frequently used to assist ventilation for people with COPD.

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Endotracheal Intubation

Inserting a tube through the nose or mouth into the trachea to manage an emergency airway.

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Oral Intubation

The most common and fastest way to intubate, usually done in the emergency department.

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Nasal Intubation

Used when there's facial or oral trauma, but not for clients with clotting problems.

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Intubation Confirmation

Verifying correct placement of the ET tube using a chest x-ray and checking end-tidal carbon dioxide levels.

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ET Tube Cuff

A cuff on the ET tube that is inflated to create a seal, preventing air leaks and ensuring proper ventilation.

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Mechanical ventilation

A medical procedure that provides breathing support to individuals experiencing respiratory failure, delivering 100% oxygen that is warmed and humidified.

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Positive-pressure ventilators

Ventilators that deliver air to the lungs under pressure during inspiration to keep the alveoli open and prevent collapse during expiration.

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Benefits of mechanical ventilation

Forced/enhanced lung expansion, improved gas exchange (oxygenation), and decreased work of breathing.

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Methods of mechanical ventilation delivery

Mechanical ventilation can be delivered via ET tube or a tracheostomy tube.

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Mechanical ventilator cycling

Ventilators can be cycled based on pressure, volume, time, and/or flow.

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What are the major indications for Noninvasive Positive Pressure Ventilation (NPPV)?

Noninvasive Positive Pressure Ventilation (NPPV) is used to maintain an open airway and adequate oxygen saturation (95% or greater) in patients with conditions like hypoxemia, hypoventilation, exacerbations of COPD, and acute pulmonary edema.

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What are some considerations before applying NPPV?

Before starting NPPV, it's crucial to explain the procedure to the patient and ensure they can communicate effectively. This might involve using yes/no questions, writing or picture boards, or lip reading.

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What are common diagnoses that might benefit from NPPV?

NPPV is frequently used for patients with conditions like hypoxemia (low blood oxygen), hypoventilation (inadequate breathing), exacerbations of Chronic Obstructive Pulmonary Disease (COPD), and pulmonary edema (fluid in the lungs).

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What are some neurological conditions that might benefit from NPPV?

Neurological disorders like multiple sclerosis, myasthenia gravis, and Guillain-Barré can affect breathing, making NPPV a potential treatment option.

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When is NPPV often employed?

NPPV is used not only for acute respiratory problems but also for respiratory support after surgery (to decrease workload), during general anesthesia or sedation, and to treat obstructive sleep apnea.

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What is ASSIST-CONTROL (AC) Ventilation?

AC ventilation provides a preset rate and tidal volume. The client initiates each breath, and the ventilator takes over to deliver the set volume. This is commonly used for intubated clients.

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What is SYNCHRONIZED INTERMITTENT MANDATORY VENTILATION (SIMV)?

SIMV sets a preset rate and tidal volume for machine breaths. The client can also initiate breaths, with the tidal volume depending on their effort. The ventilator breaths are synchronized to avoid conflicting with the client's attempts.

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What is INVERSE RATIO VENTILATION (IRV)?

IRV aims to maximize oxygenation by extending the inspiratory phase. Useful for hypoxemia that doesn't respond to PEEP. However, it can be uncomfortable for clients, requiring sedation or muscle relaxants due to potential for air trapping and cardiovascular issues.

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What is AIRWAY PRESSURE RELEASE VENTILATION (APRV)?

APRV allows natural lung recoil to expel air, with time-triggered, pressure-limited breaths. It can be initiated either spontaneously by the client or by the ventilator. APRV promotes better lung health and minimizes cardiovascular side effects compared to other modes.

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What is INDEPENDENT LUNG VENTILATION (ILV)?

ILV uses a double-lumen endotracheal tube to ventilate each lung independently. This is helpful for clients with unilateral lung disease. ILV requires two ventilators, sedation, and possibly muscle relaxants.

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What is HIGH-FREQUENCY VENTILATION?

High-frequency ventilation delivers small amounts of gas at very high rates (60 to 3,000 cycles/min). While often used in children, sedation and muscle relaxants are essential. Assessing breath sounds can be challenging due to the rapid cycles.

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What is POSITIVE END EXPIRATORY PRESSURE (PEEP)?

PEEP adds pressure during expiration, preventing alveoli collapse and improving oxygenation. It's typically added to ventilator settings in increments of 5 to 15 cm H2O to address persistent hypoxemia.

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Ventilator Alarms

These alarms signal when there's a problem with the client's ventilation, alerting the nurse to act quickly.

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Volume (Low Pressure) Alarm

This alarm sounds when the exhaled volume is low, possibly due to a disconnection, cuff leak, or tube displacement.

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Pressure (High Pressure) Alarm

This alarm occurs when the ventilator faces resistance, indicating excess secretions, biting the tubing, kinks, coughing, edema, bronchospasm, or pneumothorax.

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Apnea Alarm

This alarm alerts when the ventilator doesn't detect spontaneous breaths within a set time.

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Tracheal Cuff Pressure

This pressure needs to maintained within a specific range to prevent tracheal necrosis.

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Why Sedation for Ventilated Clients?

Sedation helps relax the client, preventing them from fighting the ventilator and allowing for better breathing.

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Neuromuscular Blocking Agents

These medications paralyze muscles, but don't sedate or relieve pain, often paired with sedatives for ventilation.

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Maintaining Tube Patency

This means keeping the breathing tube clear and open for effective ventilation.

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Weaning Intolerance Signs

Signs of weaning intolerance include increased respirations (over 30/min or less than 8/min), significant changes in vital signs (BP or HR greater than 20% of baseline), low SaO2 (below 90%), dysrhythmias, elevated ST segment, decreased tidal volume, labored breathing, increased accessory muscle use, diaphoresis, restlessness, anxiety, and decreased consciousness.

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Weaning Equipment

During weaning, keep a manual resuscitation bag with a face mask and oxygen, reintubation equipment, and suction tools readily available at the bedside.

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Post-Extubation Monitoring

After extubation, monitor for signs of respiratory distress or airway obstruction (ineffective cough, dyspnea, stridor), assess SpO2 and vital signs every 5 minutes, encourage coughing, deep breathing, and use of the incentive spirometer.

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Older Adult Considerations

Older adults have weaker respiratory muscles and less chest wall compliance, making them more susceptible to aspiration, atelectasis, and pulmonary infections. They require frequent position changes to mobilize secretions.

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Secretion Mobilization

Regularly repositioning older adult clients helps move secretions and prevent complications like aspiration and atelectasis.

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Barotrauma

Damage to the lungs caused by positive pressure, often due to a pneumothorax, subcutaneous emphysema, or pneumomediastinum.

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Volutrauma

Lung damage caused by excessive volume delivered from one lung to the other, often during mechanical ventilation.

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Oxygen Toxicity

Damage to the lungs caused by high concentrations of oxygen for extended periods.

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Hemodynamic Compromise

Decreased blood flow due to increased pressure in the chest caused by mechanical ventilation.

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Gastrointestinal Ulceration (Stress Ulcer)

Ulcers that can develop in the stomach of clients receiving mechanical ventilation due to stress.

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Study Notes

Noninvasive Positive Pressure Ventilation

  • Uses a leak-proof mask for positive pressure.
  • Keeps airways open throughout the breathing cycle, improving gas exchange.
  • Effective for sleep apnea, acting as a splint for upper airway and trachea.

Continuous Positive Airway Pressure (CPAP)

  • A type of noninvasive positive pressure ventilation.
  • Provides constant positive pressure to keep airways open.
  • Especially effective for sleep apnea.

Bi-level Positive Airway Pressure (BiPAP)

  • Machine provides a higher inspiratory pressure during inhalation.
  • Delivers a lower expiratory pressure during exhalation.
  • Requires a leak-proof mask.
  • Commonly used for COPD patients requiring ventilatory support.

Nursing Actions

  • Check for skin breakdown around the mask, as a tight seal is crucial.
  • Monitor oxygen levels (both inspiratory and expiratory pressure) for BiPAP patients.

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Description

Test your knowledge on noninvasive positive pressure ventilation techniques, including CPAP and BiPAP. Explore their applications for conditions like sleep apnea and COPD, and understand key nursing actions. This quiz is essential for nursing students and professionals working in respiratory care.

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