Ventilation Strategies in Critical Care
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Which of the following statements accurately describes the primary advantage of Pressure-Cycled Ventilation?

  • It increases the client's own respiratory effort by providing a preset pressure during inspiration.
  • It reduces the risk of hypoventilation by ensuring the client always exhales at a set pressure.
  • It assists the client's spontaneous breaths by providing positive pressure during inspiration, thereby decreasing the work of breathing. (correct)
  • It allows for the client to control the ventilation rate, minimizing the risk of respiratory acidosis.

    • When utilizing Pressure Support (PS) for a client, what is the primary intended outcome?

  • To ensure the client's expiratory effort is assisted by positive pressure.
  • To decrease the client's work of breathing during spontaneous breaths. (correct)
  • To eliminate the risk of respiratory acidosis by preventing hypoventilation.
  • To maintain a consistent tidal volume regardless of spontaneous breaths by the client.

    • A client who is currently on a ventilator and requires weaning is being considered for Pressure Support (PS). What is a potential benefit of using PS in this situation?

  • It assists the client in regaining control of their own breathing by gradually decreasing the ventilator's support. (correct)
  • It prevents the development of respiratory acidosis by ensuring adequate gas exchange during the weaning process.
  • It can fully eliminate the need for invasive ventilation, allowing for immediate removal of the ventilator.
  • It eliminates the risk of hypoventilation by providing continuous positive pressure support during inspiration.

    • Which of the following scenarios would benefit the most from Continuous Positive Airway Pressure (CPAP) treatment?

    <p>A client diagnosed with sleep apnea who experiences recurrent episodes of apnea during sleep. (A)</p> Signup and view all the answers

    What is a possible reason why a client with COPD and acute pneumonia may not be a suitable candidate for NIPPV (BiPaP) therapy?

    <p>Pneumonia can worsen airway resistance and make it challenging for BiPaP to deliver adequate pressure. (D)</p> Signup and view all the answers

    What distinguishes CPAP from PEEP (Positive End-Expiratory Pressure) in terms of application?

    <p>CPAP is delivered only during inspiration, while PEEP is applied during both inspiration and expiration. (A)</p> Signup and view all the answers

    Which of the following is a potential benefit of utilizing either CPAP or BiPaP therapy for weaning a client off mechanical ventilation?

    <p>It provides a way to support ventilation while gradually reducing the need for full ventilator support. (C)</p> Signup and view all the answers

    What is a potential use of NIPPV (BiPaP) therapy beyond sleep apnea and weaning, especially in the context of acute respiratory failure?

    <p>To prevent reintubation after a client has been successfully extubated from mechanical ventilation. (A)</p> Signup and view all the answers

    How does Pressure-Cycled Ventilation differ from Volume-Cycled Ventilation in terms of how the breathing cycle is controlled?

    <p>Pressure-Cycled Ventilation uses a preset pressure to trigger the end of inspiration, while Volume-Cycled Ventilation utilizes a preset volume of air to end inspiration. (B)</p> Signup and view all the answers

    What is the patient's initial respiratory rate?

    <p>34 breaths per minute (D)</p> Signup and view all the answers

    What is the patient's initial blood pH?

    <p>7.42 (D)</p> Signup and view all the answers

    What is the patient's initial PaO2?

    <p>60 (A)</p> Signup and view all the answers

    Which of the following is NOT an indication for intubation and mechanical ventilation?

    <p>Pulse oximetry below 0.95 when on at least 50% oxygen (D)</p> Signup and view all the answers

    What type of airway adjunct was used in the initial treatment of this patient?

    <p>None, the patient is intubated (D)</p> Signup and view all the answers

    Which immediate prescription is essential for managing acute adrenal crisis due to sepsis?

    <p>Hydrocortisone 100mg IV push (B)</p> Signup and view all the answers

    What is the primary reason for administering a one-liter IV Normal saline bolus for this patient?

    <p>To ensure adequate hydration and circulation (D)</p> Signup and view all the answers

    What monitoring is essential for this patient during the treatment of acute adrenal crisis?

    <p>Vital signs every 15 minutes (C)</p> Signup and view all the answers

    Why is continuous IV fluid of D5NS @ 150mL/hr indicated in this scenario?

    <p>To provide hydration and caloric support (A)</p> Signup and view all the answers

    Which medication is least likely to be immediately relevant for treating the acute adrenal crisis associated with pneumonia?

    <p>Fludrocortisone (Florinef) PO (D)</p> Signup and view all the answers

    What should be done if the problem with a patient is uncertain?

    <p>Manually ventilate with an ambu bag and call respiratory therapy (A)</p> Signup and view all the answers

    What is a common cause of high pressure alarms in ventilated patients?

    <p>Secretions blocking the movement of air (C)</p> Signup and view all the answers

    Which condition could contribute to a low pressure limit alarm?

    <p>Disconnection of the tubing from the ventilator (B)</p> Signup and view all the answers

    What situation could lead to apnea in a patient on a ventilator?

    <p>Sedation is still affecting the patient's respiratory drive (A)</p> Signup and view all the answers

    Which of the following is likely to cause difficulty in ventilating a patient?

    <p>Bronchospasm in the patient’s lungs (A)</p> Signup and view all the answers

    How should care team members approach the care of a patient moved to the intensive care unit?

    <p>Work together to ensure patient comfort and stability (D)</p> Signup and view all the answers

    What could indicate a kink in the tubing of a ventilator setup?

    <p>Low oxygen saturation levels in the patient (C)</p> Signup and view all the answers

    Which of the following would NOT typically cause a high pressure alarm on a ventilator?

    <p>Cuff leak in the endotracheal tube (A)</p> Signup and view all the answers

    What is a risk associated with manual ventilation using an ambu bag?

    <p>Over-ventilation of the patient (A)</p> Signup and view all the answers

    If a patient displays signs of distress while on a ventilator, which action should be prioritized?

    <p>Check for kinks or blockages in the tubing (D)</p> Signup and view all the answers

    What is the primary reason for a client to be seen immediately?

    <p>Urgent need for care (A)</p> Signup and view all the answers

    Which laboratory tests are typically ordered for a client in urgent care?

    <p>CXR, ABG, CBC, BMP (B)</p> Signup and view all the answers

    When should the provider be notified if there is no improvement in the client's condition?

    <p>As soon as possible (A)</p> Signup and view all the answers

    Which vital sign is considered an early indicator of clinical deterioration?

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

    What is a key component of timely documentation in urgent care situations?

    <p>Immediate charting of vital signs and assessments (C)</p> Signup and view all the answers

    Which changes in a client’s condition warrant a call to the Rapid Response Team (RRT)?

    <p>Notable changes within vital signs (C)</p> Signup and view all the answers

    What role does the Early Warning Score (EWS) play in patient care?

    <p>It alerts healthcare staff to clinical deterioration (C)</p> Signup and view all the answers

    What should you do after receiving new orders for a client?

    <p>Read back and verify with the provider (A)</p> Signup and view all the answers

    Which of the following is not a recommended action in response to an urgent client need?

    <p>Delay treatment for 24 hours (B)</p> Signup and view all the answers

    Which element is critical for improving staff communication as per National Patient Safety Goals?

    <p>Using medications safely (D)</p> Signup and view all the answers

    Flashcards

    Vital Signs

    Measurements of body functions like temperature, heart rate, and blood pressure.

    Sinus Tachycardia

    A condition where the heart rate exceeds normal resting rates, typically over 100 beats per minute.

    Respiratory Acidosis

    A condition where CO2 levels increase in the body, lowering pH due to inadequate breathing.

    Intubation

    The process of inserting a tube into the trachea to maintain an open airway.

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    Pulse Oximetry

    A non-invasive method to measure the oxygen saturation of the blood.

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    Hypoxemia

    Low levels of oxygen in the blood, typically indicated by a low PaO2.

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    Indications for Intubation

    Symptoms or conditions that warrant the placement of a breathing tube.

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    Urgent Client Assessment

    Immediate evaluation of a client's changing medical condition.

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    Transfer to ICU

    Moving a patient to a higher level of care for critical conditions.

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    Request Orders

    Instructions for lab tests and consultations needed for care.

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    Early Warning Score (EWS)

    A system to identify risk of clinical deterioration in patients.

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    Timely Documentation

    Prompt recording of vital signs and assessments for patient safety.

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    Vital Signs Impact

    Signs that indicate client’s current clinical status and changes.

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    Notify Provider

    Communication protocol when a patient shows no improvement.

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    Respiratory Therapy Consultation

    Referral for specialized respiratory support and management.

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    Changes in Client Condition

    Variations in vital signs indicating potential health issues.

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    Acute Mental Status Change

    Sudden alterations in a patient's cognitive function or consciousness.

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    Ambu Bag Use

    A device to manually ventilate patients when unsure of the problem.

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    High Pressure Alarm Causes

    Conditions that lead to high pressure in the ventilator: secretions, tube biting, kinks, bronchospasm, pneumothorax, and pulmonary edema.

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    Low Pressure Alarm Causes

    Conditions that trigger low pressure: disconnection, cuff leak, or unplanned extubation.

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    Apnea in Weaning

    A condition where the patient stops breathing, often seen when sedation is off.

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    Secretions Blockage

    Mucus that can block airflow in ventilated patients, causing high pressure alarms.

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    Tube Biting

    When a patient bites on the ventilator tube, causing a high pressure alarm.

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    Bronchospasm

    A spasm in the bronchial tubes which can restrict airflow and raise ventilator pressure.

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    Pneumothorax

    Air in the pleural space that can cause lung collapse, leading to high pressure alarms.

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    Pulmonary Edema

    Fluid in the lungs, increasing resistance and potentially causing high pressure alarms.

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    Unplanned Extubation

    Accidental removal of the endotracheal tube causing low pressure alarm.

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    PIP Control

    Pressure in a ventilator that can be managed to avoid hypoventilation.

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    Hypoventilation

    Insufficient breathing leading to increased carbon dioxide levels.

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    Atelectasis

    Collapse of lung tissue due to inadequate ventilation.

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    Pressure Support (PS)

    Ventilator mode assisting spontaneous breaths with preset pressure.

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    CPAP

    Continuous Positive Airway Pressure, aiding spontaneously breathing patients.

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    NIPPV

    Non-invasive Positive Pressure Ventilation used to prevent reintubation.

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    PEEP

    Positive End-Expiratory Pressure that maintains airway patency.

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    Weaning Process

    Gradually reducing ventilator support as patient improves.

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    COPD and NIPPV

    Patients with COPD and acute pneumonia might not be good candidates for NIPPV.

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    Acute adrenal crisis

    A life-threatening condition due to adrenal insufficiency, often triggered by severe stress like infection.

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    Hydrocortisone administration

    IV push of hydrocortisone to manage adrenal crisis by replacing cortisol.

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    Fluid resuscitation

    Administering IV fluids like normal saline to restore blood volume and improve circulation.

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    Sodium polystyrene (Kayexalate)

    Medication used to lower potassium levels in the blood but not indicated here.

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    Monitoring vital signs

    Regular checks of blood pressure, pulse, and other signs to assess patient's stability.

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    Study Notes

    Respiratory Failure & Advanced Airways

    • Respiratory failure is a failure of oxygenation or ventilation, or both.
    • Altered gas exchange (room air) causes hypoxemia (PaO2 < 60 mm Hg) and hypercapnia (PaCO2 > 50 mm Hg).
    • Acidosis is indicated by pH ≤ 7.30.
    • Normal arterial oxygen saturation (SaO2) is <90%.
    • Hypoventilation, intrapulmonary shunting, ventilation-perfusion mismatch, and diffusion defects can cause failure of oxygenation.
    • Decreased barometric pressure (high altitude), non-pulmonary hypoxemia, low cardiac output, and low hemoglobin can also cause oxygenation failure.
    • Some conditions prevent tissues from using oxygen despite availability, such as cardiovascular issues (shock, altered perfusion) or poisoning (carbon monoxide).
    • Failure of ventilation results in hypercapnia and is related to increased CO2 production, decreased alveolar ventilation, airway and alveoli abnormalities, CNS dysfunction, and chest wall or neuromuscular conditions.

    Normal Respiratory System

    • Oxygen saturation
    • Pink skin, appropriate respiratory rate and expansion
    • Clear lung sounds
    • ABGs within normal limits
    • CXR within normal limits
    • Normal arterial blood gas levels
    • Hemoglobin (Hgb) = 9 or 10 grams per deciliter

    Acute Respiratory Failure (ARF)

    • Failure of oxygenation and/ or ventilation.
    • Altered gas exchange
    • Indicators:
    • PaO2 < 60 mm Hg = hypoxemia
    • PaCO2 > 50 mm Hg = hypercapnia
    • pH ≤ 7.30 = acidosis
    • SaO2 < 90%

    Acute Respiratory Failure Case Study

    • Patient: Ms. Emmi Physema, a 62-year-old with COPD and hypertension
    • Symptoms: increasing shortness of breath (SOB), new-onset confusion, restlessness
    • Objective findings: disoriented, bilateral wheezes and rales, 1+ edema in ankles, S1 and S2 cardiac sounds, pulse rate = 115, respirations = 28, SpO2 rate = 88% in room air.
    • Diagnostic data: CXR - right middle lobe pneumonia, EKG - sinus tachycardia, WBC = 15,000/mL, Hgb = 16 g/dL, Hct = 48%, ABG: pH 7.30, PaCO2 60, PaO2 65, HCO3- 35.
    • Primary concern: potentially partially compensated respiratory acidosis
    • Possible interventions: elevating HOB, administering O2 therapy, managing respiratory distress through NIPPV (BiPap), antibiotics, albuterol, corticosteroids

    Form and Prioritize Hypotheses

    • Possible causes for the patient (Ms. Physema): Pneumonia, COPD exacerbation.
    • Associated cues: lung sounds, WBC, CXR, Hgb, ABG, SpO2, polycythemia

    Generate Solutions

    • Elevating the head of the bed (HOB)
    • Administering oxygen (O2 therapy)
    • Management of respiratory distress through NIPPV (BiPap).

    Case Study Continues (Evaluation)

    • Patient: Ms. Physema
    • Assessment Findings:
    • Respirations 20
    • Pulse oximetry 88% on 4 L/M
    • Lethargic
    • ABG: PaCO2 95 mmHg, PaO2 85 mmHg
    • Priority: Possible worsening respiratory acidosis and decreasing oxygenation.

    Acute Respiratory Failure Concerns and Actions

    • Respiratory muscle fatigue
    • Symptoms: Diaphoresis, nasal flaring, tachycardia, abdominal paradox, muscle retractions (intercostal, suprasternal, supraclavicular), central cyanosis, lethargy, somnolence, coma, respiratory acidosis
    • Nursing actions:
    • Improve O2 delivery: Administer O2, ensure adequate cardiac output and blood pressure, correct low hemoglobin, administer bronchodilators
    • Decrease O2 demand: Provide rest, reduce fever, relieve pain anxiety, decrease work of breathing, position for optimal gas exchange, prepare for possible intubation and mechanical ventilation
    • Maintain airway patency, prepare for possible intubation intubation and mechanical ventilation

    Critical Thinking Challenge

    • What are the contraindications for Noninvasive Positive Pressure Ventilation (NIPPV, BiPap)? -Inability to manage patent airway -Respiratory drive absent -drug overdose -Refractory hypoxemia (ARDS) -Intubation required

    Endotracheal Intubation

    • Procedure to maintain airway
    • Used to remove secretions
    • Used to prevent aspiration
    • Used to provide mechanical ventilation
    • Preferred route is orotracheal to reduce infection risk

    Intubation Equipment

    • Stylet (disposable) for guiding the tube
    • Endotracheal tube with 10 mL syringe for cuff inflation
    • Laryngoscope handle with curved blade or straight blade
    • Water-soluble lubricant
    • Colorimetric CO2 detector for assessing tube placement
    • Tape/Commercial device to secure tube
    • Yankauer disposable suction device
    • Magill forceps (optional)

    ###Endotracheal Intubation (by RT or provider)

    • Explanation of procedure to the client
    • Remove dentures
    • Ensure patent IV hyperoxygenate client with 100% NRB
    • Continuous SpO2 monitoring Collect necessary supplies: ET tube, stylet, lubricant, BVM, Ambu bag, CO2 detector, laryngoscope, blades, etc.
    • Insert ET tube, inflate balloon
    • Ventilate with 100% O2 via bag-valve-mask (BVM), Ambu bag
    • Verify placement with capnography and CXR, then connect to ventilator

    Case Study Progresses

    • Patient: Ms. Physema
    • Condition: continuous monitoring
    • Vitals and ABG data:
    • Temperature: 99°F oral
    • Heart rate: 135, sinus tachycardia
    • Respiratory rate: 34, increased accessory muscle use
    • Blood pressure: 165/105 (125 MAP) SpO2: 86% despite increasing O2 to 80% via BiPAP
    • ABG: pH 7.42, PaCO2 58, PaO2 60, HCO3- 30
    • Decision: intubation and mechanical ventilation

    Airway Adjuncts/Oropharyngeal airway

    • Airway - used for unconscious pts, to maintain a patent airway after anesthesia.
    • No oropharyngeal airway needed for conscious patients

    Indications for Intubated Ventilation

    • Hypoxemia (PaO2 ≤ 55 mm Hg on FiO2 > 0.5 [50% oxygen], pulse oximetry <90% on FiO2 > 0.5)
    • Hypercapnia (PaCO2 ≥ 50 mm Hg with pH < 7.32)
    • Progressive deterioration (tachypnea, bradypnea, or apnea, decreasing tidal volume [Vt], increased work of breathing [WOB]), inability to maintain airway, neurological dysfunction.

    Endotracheal Intubation

    • Insertion of an endotracheal tube (ETT).
    • Orotracheal route is preferred to reduce infections.
    • Nasal route is used if oral trauma or surgery is present.
    • Purpose: maintain an airway, remove secretions, prevent aspiration, and provide mechanical ventilation.

    Tracheostomy

    • Surgically created stoma to maintain long-term airway -Used to support long-term mechanical ventilation or facilitate recovery -Frequently suctioning -Protecting the airway -Prevent airway obstruction -Reduce work of breathing

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    Respiratory Failure & Advanced Airways PDF

    Description

    Test your knowledge on various ventilation strategies such as Pressure-Cycled Ventilation, Pressure Support, CPAP, and NIPPV. This quiz covers the advantages, applications, and potential outcomes of these ventilation methods in critical care settings. Assess your understanding of their roles in patient management.

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