Term
| Simple Face Mask Flow (range of amount that can be delivered to patient in liters) |
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Definition
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Term
| When is simple face mask flow used |
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Definition
| for short term use only, generally less than 12 hours. |
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Term
| is simple face mask good? |
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Definition
| pt receives 75% inspired volume from room air, requires high flow to prevent CO2 rebreath. |
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Term
| Which kind of 02 masks can you titrate |
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Definition
nasal canula
venturi mask |
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Term
| Characteristic of venturi Mask |
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Definition
| you can adjust the amount of 02 given |
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Term
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Definition
| variable, 4-10L/min = 24-50% |
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Term
| What is special about nonrebreather |
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Definition
| one way valves prevent exhaled air from returning to bag, stops CO2 rebreath. used in rapid desaturation situations. |
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Term
| Flow of nonrebreather masks? |
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Definition
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Term
| What is your job as a nurse with settings on a ventilator? |
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Definition
| monitor settings, any change in setting must be written by a physician in an order. |
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Term
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Definition
volume ventilation - most common in adults
pressure ventilation- most common in children. |
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Term
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Definition
| doctor tells you how much volume of each breath will be given to the patient. |
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Term
| Five common settings on a ventilator |
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Definition
Respiratory Rate
Tidal Volume
Fractional Inspired Oxygen
Pressure Support
Positive end-expiratory pressure (PEEP) |
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Term
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Definition
| Setting on ventilatory, this is a way to ventilate. ventilatory senses pt's attempt to inhaled and adds an additional 5-10% of pressure to help you take a breath. This method helps to SUPPORT SPONTANEOUS RESPIRATION because you initiate inhalation on your own. |
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Term
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Definition
| positive end-expiratory pressure: positive pressure at the end of expiratory pressure. at end of exhalation there is a pre-set sonometers of water of pressure that is necessary to keep alveoli open. physiological normal is 5 sonometers of water pressure, this for EVERYONE all the time to keep alveoli open. five sonometers of water pressure must be added to the ventilatory (or the ventilator is set to this) and this is normal to create an artificial situation with physiological normal. |
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Term
| If you have a patient with worsening pneumonia that is on a ventilator and is struggling to keep their alveoli open, would it improve their status by increasing the PEEP to help push water out of alveoli? |
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Definition
| Yes, but the downside to this is bad because you are increasing pressure in thoracic cavity so you are reducing cardiac output and decreasing venous return and therefore affecting perfusion. |
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Term
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Definition
| what the ventilator will give the patient in one breath |
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Term
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Definition
| percentage of oxygen delivered to a lung |
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Term
| What you will assess every four hours on patient on ventilatory |
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Definition
Tital Volume - what the ventilatory gives the patient in one breath
Fi02 - percentage of oxygen being delivered to each lungs
RR- What is being set or assessed on the patient ( this rate can be higher than what the vent. is set at)
PEEP - directly affects thoracic pressure
Pressure Support -
Expiratory Tidal Volume - when vent. gives 500 breath, then you should give off 500 too. but if patient is breathing on their own between given breaths, you want to monitor this because it tells you how well the patient is tolerating being ventilated and gives you an idea of how good their lung function is.
PIP (peek inspired pressure) |
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Term
| Assist Control Mode (mode of ventilation) |
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Definition
(you will never have pressure support)
gives patient preset RR and TV and that is all. each additional breath that the patient takes on their own (spontaneously initiated) the machine will sense this and it will give him a full ventilated breath. So all the breaths that the patient takes, spontaneous or not, will all receive the same total volume |
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Term
| What kind of patient would be on assist control mode ventilator |
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Definition
someone who needs fully controlled ventilation (very ill)
Complete control mode, it does all of the work for the patient, who becomes very dependent on this machine. This mode is used if the want to take away all work from pt |
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Term
| Synchronous Intermittent Mandatory Ventilation (SIMV) |
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Definition
| Ventilation: Doesn't breath for you, breaths in synch with you. As the nurse you set the respiratory rate to something and it will give these breaths to the patient at a certain total volume regardless, when the patient tries to breath spontaneously, the ventilator will sense this and assist the patient with these spontaneous breaths. the machine knowns when you are trying to breath spontaneously so it knows how to space out the certain number of set breaths that it has to give. |
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Term
| what kind of patients are SIMV used on? |
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Definition
| patients that have some ability to breath spontaneously but are not able to maintain an adequate minute ventilation. USUALLY USED TO WEAN PT. FROM MECHANICAL VENTILATION |
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Term
| Continuous Positive Airway Pressure (CPAP) |
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Definition
| The patient breaths spontaneously with a positive pressure applied throughout respiratory cycle so the RR and TV are function of patient effect. |
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Term
| What kind of patients go on CPAP? |
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Definition
| patients that can breath spontaneously on their own but need to improve oxygenation, usually go on CPAP before extubation |
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Term
| what are you giving patient on continuous positive airway pressure (3 things) |
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Definition
5 of PEEP: to keep alveoli open
certain % oxygenation
a little pressure support to overcome the diameter of the tube |
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Term
| What do you monitor on a patient on CPAP |
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Definition
| Spontaneous expiratory tital volume |
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Term
| Do you adjust the rate or the pressure support if you have low total volume? |
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Definition
| ALWAYS adjust the pressure support slowly, this will allow patient to do more work on their own, adjusting the rate are big jumps, adjusting the pressure support is little jumps. |
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Term
| What kind of people are on Bi-Level/ApRV |
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Definition
| Very ill patients that can't tolerate high inspiratory pressure because they have scarred lungs from disease processes, normal |
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Term
| bi level is not volume ventilation, instead its on a time cycle and doesn't depend on respiratory rate) |
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Definition
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Term
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Definition
| cont. positive pressure applied, so instead of blowing air into the lungs with each breath, applies pressure and allows the lungs to fill when this pressure is applied that allows lungs to fill to a certain pressure. |
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Term
| what is set and what is variable with bi-level ApRV |
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Definition
| Pressure is consistent, volume is variable, every breath is a different volume depending on compliance of the lungs. |
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Term
| with volume ventilation, what is set and what is variable. |
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Definition
| volume set, pressure variable |
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Term
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Definition
| P high is pressure control, measured in sonometeres of water, how much pressure on in halation (its always the pressure plus 5 because of physiological normal) |
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Term
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Definition
| How long your going to hold the P-high in your lung, this is measured in time |
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Term
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Definition
| How low does the pressure go after the t-high, usually goes down to zero |
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Term
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Definition
| At expiration, how long until next inhalation breath comes |
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Term
| when you are changing p-high, t-high p-low t-low |
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Definition
| you are adjusting how many breaths in a minute the patient will take, |
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Term
| how many inhalations, to exhalations |
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Definition
| 1 inhale to 3 exhales, with ventilation this ratio is reversed because it gives you the opportunity to give the lungs more oxygen. |
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Term
| what could cause low pressure alarm? |
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Definition
| if there is some kind of disconnect with the tubing to indicate leak in the system. |
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Term
| First response when an alarm goes off |
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Definition
| disconnect from ventilator and connect to ambu bag start mechanical ventilation. |
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Term
| Prior to extubation, Fi02 needs to be at? |
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Definition
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Term
| how do you give patient oxygen following extubation |
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Definition
| face mask, they need to be receiving humidity. |
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Term
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Definition
spontaneous tital volume, how many ml's can they inhale and exhale,
measure maximum inspiratory force, put pedometer on them and tell them to suck, tells how much suction they can create, must have certain amount to be able to spontaneously breath
Minute Volume,
Can they protect their airway |
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Term
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Definition
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Term
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Definition
| position in relationship to gums or lips: sonometer marks on ET: insert until 2 sonometers above corona. (junction between right and left mainstream bronchi) |
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Term
| what do you always do following ET tube placement |
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Definition
| always x ray to ensure proper placement |
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Term
| how to apply craicoid pressure during ET tube insertion? |
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Definition
| feel for membrane press on it, collapses esophagus, so they do not throw up or aspirate |
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Term
| when to use cricothyroid intubation |
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Definition
| when oral or nasal intubation not possible and in emergency situations. |
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Term
| when should cricothyroid intubation be switched to ET |
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Definition
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Term
| why are cricothyroid intubation placed where they are, it is not the same location as trachs |
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Definition
| decreases possibility of damaging vocal cords |
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