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33 Cards in this Set
- Front
- Back
Control Ventilation (VC)
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Delivers gas @ preset rate and tidal volume or pressure, regardless of clients inspiratory efforts.
Clinical Application: CV is used as the primary ventilatory mode in clients who are apneic Nsg. Implications: used in clients unable to initiate a breath; spontaneously berathing clients must be sedated and/or paralyzed |
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Assist-Control (AC):
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Delivers gas @ preset tidal volume or pressure in response to clients inspiratory efforts and will initiate breath if client fails to do so w/in preset time.
Clinical Application: is used as the primary mode of ventilation in spontaneous breathing clients w/ weak respiratory muscles Nsg. Implications: Hyperventilation can occur in clients w/ increased respiratory rates. Sedation may be necessary to limit the number of spontaneous breaths. |
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Synchronous Intermittent Mandatory Ventilation (SIMV)
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Delivered gas @ preset TV or pressure and rate while allowing client to breathe spontaneously; ventilator breaths are synchronized to clients respiratory effort.
Clinical Application: is used both as a primary mode of ventilation in a wide variety of clinical situations and as a weaning mode Nsg. Implications: May increase the work of breathing and promote respiratory muscle fatigue |
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Positive End Expiratory Pressure (PEEP)
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Positive pressure applied @ the end of expiration of ventilator breaths
Nsg. Implications: S/E include decreased cardiac output, volutrauma, and increased ICP. No ventilator breaths are delivered in PEEP and CPAP mode unless used w/ CV, A/C or SIMV Clinical Application: used in clients w/ hypoxemia refractory to oxygen therapy; they increase functional residual capacity and improve oxygenation by opening collapsed alveoli @ end of expiration |
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Constant Positive Airway Pressure (CPAP)
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Clinical applications: used in clients w/ hypoxemia refractory to oxygen therapy; they increase functional residual capacity and improve oxygenation by opening collapsed alveoli @ end of expiration
Nsg. Implications: S/E include decreased CO, volutrauma and ICP. No ventilator breaths are delivered in CPAP mode unless used w/ CV, A/C, SIMV |
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Pressure Support Ventilation (PSV)
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Preset positive pressure used to augment clients inspiratory efforts; patient controls rate, inspiratory flow, and TV
Clinical application: used at the primary mode of ventilation in clients w/ stable respiratory drive, is used w/ SIMV to support spontaneous breaths, and is used as a weaning mode in patients who are difficult to wean Nsg. Implications: Adventages include increased client comfort, decreased work of breathing and decreased respiratory muscle fatigue, and promotion of respiratory muscle conditioning. |
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Constant Positive Airway Pressure (CPAP)
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Clinical applications: used in clients w/ hypoxemia refractory to oxygen therapy; they increase functional residual capacity and improve oxygenation by opening collapsed alveoli @ end of expiration
Nsg. Implications: S/E include decreased CO, volutrauma and ICP. No ventilator breaths are delivered in CPAP mode unless used w/ CV, A/C, SIMV |
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Pressure Support Ventilation (PSV)
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Preset positive pressure used to augment clients inspiratory efforts; patient controls rate, inspiratory flow, and TV
Clinical application: used at the primary mode of ventilation in clients w/ stable respiratory drive, is used w/ SIMV to support spontaneous breaths, and is used as a weaning mode in patients who are difficult to wean Nsg. Implications: Adventages include increased client comfort, decreased work of breathing and decreased respiratory muscle fatigue, and promotion of respiratory muscle conditioning. |
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Complicatioins of PPV
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Hypotension, decreased CO, decreased preload
S/T increased thoracic pressure can put pressure on superior vena cava and lowers BP as it decreased CO so less blood to body Higher PEEP (air that stays in the lungs) the lower the BP as there is less room for expansion |
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Complication of - list them
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Hypotension, dec. CO, dec. preload
Fluid imbalance Stress response Alveoli rupture Alveolar HYPOventilation Alveolar HYPERventilation Ventilatory associated pneumonia |
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Complication of PPV
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Fluid imbalance = Na and H2O retention
S/T decreased renal perfusion causing Na retention secondary to rennin secretion From decreased CO adn kidney output |
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Complication of PPV
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Stress Response: S/T increased cortisol release, and increase in ADH release
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Complication of PPV
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Alveoli rupture:
S/T volu-pressure trauma PS (amount of air blown in) When they rupture, cavity fills w/ air, pneumothoraz that can lead to trachial deviation |
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Complication of PPV
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Alveolar HYPOventilation
- caused by cuff leak, obstrution, incorrect vent setting, immobility that can lead to hypoxia so adjust FiO2 |
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Complication of PPV
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Alveolar HYPERventilation:
COPD clients @ risk, spontaneous hyperventilation |
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Compication of PPV
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Ventilator assoicated pneumonia:
- all of antibiotoics if vented - clients are more prone to infections - contaminated areas - lack of hand washing - colonization in the oropharynx tract |
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What are the ventilator modes
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CMV, A/C, SIMV, PSV, PEEP, CPAP
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High pressure limit alarm sounds, what do you do and what does it mean
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High pressure limit alarm = high pressure in the lungs
Secretion in ETT/airway or condensation in tubing so suction Kink in venting tube Anxiety/adgitation may need more sedation Patient biting on ETT so may need to increase sedation and add bite block Patient coughing, gagging, or trying to talk so may need to increase sedation via Verset Increased airway pressure from bronchospasm or pheumothorax so may need albuterol tx and MUST asculate lungs |
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What is the Low Pressure alarm and what do you do if it sounds
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Low Pressure alarm = low pressure in the lungs so no air getting to the lungs
Vent tubing not connected Displaced ETT or trach tube |
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What is the High Respiratory Rate alarm and what do you do
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High Respiratory Rate alarm = breathing > 20-28 breaths per min.
Patient anxiety/pain is #1 cause Secretions in ETT/airway so suction Hypoxia Hypercapnia (breathing too fast) |
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What is the Low Exhaled Volume alarm and what should you do
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Nothing is being exhaled
Vent tube not connected Leak in cuff or inadequate cuff seal Occurence of another alarm preventing full delivery of breath |
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What is PS
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THe amount of air pushed into the lungs via a ETT
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What is FiO2
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The percent of oxygen to be delivered
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What do you assess for weaning from ventilator
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Clients ability to breath over the vent
Volume pulled Pulse Ox, ABG, VS, CXR Has gone thru the MODES Mentation - start weaning off sedative T-piece that takes client off the vent and puts on wall oxygen so no PEEP adn no PS Normal ABG, TV > 350, breathing > 30, supplemental oxygen, Drs order |
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What is ARDS
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Adult (acute) Respiratory Distress Syndrome:
It is a lung inflammatory response as it attracts neutrophils to the pulmonday interstitium and INCREASES the permeability of the alveolar THUS fluid moves into the interstitial and alveolar spaces. (pulmonary edema) Alveoli fills w/ fluid/ hypoxia b/c no exchange. |
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Causes of ARDS
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Sepsis, SIRS, MODS, pneumonia, apiration, chest trauma
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Clinical manifestations fo ARDS
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Increased respiratory rate, dyspnea, respiratory alkalosis, "white out" on CXR, rales, refractory hypoxia (hypoxia dispite oxygen supplementation), hypoxemia on ABG, decreased mentation b/c no oxygen
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Collaborative care for ARDS
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Ventilatory support, mechanical
Increased PEEP support Positive pressure ventilation Permissive hypercapnea = low TV b/c want to give highere PEEPS Prone positioning as it allows fluid movement to other parts of the lung and allow ventilation of that part of the lung -use special bed to turn Lateral rotation - bed can rotate client side to side Chest vibration therapy - chest therapy done by bed |
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Complication of ARDS
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Prone to oxygen toxicity as it is deliverd at such a high rate (aka - respiratory lung syndrome)
This will eventually damage lung cells so must wean FiO2 |
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Complications of chest trauma
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Closed, open, tension pneumothorax
Closed pheumothorax = spontaneous, no known reason, dmage to lung allows air to escape CAUSED BY: esophageal rupture, broken ribs, mechanical ventilation damage Open pneumo = air from OUTSIDE gets inside CAUSED BY: gunshot, post procedures such as a tripple lumen insertion, lung biopsy Tension pneumo = caused by open or closed and it creates tension in the chest CAUSED BY: CPR, sucking chest wound as air in but not out |
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What can be done for a possible sucking chest wound
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Sucking chest wound = air is getting in but not getting out. Use needle w/ 1 way valve to allow air out OR take a deep breath, pinch nose and mouth, blow out and pressure should expell the air and then seal it.
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What is Flail chest
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multiple rib fractures that are free floating so on inspiration, the flail segment of ribs is sucked inward. This compromises the amount of inspired air in the unaffected lung; On expiration, the flail segment of ribs bellows outward, creating more space on the affected side so some air is shunted back and forth vs passing thru the upper airway.
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How can you decrease the pressure in the PA if have pulmonary hypertension
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Decrease preload, diuretics, calcium channel blockers, a drip of Epoprostenol as it decreased PVR with a very short half life, lung transplant, vasodilators, anticoagulation
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