recruits alveoli that are totally or partially collapsed and improves lung

Recruits alveoli that are totally or partially

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, recruits alveoli that are totally or partially collapsed and improves lung compliance May enhance surfactant regentartion Normal levels 3 to 5 cm H 2 O High levels of PEEP distend the alveolus providing increased surface area for gas exchange Respiratory Rate # of breaths per minute delivered Typically adjusted according to PaCO 2 Tidal Volume Volume of gas delivered with each cycle Typical setting 8 to 10 mL/kg Lung compliance based volumes 6 to 9 mL/kg to avoid volutrauma Problems with PEEP (pressure) Decreased cardiac output from increased pressure Barotrauma Crepitus, pneumothorax Listen to bilateral breath sounds (absent on one side), tracheal deviation (should be midline but deviates to one side with a pneumothorax), hypertensive, tachycardia, tachypneic, O2 sats drop High PEEP would suspect pneumothorax and to confirm you auscultate bilateral breath sounds Example AC 16 (respiratory rate), TV 400, .40, 5 PEEP If they take extra breaths, the ventilator will assist to make sure they get the 400 tidal volume and 40% plus 5 of PEEP Gives full tidal volume SIMV 16, VT 400, .40, 5 PEEP Take extra breath, still get the 40% and 5 of PEEP but get their own tidal volume Does not give tidal volume with extra breaths Both can add PS (pressure support) If someone is on high PEEP, what would make you think maybe they have a pneumothorax? Decreased breath sounds, tracheal deviation, tachycardia, tachypnic, sats drop, restless, anxious Going to think, “ohh, maybe they have a pneumo, I should listen to bilateral breath sounds” Ventilatory Alarms Know high pressure & low pressure alarms Alarm systems are necessary to warn the nurse of developing problems Never ignore or silence alarms without assessing the patient!! Check ventilator settings frequently Two specific types of alarms: Low pressure alarms Disconnection from ventilator Decrease in patient respiratory rate (CPAP) → was assisting and then stopped Decrease in tidal volume Circuit leaks High pressure alarms Decreased lung compliance (possibly from a pneumothorax)
30 Tubing kinked or filled with water Patient biting Asynchronous ventilation Bucking the ventilator Bronchospasm (wheezing ) Nursing Process Goals may include that client will: Maintain airway and appropriate ventilatory support Maintain airway assessment → cough & gag reflex, mentation (are they alert?) Ventilatory support assessment → respiratory rate & CO 2 Assess oxygenation → O 2 saturation & hemoglobin Maintain adequate cardiac output Assess with BP Pink, perfusing, peeing, mentating, peripheral pulses Receive adequate nutrition Be free of complications Infection, pressure injuries, vent dependent, barotrauma, ROM (can develop contractures, foot drop), ileus from sedation Manage pain/comfort/anxiety Assessment & Management of Ventilated Patients Nutritional support

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