HESI Critical Care Cardiac Pulmonary.pdf

6 8 mlkg ideal weight adjusted according to

Info icon This preview shows pages 5–7. Sign up to view the full content.

6-8 mL/kg (ideal weight) Adjusted according to peak/plateau pressures Respiratory rate How many breaths will machine provide 12-20 breaths initially I:E ratio; normal 1:2 Inspiratory/Expiratory ratio. How long you will spend on inspiration vs expiration. PEEP (Positive end-expiratory pressure) Provides a little bit of pressure into pts lungs @ end of expiration. Keeps alveoli open where gas exchange takes place. 5-20 cm H20. Good if 5-10 cm of H20. If goes higher (20cm), the lungs become hyper-inflated. When lungs become hyper-inflated, intrathoracic pressure increases; heart becomes compressed & venous return decreases. Can cause reduced cardiac output if high and impedes venous return For the most part PEEP seems great. The problem is when you use higher levels of PEEP then the lungs hyperinflate (so they do NOT collapse enough). This will increase the cardiothoracic pressure This increases the cardiothoracic pressure so it decreases venous return by decreasing cardiac output (not said but you can think about it as pushing the heart over and kinking the vessels so there is less cardiac output) Our body naturally creates PEEP (about 5 normally) but the problem is when we use high levels of PEEP You end up using high levels of PEEP with ARDS patients, critically ill patients, etc. You do NOT want to put someone with COPD on a ventilator because it is hard to get them off due to the hyperinflation of their lungs, etc. Another problem with PEEP is that as you increase the amount of PEEP that the patient is getting then you can pop the alveoli and if too many pop then the person could get a pneumothorax. Sensitivity = how hard the patient has to work to get the flow of oxygen from the ventilator You don’t want the machine to try and give the patient a breath when they are trying to expire! Sensitivity; amount of pt effort How hard the pt (sensitivity) has to work to get air to flow from the ventilator. You don ’t want sensitivity too low bc pt has to work really hard to get air from machine. If sensitivity too high, the pt will fight with ventilator. Goal is to avoid patient- ventilator dyssynchrony (“fighting the ventilator”)
Image of page 5

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

Critical Care NR 340 Exam 1 (6) Data to Monitor during Mechanical Ventilation Exhaled Tidal Volume (EVt): how much volume is pt exhaling. Should not be more than 50 mL different from set Vt. To make sure that air that goes in is coming out. Ex. Machine is 500 ml of air per breath. Exhaled Vt is only 300 mL. Giving you 500 but only 300 is coming out; where is it going? Peak Inspiratory Pressure (PIP) How hard the ventilator has to work to ventilate the pt Want it to be low; we don’t want machine to work really hard to give you O2.
Image of page 6
Image of page 7
This is the end of the preview. Sign up to access the rest of the document.
  • Fall '18

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern