HESI Critical Care Cardiac Pulmonary.pdf

Should be less than 40 mm hg reasons for elevated pip

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Should be less than 40 mm Hg Reasons for Elevated PIP: 1) Pt has mucous plug. If pt has a lot of mucous, it gets stuck in ETT. Machine has to work really hard & alarm will go off 2) Pt has non-compliant lungs (aka stiff lungs). Our lungs have to be able to stretch. If pt has Pulmonary Fibrosis or ARDS, lungs become stiff. 3) Pt is biting tube. Can take bite blocks & put it near pts airway to prevent them from biting down. o When we have something in our mouth, the first instinct is to chew on it o You may have to tell the pt to stop biting this o Another thing you can do is put the oral airway device you see with ETTs. This is then called an oral airway bite block and is used to prevent the pt from biting down on the ETT. Total Respiratory Rate Pt will get set amt of breaths (12-20 breaths) from vent, but can take additional breaths if pt chooses to. Count total rate, which accounts for set rate (what machine is giving) and patient effort There are basically 2 buttons on a ventilator that a nurse can touch When you suction a patient you have to hyperoxygenate them first. There is a 100% oxygen button on the ventilator and you push this so that it can give them lots of oxygen for about 3 minutes so that you can suction Silence alarm button Modes of Mechanical Ventilation How the machine is going to give the pt these breaths Volume Assist/Control (V-A/C) Mode : used when you want ventilator to do most of work (usually because pt cannot) You set rate, tidal volume, FiO2, and PEEP Ex. Post-surgery pts r/t anesthesia. Pulmonary disease. Disadvantage: pts become reliant on it. Why would I bother if ventilator will help me? So it becomes difficult to get pt off ventilator. Key: Whether the ventilator initiates the breath or the pt initiates a breath, the tidal volume will be the same. SIMV (Synchronized intermittent mandatory ventilation): Used when we want pt to do most of the work Key: when a pt initiates a breath, the pt will only get the tidal volume that they alone can take. The ventilator will not assist the pt. Pt will still get set amt of breaths with set amt of tidal volume but if pt decides to take a breath, they can only take in as much volume as they can Will synchronize your breaths : ex. If pt takes breath at 13 breaths, instead of giving breath at 15 sec, it’ll wait 5 sec from the 13 sec when the pt took a breath. Takes into account when pt took a breath & waits 5 more sec until it gives you another. Mode used for weaning . Lets see how much tidal volume you can pull with each breath. Maybe pt is ready to go off ventilator. But if low, they may not be ready yet. This mode is not used a lot because you could hyperventilate the pt here if the breaths are very shallow (bc of the synchronization, if the pt is hyperventilat ing then the machine doesn’t know when to give the pt breaths so it could try to give breaths when the pt is exhaling) The tall peaks on this slide picture shows what the ventilator is doing. The lower peaks is where the pt takes their own breaths in (so this is all that they could take in on their own)
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  • Fall '18

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