ventilation

Question 1

endotrach intubtation

Answer 1

A tube is inserted through the client’s nose or mouth into the trachea.

Question 2

mouth intubation

Answer 2

the easiest and quickest form of intubation and is often performed in the emergency department.

Question 3

nasal intubation

Answer 3

performed when the client has facial or oral trauma.
- This route is not used if the client has a clotting problem.

Question 4

what does mechanical ventilation provide

Answer 4

• Provides breathing support until lung function is restored
• Positive-pressure ventilators deliver air to the lungs under pressure throughout inspiration and/or expiration to keep the alveoli open during inspiration and to prevent alveolar collapse during expiration

Question 5

benefits include of mechanical ventilation

Answer 5

• Forced/enhanced lung expansion
• Improved gas exchange (oxygenation)
• Decreased work of breathing
• Mechanical ventilation can be delivered via:
  ET tube.
• Tracheostomy tube.

Question 6

nursing actions mechanical ventilation

Answer 6

• Maintain a patent airway.
• Assess the position and placement of tube.
• Apply protective barriers (soft wrist restraints) according to hospital protocol to prevent
  self-extubation.
• Suction oral and tracheal secretions to maintain tube patency.
• Support ventilator tubing to prevent mucosal erosion and displacement.
• Have a resuscitation bag with a face mask available at the bedside at all times in case of ventilator malfunction or accidental extubation.

Question 7

Assess respiratory status every

Answer 7

1 to 2 hr: breath sounds equal bilaterally, presence of reduced or absent breath sounds, respiratory effort, or spontaneous breaths.
- Suction the tracheal tube to clear secretions from the airway.
- Monitor and document ventilator settings hourly.

Question 8

Pressure (high pressure) alarms

Answer 8

indicate excess secretions, client biting the tubing, kinks in the tubing, client coughing, pulmonary edema, bronchospasm, or pneumothorax.

Question 9

Apnea alarms

Answer 9

indicate that the ventilator does not detect spontaneous respiration in a preset time period.
- airway may not be in right place

Question 10

Analgesics

Answer 10

morphine and fentanyl

Question 11

Sedatives

Answer 11

propofol, diazepam, lorazepam, midazolam, and haloperidol, vichyronia

Question 12

neuromuscular blocking agents

Answer 12

pancuronium, atracurium, and vecuronium are infrequently used in the clinical setting due to the their long half-life.
- The use of a sedative or analgesic agent in conjunction with a neuromuscular blocking agent is typically prescribed.

Question 13

Ulcer-preventing agents

Answer 13

• famotidine or lansoprazole
• zantach and proton inhibitor

Question 14

nursing actions for readiness for extubation

Answer 14

• Assess for readiness for extubation
• Labored respirations, increased use of accessory muscles, and diaphoresis
• Restlessness, anxiety, and decreased level of consciousness
• Have a manual resuscitation bag with a face mask and oxygen readily available at the client’s bedside.
• Have reintubation equipment at bedside.
• Suction the oropharynx and trachea.
• Deflate the cuff on the endotracheal tube, and - remove the tube during peak inspiration.

Question 15

post exutination

Answer 15

• Following extubation, monitor for signs of respiratory distress or airway obstruction, such as ineffective cough, dyspnea, and stridor.
• Assess SpO2 and vital signs every 5 min.
• Encourage coughing, deep breathing, and use of the incentive spirometer.
• Reposition the client to promote mobility of secretions.
• Older adult clients have decreased respiratory muscle strength and chest wall compliance, which makes them more susceptible to aspiration, atelectasis, and pulmonary infections.
• Older adult clients require more frequent position changes to promote mobility of secretions.

Question 16

complications for intubation and ventilation

Answer 16

Trauma
Barotrauma
Fluid retention
Hemodynamic compromise
Aspiration

Question 17

how to prevent mechanical intubation

Answer 17

• Keep the head of the bed elevated 30° at all times to decrease the risk of aspiration.
• Check residuals every 4 hr if the client is receiving enteral feedings to decrease the risk of aspiration.
• Gastrointestinal ulceration (stress ulcer)
• Monitor gastrointestinal drainage and stools for occult blood.
• Administer ulcer prevention medications (sucralfate and histamine2 blockers).

Question 18

VAP bundle

Answer 18

ventilator assoicated pneomonia due to humitfied air

CHG mouth wash every 4hr
monitor for fever
prevent aspiration
gut prophalaxis

Question 19

how often is ven tubing changed

Answer 19

every 24hr by respiratory