Mechanical Ventilation - Medical-Surgical - Respiratory System | @LevelUpRN

Level Up RN

28 Aug 202105:55

Summary

TLDRIn this Level Up RN video, Cathy discusses mechanical ventilation, covering alarms, settings, and nursing care. She explains low and high pressure alarms, using the mnemonic 'Two PB sandwiches can make you sick' to remember causes. Key ventilator settings like respiratory rate, tidal volume, FiO2, I:E ratio, and PEEP are outlined. Nursing care best practices include having resuscitation bags, monitoring vitals, and preventing complications post-extubation. A quiz tests knowledge on alarms and bedside essentials.

Takeaways

🌟 Mechanical ventilation enhances gas exchange and reduces the work of breathing until the cause of respiratory failure is addressed.
🚨 Low pressure alarms are triggered by leaks, such as disconnection, cuff leaks, or tube displacement.
🚨 High pressure alarms are due to increased pressure and can be remembered using the phrase 'Two PB sandwiches can make you sick', which stands for Pulmonary edema, Pneumothorax, Bronchospasm, Biting, Secretions, Cough, and Kink.
🛠 Settings on a mechanical ventilator include respiratory rate, tidal volume (VT), FiO2 (oxygen concentration), I:E ratio (inspiration to expiration), and PEEP (positive end-expiratory pressure).
🏥 ICU nurses should be trained and comfortable with operating ventilators and understand the importance of having a manual resuscitation bag and reintubation equipment readily available.
👁 Regular assessments for patients on mechanical ventilation should include level of consciousness, vital signs, breath sounds, pulse oximetry, and ABGs (arterial blood gases).
🌀 Suctioning of oral and tracheal secretions is necessary for patients on mechanical ventilation.
🛌 Repositioning the ET tube every 24 hours or more frequently is crucial to prevent skin breakdown and hospital-acquired pressure injuries.
🦷 Providing frequent oral care is an essential part of nursing care for mechanically ventilated patients.
💊 Monitoring for complications such as ventilator-associated pneumonia is a key aspect of care for patients on mechanical ventilation.
🌈 After extubation, patients should be encouraged to take deep breaths, cough, and use an incentive spirometer to aid recovery.

Q & A

What is the primary purpose of mechanical ventilation?
-Mechanical ventilation improves gas exchange and decreases the work of breathing until the cause of respiratory failure can be identified and corrected.
What are the two types of alarms mentioned in the video?
-The two types of alarms mentioned are low pressure alarms and high pressure alarms.
What causes a low pressure alarm in a mechanical ventilator?
-Low pressure alarms are due to leaks, which can be caused by disconnection, cuff leak, or tube displacement.
How can the phrase 'Two PB sandwiches can make you sick' help remember the causes of high pressure alarms?
-The phrase helps remember the causes of high pressure alarms by associating them with the first letters: 'Two PB' stands for pulmonary edema and pneumothorax, 'B' for bronchospasm and biting, and 'Sick' for secretions, cough, and kink.
What is respiratory rate in the context of mechanical ventilation?
-Respiratory rate is the number of breaths per minute that are delivered to the patient.
What does the abbreviation 'VT' stand for and what does it represent?
-VT stands for tidal volume, which is the volume of gas that is delivered with each breath.
What is the FiO2 setting in mechanical ventilation and what range does it cover?
-FiO2 is the fraction of inspired oxygen, which is the O2 concentration of the air being delivered to the patient and it can vary between 21% and 100%.
What is the I:E ratio in mechanical ventilation and what are typical values?
-The I:E ratio is the duration of inspiration to expiration, and that ratio is typically 1:2 or 1:1.5.
What does PEEP stand for and what is its function?
-PEEP stands for positive end-expiratory pressure, which is the pressure applied at the end of expiration to distend the alveoli and prevent collapse.
What equipment should be readily available at the bedside for a patient on mechanical ventilation?
-A manual resuscitation bag and reintubation equipment, including two different tube sizes, should be readily available.
What are some nursing care best practices for a patient on mechanical ventilation?
-Best practices include regularly assessing the patient's level of consciousness, vital signs, breath sounds, pulse oximetry, and ABGs, suctioning oral and tracheal secretions as needed, repositioning the ET tube every 24 hours or more frequently, providing frequent oral care, and monitoring for complications such as ventilator-associated pneumonia.
What should patients do after extubation to aid in their recovery?
-After extubation, patients should take deep breaths, cough, and use their incentive spirometer.

Outlines

00:00

😷 Mechanical Ventilation Basics and Alarms

In this segment, Cathy from Level Up RN introduces the topic of mechanical ventilation, emphasizing its role in improving gas exchange and reducing the work of breathing for patients with respiratory failure. She outlines the types of alarms associated with ventilators, specifically focusing on low and high-pressure alarms. Low-pressure alarms are attributed to leaks, which can occur due to disconnection, cuff leaks, or tube displacement. High-pressure alarms are more complex, and Cathy uses a mnemonic 'Two PB sandwiches can make you sick' to help remember the causes: pulmonary edema and pneumothorax (Two Ps), bronchospasm and biting (Two Bs), and secretions, cough, and kink (S-C-K). The segment also touches on the importance of understanding ventilator settings for ICU nurses.

05:06

📋 Ventilator Settings and Nursing Care

This part of the video script delves into the specific settings of a mechanical ventilator, such as respiratory rate, tidal volume (VT), fraction of inspired oxygen (FiO2), I:E ratio, and positive end-expiratory pressure (PEEP). Cathy stresses the need for ICU nurses to be well-trained in managing ventilators. The nursing care section highlights the importance of having a manual resuscitation bag and reintubation equipment at the bedside. Regular assessments of the patient's consciousness, vital signs, breath sounds, pulse oximetry, and arterial blood gases (ABGs) are crucial. Additionally, oral and tracheal suctioning, ET tube repositioning, oral care, and monitoring for complications like ventilator-associated pneumonia are discussed. Post-extubation care, including encouraging deep breathing and coughing, is also mentioned. The segment concludes with a quiz to test viewers' knowledge on the causes of alarms and necessary equipment at the bedside for a ventilated patient.

📢 Conclusion and Engagement Invitation

Cathy concludes the video by inviting viewers to engage with the content. She encourages subscribing to the channel, sharing the video with peers in nursing school, and leaving comments about what they found most helpful. The segment serves as a call to action for viewers to interact with the content and with the community, indicating the end of the respiratory system series.

Mindmap

Keywords

💡Mechanical Ventilation

Mechanical ventilation is a medical procedure where a machine (ventilator) assists or takes over the work of breathing for patients who are unable to breathe adequately on their own. It improves gas exchange and decreases the work of breathing until the cause of respiratory failure can be addressed. In the video, this term is central as it discusses the various aspects of mechanical ventilation, including types of alarms, settings, and nursing care.

💡Low Pressure Alarm

A low pressure alarm in mechanical ventilation indicates a potential leak in the system. Causes include disconnection, cuff leak, and tube displacement. The video emphasizes the importance of being aware of these alarms and their causes to ensure patient safety.

💡High Pressure Alarm

High pressure alarms signal an increase in pressure within the ventilator system. The video provides a mnemonic, 'Two PB sandwiches can make you sick,' to remember the causes: pulmonary edema, pneumothorax, bronchospasm, biting, secretions, cough, and kink.

💡Respiratory Rate

Respiratory rate refers to the number of breaths taken per minute. In the context of mechanical ventilation, it is a setting that determines how often the ventilator delivers breaths to the patient, which is crucial for maintaining adequate oxygenation.

💡Tidal Volume (VT)

Tidal volume is the volume of air inhaled or exhaled in a single breath. In mechanical ventilation, it is a setting that specifies the amount of gas delivered with each breath, ensuring that the patient receives the necessary volume for proper gas exchange.

💡FiO2

FiO2 stands for the fraction of inspired oxygen, which is the concentration of oxygen in the air delivered to the patient. The video mentions that it can vary between 21% and 100%, indicating the importance of adjusting this setting to meet the patient's oxygen needs.

💡I:E Ratio

The I:E ratio represents the ratio of inspiration to expiration times in mechanical ventilation. A typical ratio is 1:2 or 1:1.5, which means the inspiratory phase is shorter than the expiratory phase. This setting is important for efficient gas exchange.

💡PEEP

PEEP stands for positive end-expiratory pressure, which is the pressure applied at the end of expiration to keep the alveoli partially inflated and prevent their collapse. This is a critical setting in mechanical ventilation to improve oxygenation and prevent atelectasis.

💡Manual Resuscitation Bag

A manual resuscitation bag is a device used to provide manual ventilation in case of ventilator failure or during transport. The video emphasizes having one readily available at the bedside for patients on mechanical ventilation.

💡Reintubation Equipment

Reintubation equipment includes the necessary tools to reinsert a breathing tube in case of accidental extubation. The video mentions that this equipment should be readily available at the bedside for patients on mechanical ventilation.

💡Ventilator-Associated Pneumonia (VAP)

VAP is a type of pneumonia that occurs in patients who are on mechanical ventilation. The video discusses the importance of monitoring for complications such as VAP as part of the nursing care for mechanically ventilated patients.

Highlights

Mechanical ventilation improves gas exchange and decreases the work of breathing.

Low pressure alarms are due to leaks, including disconnection, cuff leak, and tube displacement.

High pressure alarms are due to an increase in pressure, with causes remembered by the saying 'Two PB sandwiches can make you sick'.

Two Ps in the saying stand for pulmonary edema and pneumothorax.

Two Bs in the saying stand for bronchospasm and biting.

S-C-K in the saying stands for secretions, cough, and kink.

Respiratory rate is the number of breaths per minute delivered to the patient.

Tidal volume (VT) is the volume of gas delivered with each breath.

FiO2 is the fraction of inspired oxygen, varying between 21% and 100%.

I:E ratio is the duration of inspiration to expiration, typically 1:2 or 1:1.5.

PEEP is the positive end-expiratory pressure applied to prevent alveoli collapse.

At the bedside, have a manual resuscitation bag and reintubation equipment available.

Regularly assess the patient's level of consciousness, vital signs, breath sounds, pulse oximetry, and ABGs.

Suction oral and tracheal secretions as needed.

Reposition the ET tube every 24 hours or more frequently to prevent skin breakdown.

Provide frequent oral care to the patient.

Monitor for complications such as ventilator-associated pneumonia.

After extubation, encourage deep breaths, coughing, and use of the incentive spirometer.

Quiz question 1: Excess secretions cause high pressure alarms.

Quiz question 2: A manual resuscitation bag and reintubation equipment should be kept at the bedside.

Quiz question 3: A cuff leak causes low pressure alarms.