Mechanical Ventilation - Medical-Surgical - Respiratory System | @LevelUpRN
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
😷 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.
📋 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
💡Low Pressure Alarm
💡High Pressure Alarm
💡Respiratory Rate
💡Tidal Volume (VT)
💡FiO2
💡I:E Ratio
💡PEEP
💡Manual Resuscitation Bag
💡Reintubation Equipment
💡Ventilator-Associated Pneumonia (VAP)
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.
Transcripts
Hi. I'm Cathy with Level Up RN. In this video, we are going to talk about mechanical ventilation,
and at the end of the video, I'm going to give you guys a little straightforward quiz to
test your knowledge of some of the facts I'll be covering in this video.
So mechanical ventilation improves gas exchange and decreases the work of breathing
until the cause of respiratory failure can be identified and corrected. So we're going to go
through the different types of alarms that you will hear with mechanical ventilators,
and then we're going to talk about the settings, and then nursing care with mechanical ventilation.
So we have low pressure alarms and high pressure alarms. Low pressure alarms are due to
leaks. So low pressure, leaks; both start with L. Causes include disconnection,
cuff leak, as well as tube displacement. Then we have our high pressure alarms, which is due to an
increase in pressure, which makes sense. So there are a variety of causes of a high pressure alarm,
and they can be hard to remember, so luckily for you guys, there's a member of the Level Up RN
community who provided this little saying to help you remember them all. So she wrote in:
"Two PB sandwiches can make you sick." So two peanut butter sandwiches can make you sick.
So we have our two PB. So two Ps include pulmonary edema and pneumothorax. The two
Bs include bronchospasm and biting. And then with sick, S-C-K, we have secretions for the S,
cough for the C, and kink for the K. So, "Two PB sandwiches can make you sick"
will help you remember the first letter of all of the key causes of a high pressure alarm.
Next, let's talk about some of the settings that we'll see with a
mechanical ventilator. And obviously, if you're going to be working in the ICU, you should get
training and precepting so that you're very comfortable with operating a ventilator.
So I'm going to go through some of the settings here on the flash card, but not every single one.
So we have respiratory rate. This is the number of breaths per minute that are
delivered to the patient. Then we have the tidal volume, or VT, as it's abbreviated,
and this is the volume of gas that is delivered with each breath. Then we have our FiO2,
which is the fraction of inspired oxygen, and this is the O2 concentration of the air
that is being delivered to the patient, and it can vary between 21% and 100%. Then we have our I:E
ratio. This is the duration of inspiration to expiration, and that ratio is typically 1:2
or 1:1.5. Then we have our PEEP, which is the positive end-expiratory pressure. This is the
pressure that is applied at the end of expiration to distend the alveoli and prevent collapse.
All right. Now let's talk about best practices for nursing care of a patient who is mechanically
ventilated. So at the bedside, we want to have a manual resuscitation bag as well as reintubation
equipment, which includes two different tube sizes that are readily available. Then we
want to regularly assess our patient's level of consciousness, their vital signs, their breath
sounds, as well as their pulse oximetry and their ABGs. We want to suction their oral and
tracheal secretions as needed. And then we need to reposition their ET tube every 24 hours or
more frequently to prevent skin breakdown, because if that tube just rest there against the mucosa,
it can cause damage and a pressure injury, and then that would be a hospital-acquired
pressure injury. We want to provide our patient with frequent oral care, and we want to monitor
for complications such as ventilator-associated pneumonia. And then after extubation, we want to
encourage our patient to take deep breaths, cough, and use their incentive spirometer.
All right. Time for a quiz. I have three questions for you regarding
mechanical ventilation. First question, excess secretions will cause what type of alarm?
If you said a high pressure alarm, you're correct. Question number two,
what should be kept at the bedside for a patient who is on a mechanical ventilator?
The answer is a manual resuscitation bag as well as reintubation equipment.
Question number three, a cuff leak will cause what type of alarm?
The answer is a low pressure alarm. All right. That is it for this video, and that is it for
the respiratory system. So I hope this video series has been super helpful for you guys.
If so, be sure to subscribe to our channel, share a link to your classmates and friends
in nursing school, and leave me a comment and let me know what you liked best about
these videos. Thank you so much for watching. I invite you to subscribe to our channel and share
a link with your classmates and friends in nursing school. If you found value in this video, be sure
and hit the like button, and leave a comment and let us know what you found particularly helpful.
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