Ventilator Settings Made Easy - Mechanical Ventilation (AC, SIMV, FiO2) NCLEX RN & LPN

[Applause] thank you [Music] now for ventilator settings and mechanical ventilation mechanical ventilation means that a machine is mechanically giving breaths or ventilations to a patient and the ventilator is the actual machine that works a lot like an air pump that pumps air into tires on a bicycle in the same way we're pumping air into the lungs this is called ppv positive pressure ventilation which is very different than normal breathing you see in normal breathing the diaphragm and lungs use negative pressure to bring in oxygen rather than having it blasted from positive pressure being pushed into the lungs naturally this ppv or positive pressure is a big danger it can cause trauma in the lungs with over inflation this trauma is called Barrow trauma so just think breathing trauma for Bare Road trauma that damage to the lungs and in severe cases it can even pop along if the pressure is high enough this is called a pneumothorax or a per pneumothorax as I like to call it for a popped lung but we'll cover this in the complication segment and also all the ventilator settings like alarms monitoring modes and settings but first let's cover the most tested topics for your NCLEX and exams first up is suction which causes a huge risk for trauma bleeding and hypoxia that low oxygen so it's only performed when needed now the top five key points that are most tested write these down number one we always suction out never in key terms is never apply suction when inserting the catheter into the airway you like that did you well click here and get access to over a thousand fun visual videos 300 study guide cheat sheets and a massive quiz Bank loaded with detailed rationales to test your knowledge neatly organized in our new app click here to get started for free [Music] so the memory trick just think to get secretions out we suction on the way out now number two is 10 seconds or less for suctioning and number three 100 oxygen 30 seconds before suctioning since suctioning can remove oxygen and secretions at the same time which causes a huge risk for hypoxemia and even cardiac dysrhythmias now number four we avoid suctioning before ABG draws huge NCLEX tip here we have to wait at least 20 minutes since it will deplete oxygen levels and show incorrect results and number five avoid suctioning routinely huge risk for trauma key term here is acute lung injury so we only suction when needed so watch out for the key term routinely don't get tricked here avoid suctioning routinely many students get this wrong now a little side note here Kaplan mentions we adjust the fio2 when preparing to suction the endotracheal tube and Hesse mentions a patient with increased ICP when should suctioning be performed when the O2 sat drops because of increased respiratory secretions the key term here states that increased respiratory secretions indicates an assessment has been made so before the intervention is done don't get tricked always assess before suctioning next is Oral Care and the big key term here is VAP ventilator Associated pneumonia that deadly infection inside the lungs we have to do two key things here so write this down reposition side to side every two hours to help mobilize secretions and number two Oral Care with key term chlorhexidine every two hours typically followed by Oral suctioning so a common exam question here is the best indicators of ventilator Associated pneumonia that VAP select all that apply so the best indicator for that VAP is a positive sputum culture a fever over 100.3 and even chest x-rays that show new infiltrates and a common NCLEX question here is appropriate interventions for a patient intubated on continuous sedation to prevent that VAP ventilator Associated ammonia select all that apply so daily sedation and weaning protocols called sedation vacations number two is Elevate the head of the bed at least 30 to 45 degrees number three is that Oral Care with chlorohexidine and number four as usual hand hygiene always wash those hands and number five no that is incorrect if you chose that then you nasty next is NG tube feeding and GI ulcers when a patient is innovative so starting with NG tube write this down no bolus feedings due to the increased risk for aspiration so let's be real here ebola's feeding is like taking a beer bong that's a lot going in all at once huge risk for choking and aspiration so we always use continuous feedings to prevent that aspiration when a client is on an ET tube number two is GI stress ulcers from gastric secretions that burn a hole in the GI tract so ATI mentions a complication associated with long-term mechanical ventilation is stress ulcers so we typically give acid reducers like ppis or H2 blockers prophylactically to prevent those ulcers next is complications and the number one thing is a dropping O2 saturation you must always assess first so write this down auscultate lung sounds so again always assess before any intervention to confirm to placement if secretions or a mucus plug are the problem then we simply suction it out but if it's not and the O2 sat keeps on dropping then we must use mechanical ventilation with oxygen attached and call for help now don't let the NCLEX trick you here we do not give high flow O2 via non-read breather mask since it doesn't provide ventilation or breaths into the lungs now number two as mentioned before is secretions then we simply suction it out and number three is that manual ventilation with a resuscitation bag or an Ambu bag so naturally bedside Essentials we have to have an extra Innovation setup and that bag valve mask or Ambu bag also called a resuscitation bag so Kaplan mentions essential to have resuscitation bag at a bedside when a patient is intubated now other complications as mentioned before is a pneumothorax or that popped lung from barotrauma caused by that high peep huge NCLEX tip here so write down these key terms over 60 percent of students miss this so remember the pneumothorax is a popped lung from too much positive pressure from that vent AKA peep which ruptures the little alveoli in the lungs and now air trapping is inside the pleural space and lastly number three is our hypotension that low blood pressure another adverse effect from all that positive pressure going into the lungs causing pressure on the thoracic blood vessels sort of like squeezing the heart down reducing the heart's ability to pump which reduces cardiac output so less blood being pumped out of the heart for Less cardiac output and this causes blood pressure to drop lastly is extubation so when a tube is taken out we have a high risk for Airway obstruction and respiratory distress so write this down we always use warm humidified oxygen via face mask number two is Oral Care with key term here oral sponges so no ice chips and no oral fluids we have a high risk for aspiration and Airway obstruction number three is the NPO so nothing per oral and lastly number four is high Fowler's position so make sure the head of the bed is up to maximize lung expansion and prevent aspiration now two deadly risks after extubation first up is atelectasis and pneumonia so atelectasis is where the alveoli collapses and traps infection leading to deadly pneumonia so we must instruct the patient to use the incentive spirometer every hour in order to re-expand and open up those weak alveoli and number two is turn cough and deep breathe to mobilize secretions and cough out all that mucus which causes the infection now number two is the Strider here we call it the Strider squeak it's a noise heard upon inspiration indicating a very narrow Airway this must be reported immediately because it's a huge Airway issue and a medical emergency so ATI mentions a Strider following extubation we must report to the provider immediately and Kaplan mentions extubated from endotracheal intubation 10 minutes prior the priority assessment finding to report to the hcp is the Strider so just think a Strider squeak is very serious you must report this now a bonus side note here is tracheostomy care the number one priority for a new tracheostomy we're talking immediately after surgery fresh post-operative we must key terms here check the tightness of the ties and use one finger to fit under the ties this prevents dislodgement and loss of the airway so write that down the number one priority for a new tracheostomy returning from the operating room now the NCLEX focuses on things that will kill the patient and other safety topics primarily so always focus on things that will kill the patient or cause harm the worst thing that can happen is accidental dislodgement of this tube resulting in that loss of Airway since the new trach placement is very difficult to reinsert because it takes time to heal so we must check tightness of the ties to prevent the Lost Airway that's always the number one priority so don't let the NCLEX trick you here priority is always Airway not performing mouth care to prevent infection and not doing a dressing change on this new trach or changing the inner cannula many students get this wrong so please write it down checking tightness of the ties means maintaining the airway here okay now what happens if the tracheostomy does get dislodged or pops out let's say you're going to check on your patient and you find the trach tube sitting on the bed oh snap well now we have a loss of Airway from a closed stoma and the patient's gasping for air this my friends is a medical emergency so what's your first action well we need to secure that Airway right so listen close here for a mature tracheostomy seven days or more we insert the new tracheostomy tube using a curved hemostat but technically we should always have an arbitrator at the bedside used to reinsert and number two is we cover the stoma with a sterile occlusive dressing and ventilate the lungs by using a bag valve mask over the nose and mouth now those two steps love to show up on the NCLEX since this is a life-saving intervention here now let's just say it's a new tracheostomy less than seven days well then we only do number two here covering the stoma with that occlusive dressing and then using a bag valve mask to ventilate the nose and mouth since the trach is not mature enough to be immediately reinserted lastly a little side note for other key points Kaplan mentions controlled mandatory ventilation for clients with Gian Berets which I call Ground Up Berets since ascending paralysis goes from the feet to the respiratory tract and paralyzes the diaphragm which we cover in another video but since it's very deadly it's highly tested here and has he mentions a patient with increased ICP has normal pH increased paco2 that carbon dioxide the hcp orders an increase in respiratory rate of the patient's ventilator the nurse knows that this change should have which outcome on the patient's ICP well it will decrease the carbon dioxide which will decrease that ICP via vasoconstriction you see carbon dioxide dilates the blood vessels making the blood acidotic we call it carbon Dio acid and this dilation from carbon dioxide allows way more blood flow to the brain which increases ICP that intracranial pressure so we need to get all that acid out of the body by blowing it off with hyperventilation like get your acid out of here so hyperventilation puts the patient into respiratory alkalosis so think of panning like a dog for alkalosis so without carbon dioxide making the blood acidic we vasoconstrict the blood vessels for Less blood flow and less pressure to the brain now Switching gears here let's cover all the key ventilator numbers from alarms modes settings and monitoring first thing I want to highlight is the pretty blue light here this tells us a lot of important numbers then down here at the bottom is the clear curly stuff which a lot of lung butter builds up in there lastly is the big old round dial here always a family favorite oh yeah you turn this sometimes and uh I'm just kidding this is actually a meme from Facebook and I think it's pretty funny here because half the time no one knows how a ventilator Works they just push it around like a big refrigerator okay let's start the lecture starting with alarms so we have two types low pressure and high pressure here so for low pressure this is known as a low tidal volume alarm just think of the double L's here it means L we have a loss of connection resulting in an air leak now it's typically caused from a cuff leak that's not tight enough or ET tube displacement which is very scary or just disconnection of the tubes and high pressure alarm also called high peaked pressure alarm just think H for high blockage anything that can cause a blockage of airflow resulting in peaked airway pressure so we must assess first for blockage now this is typically from biting a tube kinks in the tube excessive Airway secretions like a mucous plug or even coughing which is probably the most common and another common one is a client who fights the ventilator typically when waking up from sedation now some more serious ones are pulmonary edema that fluid in the lungs and pneumothorax that popped lung with trapped air this causes more pressure so really just anything that causes a blockage of airflow now Kaplan mentions a client with emphysema receiving mechanical ventilation appears restless and agitated priority action when a high pressure alarm sounds instruct the client to allow the machine to breathe for the client and a common NCLEX question here the nurse responding to a high pressure alarm on the ventilator would assess for which condition so once again think high pressure high blockage so option number one auscultate the lungs for pulmonary edema yes this is high blockage option two biting the ET tube yes again another blockage now option three and four are incorrect tube displacement guys that's a low leak here a leaky air and number four disconnection of tubes again we're leaking air there's no blockage here and option five and six are correct excessive Airway secretions can cause blockages and kinked Airway tubing will definitely cause a blockage now let's cover modes here the two ones you have to know is AC and simv so AC is for assist control this means full machine control over the patient's respiratory rate so it's a hundred percent machine control typically used after CPR or even in life support like long-term care clients so just think AC is for actively controls breathing next is simv this is known as the weaning mode so the fancy word is synchronized intermittent mandatory ventilation basically the patient controls breathing mainly and the Machine assists so think of the double s's here s for simv is s for step down we're basically stepping away from full control and we're doing the weaning we're allowing the patient to take control of their own respirations here next is all the main the crazy settings here so starting with the first one VT also known as V4 this is known as tidal volume now I know you're probably thinking it should be TV but no it's VT so the description is the volume of air set to be delivered with each breath so every time a patient takes a breath of air this is the volume they get so 500 to 800 MLS of air is typically normal in terms of how much air they get so the memory trick for tidal volume just think a tidal wave of air next is f r r this is our frequency of respirations so just the number of breaths per minute and just like normal like your normal vital signs 12 to 20 is the typical setting here so the memory trick just think frr as freaking respiratory rate man okay next is fio2 it's our oxygen concentration typically between 35 to 100 percent so naturally higher the oxygen percentage the more severe the patient is so the memory trick fio2 just think VO2 for feed me O2 next up is our peep positive and expiratory pressure so I would really focus on this one because a lot of complications really the most deadly complications come from this setting so it keeps the alveoli open with positive pressure at the end of the respiration and a huge caution is that barotrauma which eventually can even lead to a pop lung that pneumothorax so the key point is the peep improves gas exchange keeping that alveoli open to push oxygen in and expel CO2 out especially with ards where fluid fills up that alveoli which blocks gas exchange so for the memory trick think of the double P's peep pushes open that alveoli and very lastly is the PS kind of like when you're writing an email and you leave PS this is our pressure support it pushes air to help with spontaneous breathing so think PS is spontaneous breath support just helping the patient breathe when they want to take a spontaneous breath so a common NCLEX question always revolves around the most deadly complications here so which complication is associated with excessively high levels of Peep the answer is Barrow trauma or even pneumothorax remember a popped lung from too much pressure being pushed into the lungs or basically this positive pressure from the vent being pushed into the lungs that's the worst case scenario okay next up is monitoring we have three types the ve the PIP and the pimp I'm just kidding and the P plat so first up is the v e this is for minute ventilation here it's the amount of air delivered per minute so the memory trick is v e ventilations every minute next is our pip here so peaked inspiratory pressure this is the max pressure during inspiration so the memory trick think pip is the tip of max pressure and our last one here is p plat our Plateau pressure this is pressure applied to hold open the small Airways and alveoli before expiration it indicates lung compliance for example our patients and ards who have stiff hard lungs the lungs are not compliant they're stiff and hard so Plateau pressure gently reopens the alveoli by holding it open a little bit longer so the memory trick think Plateau is a paused lung to hold open the air sacs just a little bit longer okay that wraps it up for ventilators don't forget to take your quiz and download the study guides thank you so much for watching thanks for watching for our full video and new quiz Bank click right up here to access your free trial and please consider subscribing to our YouTube channel last but not least a big thanks to our team of experts helping us make these great videos alright guys see you next time [Music] foreign [Music]

Channel: Simple Nursing

Views: 424,375

Keywords: Ventilator settings, Ventilator, Mechanical Ventilation, SIMV, AC, FiO2, oxygen delivery, Intubation, Endotracheal intubation, IE tube

Id: 52TUHwnhZeo

Length: 24min 2sec (1442 seconds)

Published: Tue May 18 2021