NUR 425 Study Set with Questions and Complete Solutions
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Course
NUR 425
Institution
NUR 425
Assist/Control (AC) Ventilation Preset # of breaths and tidal volume (Vt) Patient may trigger additional breaths-considered a weaning mode Vt of spontaneous breaths DOES NOT vary- Ventilator supports ALL breaths (set RR and patient-triggered breaths) with the set Vt Ventilator performs most of the ...
NUR 425 Study Set with Questions and
Complete Solutions
Assist/Control (AC) Ventilation ✅Preset # of breaths and tidal volume (Vt)
Patient may trigger additional breaths-considered a weaning mode
Vt of spontaneous breaths DOES NOT vary- Ventilator supports ALL breaths (set RR
and patient-triggered breaths) with the set Vt
Ventilator performs most of the WOB
Useful in normal respiratory drive but weak or unable to exert WOB
Risk of hyperventilation and respiratory alkalosis
A/C Example ✅Example A/C Settings: Vt 700 RR 12 FiO2 45% PEEP 5cmH20
If patient does not initiate any effort? Will still receive 700 mL 12 times per minute
However, if patient can trigger spontaneous breath-will ALWAYS receive 700 mL Vt with
own breathes
Synchronized Intermittent Mandatory Ventilation (SIMV) ✅Preset # of breaths and tidal
volume (Vt)
In between "mandatory" (preset) breaths, the patient may initiate spontaneous breaths-
but these are NOT supported (unlike AC)
Volume of spontaneous breaths VARIES (whatever the patient does)
Considered a weaning mode
Helps to prevent respiratory muscle weakness, because patient contributes more WOB
Risk of hypoventilation (what if the patient doesn't take any extra breaths?)
SIMV Example ✅Example SIMV Settings: Vt 700 RR 12 FiO2 45% PEEP 5cmH20
Patient receives Vt 700 mL 12 breaths per minute with 45% FiO2
Any spontaneous breaths above 12 times per minute-the Vt VARIES (still get 45%
FiO2)
Continuous Positive Airway Pressure (CPAP)
Invasive or Non-Invasive ✅Continuous positive airway pressure throughout respiratory
cycle to a patient who is spontaneously breathing
That's it! No respiratory rate, no tidal volume, no support for any breaths...so what does
our patient have to do on their own?
Via ventilator (invasive ) or via nasal pillow, mouth/nose mask, or face mask-must have
tight seal (non-invasive)
,Similar to PEEP when provided invasively...
Example Settings:
FiO2: 40% PEEP: 5cmH20
Pressure Support (PS) ✅Pressure support can be BOTH a setting and pressure mode
Example PS as a setting (added on to SIMV- providing help with spontaneous breaths):
SIMV: RR 14 Vt: 500mL PS 10 cmH2O FiO2 50% PEEP: 5cmH20
Patient is in SIMV, but instead of their extra breaths being unsupported by the ventilator
(Regular SIMV), they get 10cmH20 support (SIMV with a PS setting)
Example PS as a mode (All the ventilator is doing is supporting breaths the patient
takes on their own):
PS: PS 10 cmH2O FiO2 50% PEEP: 5cmH20
Missing settings: No RR, No Vt- just help with breaths the patient triggers on their own!)
Patient must be spontaneously breathing if used as a MODE- otherwise they will not get
ANY breaths!
Benefits of Pressure Modes ✅Ventilator set to allow air flow until preset pressure is
reached: Popular mode!!
Vt is variable-similar to normal breathing
Peak inspiratory pressure (PIP) can be better controlled-TOP concern (high PIP can
cause pneumothorax, barotrauma etc)
However, there are risks of
hypoventilation and respiratory acidosis
Mechanical Ventilator Alarms ✅Reasons for LOW=Connections
Tube disconnected
ET tube displaced
Low tracheal cuff pressure
Ventilator malfunction
Leak in circuitry
Mechanical Ventilator Alarms ✅Reasons for HIGH=Obstruction
Decreased lung compliance
Biting on oral ETT
Copious thick secretions in airway
Condensation in circuitry tubing
Right mainstem bronchus intubation
Coughing, gagging
Bronchospasm
Equipment failure
Readiness to Wean ✅Underlying cause for mechanical ventilation is
resolved/resolving
, Hemodynamically stable; adequate cardiac output to provide tissue perfusion
Adequate respiratory muscle strength RR < 30
PaO2 > or= 80mmHg
Minimal secretions
Acceptable vital signs
Alert/awake and spontaneously breathing
Acceptable chest x-ray and ABGs
Adequate oxygenation without a HIGH FiO2 (> 50% ) and/or HIGH PEEP (> 8 cm H2O)
Absence of any factors that impair weaning-infection, anemia, fever, sleep deprivation,
pain, abdominal distention
Mental readiness
Minimal need for medications that cause respiratory depression
Short-Term Weaning Trials ✅Short duration-usually 30 minutes to 2 hours with periods
of rest
Change the mode and settings so that the patient does more work!
SIMV vs. AC (both can be weaning modes if the RR is lowered)
Pressure Support (now the patient has to trigger all breaths, but they get some support
with each breath)
CPAP (now the patient has to trigger every breath- and they don't get any extra support
with each breath)
T-Piece trials strengthens respiratory muscles (no pressure, just humidified FiO2 and a
secure airway!)
Failure to Wean ✅Respiratory rate > 35 or < 8 breaths per minute
Low spontaneous tidal volumes < 5 mL/kg
Labored respirations and use of accessory muscles
Poor ABGs or sats (< 90%) during weaning process
Tachycardia and HTN
Dysrhythmias: PVCs
ST-segment elevation not present prior to weaning
Decreased LOC
Increased WOB to point of exhaustion
Agitation, Anxiety
Diaphoresis
Q1:SIMV: Vt:500, RR:10, PEEP:5, FiO2: 30%. What happens if the patient takes an
11th breath? ✅It will be whatever volume the patient determines
Q2:AC: Vt:500, RR:10, PEEP:5, FiO2: 30%. What happens if the patient takes an 11th
breath? ✅The Vt is guaranteed to be 500
Q3:PS: PS: 10, PEEP:5, FiO2: 30%. What happens if the patient takes a breath? ✅It
will be supported by a PS of 10
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