Med-Surg Respiratory System, part 13: Mechanical Ventilation

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.