Clinical Applications of Mechanical Ventilators (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Let me give you some examples of why we would most commonly use a mechanical ventilator.

    00:06 First one, we want to protect that airway.

    00:08 So, a patient may be intubated, that means you put a tube down in that will provide air to their lungs and ventilated, that's when you hook it up to something that will breathe for the patient positive pressure.

    00:21 If they can't protect their own airway.

    00:24 Now, they might be over sedated or let's say they're in surgery, we have to be really careful with that.

    00:29 They so they have over sedation is for someone who may have done that to themselves.

    00:34 We try not to do that in the hospital.

    00:36 If somebody is under anesthesia, they have no choice, we definitely have given them enough medication to make them not move during the surgery.

    00:46 Anaphylaxis. If someone has an anaphylactic reaction, that airway swells up, they can't get air in on their own.

    00:53 We have a tube that's in there that remains stiff and allows air to be entered.

    00:57 Now they've had trauma or they have some type of obstruction.

    01:00 Those are all reasons why we could put a patient on a mechanical ventilator.

    01:05 So, first step. What types of patient are you going to meet who is ventilated? Look at the list that we have there.

    01:12 Now I want you to look away and see how many of those you can remember an answer yourself.

    01:21 Okay, now, I'm gonna give you lots of opportunities to do this as we go through and study together.

    01:27 Because everyone's brain is human.

    01:30 We're not computers with microprocessors.

    01:32 You can't process all of this information just by listening to the video without engaging with it.

    01:38 So you and I have a deal.

    01:41 We're going to study together as we go through this.

    01:44 And the more often you take a chance to pause, and try and recall what we're talking about, you're teaching your brain how to encode that information, file it in an orderly way, and you'll be able to retrieve it when you need it. Okay? So airway protection is our number one choice.

    02:01 You think about who needs their airway protected, and make sure you can come up with those list of things that we've just discussed.

    02:08 Next type of patient that will have on a ventilator, someone who has a really bad infection.

    02:14 I mean, that kind of infection that is just ravaging their body.

    02:18 So, we know that we're going to try and reduce as much workload on that patient's body.

    02:23 And if we take care of their breathing for them, make sure they are well oxygenated.

    02:29 They can focus the rest of the body's energy on trying to fight the infection.

    02:33 So now, this isn't just, "Oh, I cut my finger and I have a skin wound." This is somebody who has a massive infection.

    02:40 That may be why we placed them on a ventilator.

    02:42 Nervous system injuries.

    02:44 When this happens, you happen to the brain or to the spinal cord.

    02:49 And that significantly impacts the patient's ability to breathe.

    02:52 And that's why the ventilator has to support them.

    02:55 Some injuries patients can recover for and come off the ventilator.

    02:59 Some people have to be on the ventilator for the rest of their life.

    03:02 Someone could also have been exposed to a buildup of toxins.

    03:06 So maybe they have a buildup of toxins that were external.

    03:09 They may have excessive CO2, which can come right from inside the body.

    03:14 We would put them on a ventilator to support that breathing and hopefully we can flush those toxins out of the body.

    03:20 We've talked about the four reasons someone would most likely end up on a ventilator.

    03:25 Now, I want to talk about how do you connect the human to the microprocessor machine that delivers that air through positive pressure.

    03:33 So a tube is inserted. It's called an endotracheal tube.

    03:38 It's pretty invasive.

    03:39 You're going to put it through the patient's nose. You can also put it in their mouth, and its gonna go down into their windpipe.

    03:45 So this tube is then connected to the tubing that will go to the ventilator.

    03:50 Now the ventilator is what pushes that mixture of air and oxygen into the body.

    03:56 So, computer - patient, all connected by tubing.

    04:01 One that goes right down into the windpipe, and the other that is connected to the machine.

    04:06 Let me show you this animation of what it looks like when we put a tube in.

    04:12 See, there's the blade. They're pushing back the tongue.

    04:15 They've got a good visualization of the airway.

    04:17 There goes the ET tube, right into the windpipe.

    04:21 That's the tube that's going to be connected.

    04:23 Now at the end, you see that little blue part on the tube, that's a cuff, and we insert air to inflate that.

    04:30 And that's what helps the tube stay into place.

    04:34 Here's a close up of what the endotracheal tube looks like.

    04:37 This is the tube that you just saw, slid into the patient in the animation.

    04:42 On the far left, that's the tip that shouldn't be down inside the patient at the furthest point.

    04:48 To the right of that you see a pillow, that is a little small balloon that we call it that gets inflated.

    04:55 And that's what helps to keep that tube in.

    04:58 If you didn't have that balloon there to help secure it, it would slide right out much easier than it already does.

    05:04 Now moving closer to the top of the tube on the right, you see there's a white tiny tube connected to a small blue piece.

    05:12 On the end of that you connect a syringe, and you can inject the air that will inflate the cuff.

    05:18 So when you're taking care of a patient, you will look for this.

    05:21 You'll see this little tiny tube with the blue end on it.

    05:24 That's how you can inflate and deflate the cuff.

    05:27 You'll deflate the cuff when you extubate someone to remove the tube.

    05:31 Also, you watch this very closely and keep very specific amounts of pressure in that cuff.

    05:37 Each hospital, protocol, patient's situation, they're going to have specific measurements on how much air you should be put in that cuff every time it's used.

    05:48 So, you go up continuing that and you see that blue tip on the end, that's an actual piece of plastic where you connect the ventilator tubing to that part of the endotracheal tube.

    06:00 Now, after the patient is intubated, the first thing you want to do is secure the device.

    06:05 Now there's all kinds of holders for an endotracheal tube.

    06:09 Some places use tape, that's not very nice.

    06:11 Though, there's some really cool endotracheal tube holders that have Velcro and foam and are much more comfortable for your patient.

    06:19 But whatever you're using in whatever situation you're in, first thing is secure that device because that is your patient's airway.

    06:27 Now once it's secured, and you've listened.

    06:30 You've auscultate it, make sure that you find that it's not just on one side.

    06:35 You've got good breast sounds being delivered.

    06:37 You have to verify placement with a chest x-ray.

    06:40 So this will show up on a chest x-ray.

    06:43 It's got a little line through it that will make it visible on the x-ray.

    06:46 But that's critically important that every patient has a chest x-ray, as soon as possible immediately, if possible, to make sure it's in the right place.

    06:56 Keep an eye on that cuff.

    06:58 Remember, it's only supposed to be a certain level of air in there or amount of air in there.

    07:02 And that balloon is pushing on the patient's tissues.

    07:07 So the shortest amount of time that we can have that tubing is the best for any patient.

    07:13 So let's look at some other things. When does this happen? Why other patients might be having this? What are some medical diagnoses the patients that could end up intubated? Well, ARDS. Wow, that's a really serious diagnosis Acute Respiratory Distress Syndrome.

    07:31 This is about as bad as it gets for your body.

    07:34 Turning on yourself and your lungs not being able to function.

    07:38 This patient will have severe hypoxemia.

    07:41 Now take a look at that word. Hypo means low.

    07:44 Ox also stands for oxygen. -Emia is blood.

    07:49 So when someone has a diagnosis of ARDS, they have very, very low oxygen in their blood.

    07:55 Not adequate for tissue.

    07:58 Chronic Obstructive Pulmonary Disease.

    08:01 Remember we talked about one of the reasons we put someone on a ventilator because they've got this buildup of toxins? Well, someone with COPD, if they're having a severe exacerbation, or maybe they have a couple things going on at one time, they can have hypercapnia.

    08:15 That means they've got way too high CO2 before we would put them on a ventilator.

    08:20 At CO2, they've got some mental status changes.

    08:23 We're going to put them on a ventilator for a while to see if we can bring things back to homeostasis.

    08:28 So, ARDS, Chronic Obstructive Pulmonary Disease.

    08:33 The third one is cardiac or respiratory arrest.

    08:36 Now some of you may have heard a Glasgow Coma Scale less than eight intubate? That's how people remember it.

    08:42 But if someone has had a cardiac or respiratory arrest, we're going to support that airway as long as we need to until they can do that on their own.

    08:50 And we're talking about an anaphylaxis reaction before.

    08:52 If for some reason the patient can't protect their airway anaphylaxis is one reason for that.

    08:58 That's a severe allergic reaction that causes your airways to have edema and swelling and they're not able to get air through.

    09:05 We want to get them intubated quickly.

    09:08 Last is surgery, we talked about that a little bit.

    09:10 We give them drugs that paralyze them, including which muscle being paralyzed is most going to affect the patient's ability to breathe? If you said diapragm, well done.

    09:22 You're right on top of it.

    About the Lecture

    The lecture Clinical Applications of Mechanical Ventilators (Nursing) by Rhonda Lawes, PhD, RN is from the course Mechanical Ventilation (Nursing).

    Included Quiz Questions

    1. Surgery
    2. Spinal cord injury
    3. Anaphylaxis
    4. Pneumothorax
    5. Mild upper respiratory infection
    1. An endotracheal tube can be inserted through the client's nose or mouth.
    2. All clients requiring mechanical ventilation are connected to the ventilator through a tracheostomy.
    3. Mechanical ventilation delivers 100% oxygen directly to the lungs.
    4. The airway is inserted in the client’s mouth and stops before the uvula.
    1. Prepare the client for a chest x-ray.
    2. Recheck breath sounds in an hour.
    3. Deflate the endotracheal tube cuff.
    4. Provide supplemental oxygen via nasal prongs until the client is accustomed to the ventilator.
    1. Through an inflatable balloon that sits in the client’s airway.
    2. Directly to the client’s face using tape or other device.
    3. Through a small wire that sits in the airway and is tied to the external ventilator tubing.
    4. Through the negative pressure initiated by the ventilator.
    5. Through a small plastic cap that sits at the opening of the trachea.

    Author of lecture Clinical Applications of Mechanical Ventilators (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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