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.
The lecture Clinical Applications of Mechanical Ventilators (Nursing) by Rhonda Lawes, PhD, RN is from the course Mechanical Ventilation (Nursing).
In which situations are mechanical ventilators commonly used? Select all that apply.
What is true about the process of mechanical ventilation?
The client has just been intubated and is connected to the ventilator. What should the nurse do next after securing the device and listening for breath sounds?
How is an endotracheal tube secured? Select all that apply.
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