Introduction to Mechanical Ventilation (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Hi, I'm Professor Lawes.

    00:02 And I am really excited to bring you this series on Mechanical Ventilation.

    00:07 So I'm going to walk you through all of the most important things that you'll need to know as a nurse, caring for a patient who's on a ventilator.

    00:15 So let's start from the very beginning.

    00:17 Okay, so this is a mechanical ventilator.

    00:20 When you say a patient's on the vent, this is what they're referring to.

    00:24 And what's got this microprocessor in it? It's pretty fancy these days. And that's what controls the device.

    00:30 Now, it delivers a mixture of air and oxygen into the patient's lungs.

    00:36 Now, this replaces their natural respiration.

    00:38 So, patients who are on a ventilator are obviously having some type of respiratory difficulty.

    00:43 And I want to introduce you to who will become your best friend, If you're smart, if you're working on a unit for any patients that need respiratory support.

    00:53 I want to talk about the difference in between a respiratory therapist and a nurse.

    00:57 And when I work a unit, these are the people I count on and rely on.

    01:02 They're fabulous to collaborate with.

    01:04 See both of us have a license.

    01:06 As a nurse, I have an RN state license.

    01:10 A respiratory therapist has an RRT or a Registered Respiratory Therapist state licensed.

    01:15 So we're both licensed healthcare personnel.

    01:18 Nursing collaborates with respiratory therapy and respiratory therapy collaborates with nursing.

    01:24 Hey, when this all works well, when you have a positive and strong relationship with your respiratory therapy team, they can spot things really quickly work together and help avoid major problems or danger with your patients.

    01:38 Now, technically, the nurse is going to assess the patient as a whole, right, from head to toe.

    01:43 And we're overseeing all of the care.

    01:45 The respiratory therapist is going to focus on the cardiopulmonary system.

    01:49 But man, I wish I could tell you how many times a respiratory therapist has noticed a slight change.

    01:57 We got put our heads together and we're able to come up with a solution that avoided a really bad outcome.

    02:02 So you want to see them as your equal.

    02:04 You collaborate with them. They know their stuff.

    02:08 They have an intuition, just like nurses have intuition based on experience.

    02:13 So, hopefully, you quickly establish a really solid relationship with a respiratory therapy team where you work.

    02:19 Okay, now, let's talk about breathing.

    02:23 Yep, you're doing it all the time.

    02:25 But you may not have really sat down and thought about it.

    02:28 In order for you to understand mechanical ventilators, you need to understand what goes on in a natural inhalation.

    02:36 So just stop for just a second and take a deep breath in.

    02:43 Okay, that's how it's supposed to work.

    02:45 You wanted to take a breath, you took a breath, everything's going well.

    02:49 But the patients we take care of in the hospital, it's usually not that simple.

    02:53 So, it's important that you understand how it works naturally, or normally in your body.

    03:00 Now you have the diaphragm, right? That's that muscle.

    03:03 It was right across the center. It contracts.

    03:06 And when I say it contracts, it pulls down.

    03:09 And that's what creates negative pressure into the lungs.

    03:13 Okay, I know that you guys have heard that term, negative pressure, diaphragm involve.

    03:18 You've heard it before in lots of other lectures.

    03:21 But I want you to really think about how it works.

    03:24 So this is where I want you to get the picture.

    03:26 That diaphragm flattens out.

    03:29 That creates an open space, and air is able to enter into the lungs, right? That's natural inhalation.

    03:36 You just took a breath with us together.

    03:38 What we're going to talk about today is when natural inhalation doesn't provide enough oxygen to the patient's body.

    03:45 We use a mechanical ventilator.

    03:48 Remember, that's that machine with a microprocessor in it.

    03:50 Now, the mechanical ventilator has to push oxygenated air in with positive pressure into a person's lungs.

    03:59 Naturally inhalation.

    04:01 My diaphragm helps to create negative pressure and air goes in gently.

    04:06 Mechanical ventilator, that is pushing oxygenated air into it with positive pressure.

    04:13 So, this, doesn't really risk damaging my lungs.

    04:18 Mechanical ventilator can come with all kinds of complications that we'll talk about further along in this video series.

    04:25 So, let's start at the very top.

    04:28 You've got a framework, you know, the people we work with.

    04:31 We've talked about what negative pressure is, and we'll get a little bit more into that.

    04:35 And we talked about how a mechanical ventilator is different because it is pushing air into those lungs.

    04:43 So, let's just do a quick review of your anatomy.

    04:46 We'll start at the top because that's where the air enters.

    04:49 So you've got your nasal cavity.

    04:51 Now you can also take it in and your mouth.

    04:53 But let's say you're taking air in.

    04:55 In your nasal cavity where those cilia are so they can function like they're intended to do to protect you from really nasty things getting into your respiratory tract.

    05:05 Travels down through the pharynx, down through to the trachea into the lungs.

    05:10 So that airway is what needs to be complete, intact, and unobstructed in order for air to come from the outside into your lungs.

    05:20 And this is a super cool picture. Look at this.

    05:22 The artists have created for you.

    05:24 There's the lungs, or the pink tissue.

    05:26 You've got the ribcage right there.

    05:28 You've got your sternum in the middle.

    05:31 Now, we're gonna take a little chunk out of that, because I want to explain to you more about negative pressure.

    05:37 So you see we've taken that chunk out of the tissue.

    05:39 And now we're going to pull back even more.

    05:42 And I want you to understand how these things all fit together.

    05:45 Now I'm going to start with the outside and then go into the very innermost side just to start with.

    05:51 So, on the outside, you see that flesh colored area, that would be the skin. So, that's the skin.

    05:59 Now, move all the way through the different layers, and that is the lung tissue.

    06:04 What I want to talk to you about is the stuff in between.

    06:07 So let's help you get a little oriented.

    06:09 You've got the skin, which is the outside, and the lung, which is all the way on the inside what we're going to look at.

    06:16 Now, let's look for some big markers.

    06:19 Some big landmarks that can help you know where you are.

    06:22 Pretty sure you can pick out the ribcage, right? Take a look at where that is.

    06:27 All right, so in this picture, you see two ribs.

    06:31 And they're letting us see there that it's bone, and they've sliced through it just to help us get an idea of what it looks like.

    06:38 So, you've got the skin, the lungs.

    06:40 We've got the ribcage right in the middle.

    06:43 Now, notice of that top rib, you've got three vessels.

    06:47 One is blue, one is red, one is kind of a golden color.

    06:51 That's a vein, an artery, and an intercostal nerve.

    06:56 Okay, so we've got a blood supply that's bringing oxygenated blood.

    07:01 That's the artery. You've got the vein taking deoxygenated blood back to the heart, and then you've got the nerve.

    07:07 Okay, so we've got our locations we know where we are.

    07:10 The next thing I want you to see is to take a look at the layers.

    07:14 Now, this is what helps keep as whole system intact.

    07:18 I want you to look at the pleura.

    07:21 You see closest to the lungs, we have what's called a visceral pleura.

    07:26 Now, on the other side, you have a parietal pleura.

    07:29 So you've got visceral, parietal.

    07:31 See those two? They have a space in between, and that's what we call the pleural cavity.

    07:38 Okay, now, these are pretty tight membranes, and they need to be whole and intact.

    07:44 So when that diaphragm flattens down, that's what allows air to come in. These pleura have to be intact.

    07:53 Now, if I've got extra fluid in there, sometimes they do a procedure called a thoracentesis.

    07:58 where you end up pulling out extra fluid for maybe an infection.

    08:02 But it's super important like impossible for the lungs to stay inflated, consistently, if there's some type of tear or opening in either one of these pleura.

    08:13 So when we say you need intact space in here, those pleura have to be intact in in good shape and functioning.

    08:21 So most important takeaways from this would be the lungs cannot inflate and deflate as they should, unless those pleura are intact.

    08:33 Okay, so we've got lots of other things in there.

    08:37 But that's the most important point I want you to take away.

    08:41 When you're helping someone support their respiratory even when you're doing a normal assessment, picture what it looks like what it takes for your lungs to function normally, the next time you're listening to lung sounds.

    08:53 So, I want to give you another perspective here.

    08:56 See that diaphragm? Look how its dome shaped.

    09:00 See how we have the pleura outline there? When that diaphragm flattens, that's what, it's like, almost causes a sucking motion, or the negative pressure because now it goes from here to here causes extra space in your cavity.

    09:17 Air will come in passively because of the negative pressure.

    09:21 And that's how you can breathe in.

    09:25 So, please do me a favor and take just a second.

    09:28 Think about if I pause here and I take a deep breath in.

    09:32 What's happening to your diaphragm? Well, it had to flatten, right? So have that picture in your mind because when the diaphragm doesn't work, that's when a person can't breathe.

    09:44 That's when they'll absolutely have to be supported.

    09:47 If they've had nerve damage or direct damage to the tissue that is the diaphragm, they will not be able to breathe on their own.

    09:55 And that's critically important that you understand that as a nurse because when we give a patient a medication like a neuromuscular blocker, that muscle will be paralyzed.

    10:04 And that's why anyone who's on a neuromuscular blocker has to be on a ventilator. Okay, you're doing really well.

    10:12 That's just a quick review.

    10:13 I know you guys have had anatomy and physiology, but I really wanted to break it down for you.

    10:18 So it makes sense when you're talking about ventilators.

    10:22 So when the diaphragm flattens, I breathe in.

    10:26 Right, my chest wall gets bigger.

    10:28 My ribs kind of stretch out a little bit.

    10:30 And then when I exhale, everything returns to normal.

    10:35 Any problems with any of those areas, breathing is going to be a difficult.

    10:39 What if that nerve is irritated that we talked about right or under the vein and artery? I'm not going to want to take big breaths, right? I'm going to want to... [breath sound] take little tiny breaths, because it's painful for me.

    10:52 When the lungs are not inflated to the adequate volume, when they're under inflated or over inflated, you're going to have problems.

    10:59 That's why it matters that we help the patient breathe as normally as possible under really abnormal situations.

    About the Lecture

    The lecture Introduction to Mechanical Ventilation (Nursing) by Rhonda Lawes, PhD, RN is from the course Mechanical Ventilation (Nursing).

    Included Quiz Questions

    1. Mechanical ventilation uses positive pressure, while natural inhalation uses negative pressure.
    2. Natural inhalation uses positive pressure, while mechanical ventilation uses negative pressure.
    3. Both mechanical ventilation and natural inhalation use positive pressure.
    4. Both mechanical ventilation and natural inhalation use negative pressure.
    1. Visceral pleura
    2. Parietal pleura
    3. Endothoracic fascia
    4. Intercostal nerve
    1. The pleura
    2. The endothoracic fascia
    3. The intercostal muscles
    4. The rib cage
    1. The diaphragm flattens.
    2. The pleural space widens.
    3. The lungs contract.
    4. The pleural space fills with air.
    1. A client with nerve damage to their diaphragm.
    2. A client who was given a neuromuscular blocker for surgery.
    3. A client given a local anesthetic for an outpatient procedure.
    4. A client with a spinal cord injury at T12.
    5. A client with pneumonia.

    Author of lecture Introduction to Mechanical Ventilation (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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