Respiratory: Mechanical ventilation (for nursing assistant training)

As a nursing assistant, you will help provide safe care to clients with mechanical ventilation. This is when a machine reduces or even takes over the work of breathing from clients who find it difficult or impossible to do so without help.The use of mechanical ventilation can range from short to long term and from care in a healthcare facility to home care.Okay, now, mechanical ventilation can be “invasive” or “noninvasive.” Invasive mechanical ventilation involves the insertion of an artificial airway.

An artificial airway is basically a tube that gets placed in the trachea.One example of this is an endotracheal tube, which is a tube that gets inserted through the mouth and down past the pharynx and larynx into the trachea.Another is a tracheostomy tube, which is inserted directly through an opening made in the skin of the neck, called a tracheotomy.Typically, both types of tubes have an inflatable balloon that forms a seal against the tracheal wall.

Tracheostomy tubes are also kept in place with a collar or ties wrapped around the client’s neck.Now, the thing with endotracheal tubes is that because they go through the pharynx and larynx, the client won’t be able to speak, drink, or eat anything via the mouth, which can be extremely uncomfortable for the client.If mechanical ventilation is required for a long period of time, a tracheostomy tube might be preferred over an endotracheal tube.Endotracheal tubes can be used only temporarily, for a few weeks, but tracheostomy tubes can be used permanently, such as for clients whose larynx has been surgically removed due to cancer or those with paralyzing conditions that require them to stay on a ventilator permanently.Now, tracheostomy tubes allow the client to take food or fluids normally through the mouth.

Speaking with a tracheostomy tube in place has also been made possible through one-way speaking valves, such as the Passy-Muir valve.This valve opens as the client breathes in and closes after they’ve breathed out, letting the exhaled air flow around the tracheostomy tube and up through the vocal cords and out of the mouth thus allowing voice sounds to be made.

There are various reasons why a client may need invasive mechanical ventilation.Starting with nervous system disorders, these include damage to the spinal cord affecting the muscles responsible for breathing as well as injury to the breathing control centers in the brain caused by severe head trauma, stroke, or even intoxication by alcohol or medications that suppress brain activity, like opioids.Invasive mechanical ventilation might be also needed during or after surgical procedures that require anesthesia; for clients with lung conditions, like respiratory distress syndrome; or heart conditions, like cardiogenic shock.Okay now, for non-invasive mechanical ventilation, no artificial airway needs to be used.

A face mask, nasal plugs, or a helmet is used instead to force air with positive pressure in the airways.That’s why it is also called non-invasive positive pressure ventilation, or NIPPV for short.

Now, this positive pressure keeps the airways open and prevents them from collapsing, allowing gas exchange to happen in the lungs.So, positive pressure during inspiration helps oxygen get absorbed, while positive pressure during expiration helps carbon dioxide get blown out.There are two types of NIPPV.

Continuous positive airway pressure, or CPAP for short, keeps a steady positive airway pressure during both inspiration and expiration.Bilevel positive airway pressure, or BiPAP, on the other hand, delivers two distinct levels of positive airway pressure: a higher one during inspiration and a lower one during expiration.Now, NIPPV can provide a safe alternative to endotracheal intubation or tracheostomy in many cases.It is mainly used to support ventilation for clients with obstructive sleep apnea as well as clients with neuromuscular diseases that affect the respiratory muscles.It can be also helpful in acute exacerbation of chronic obstructive pulmonary disease, or asthma, and pulmonary edema due to heart failure.When caring for clients on invasive mechanical ventilation, or NIPPV, there are some general considerations to keep in mind.

First of all, check that all tubing or masks are kept in place and connections are secure.For NIPPV, keep in mind that the mask needs to fit snugly so that the air doesn’t leak out but not too tight because this can be uncomfortable for the client and cause skin breakdown.For clients with endotracheal tubes or tracheostomies who are unable to speak, eat, or drink normally, it’s important to make sure that they are provided with a way to communicate, such as a call light that they can easily reach.Some alternate, non-verbal ways to communicate can be used, such as a portable text-to-speech communication aid or a communication board.In any case, be sure to respond promptly and do your best to address their needs.

It’s also important that these clients receive regular oral care to prevent the oral membranes from drying out.Some of these clients may need to be physically restrained, such as with soft wrist cuffs, to prevent them from pulling the tube out.In these cases, make sure to check in with the client regularly in order to monitor their vital signs, alleviate their agitation, and assess their need for elimination and food or drink intake.Now, when assisting a client receiving mechanical ventilation, there are a few things you should report to the nurse right away, such as the client showing signs of anxiety or distress or complaining of an abrupt onset of chest discomfort; shortness of breath; or coughing up white, foamy, green, yellow, or brown phlegm.Also, observe for any changes in vital signs or in the level of consciousness; unusual respiratory sounds; bluish discoloration of the skin; skin or mucous membrane irritation; or breakdown around the nose, cheeks, or ears.Make sure to let the nurse know any time you hear the vent alarm sound or an unconscious or critically ill client making “gurgling” sounds, which may indicate a build-up of saliva and bronchial secretions at the back of the throat or in the lungs.Be sure to check if the client has pulled out their endotracheal or tracheostomy tube in the case of invasive mechanical ventilation or nasal plugs, face mask, or helmet in the case of NIPPV.Do the same if you notice a grey or bluish discoloration of the skin, which is another indication of tissues not getting the oxygen they need.Remember to document the date, time, and any observations whenever providing care to the client.#SummaryAlright, as a quick recap… Mechanical ventilation is used to move air in and out of the lungs of clients who can’t breathe on their own.Invasive mechanical ventilation involves artificial airways, including endotracheal tubes, which go through the mouth into the trachea, and tracheostomy tubes, which go through a surgically created opening on the front of the neck called a tracheotomy.Noninvasive mechanical ventilation or noninvasive positive pressure ventilation, abbreviated as NIPPV, uses nasal plugs, face masks, or helmets to deliver positive pressure into the airways and force them open.It includes CPAP, which delivers the same amount of pressure in both inspiration and expiration, and BiPAP, which delivers two different amounts of pressures.As a nursing assistant, you’ll be responsible for tasks like making sure the mask and other equipment are in place, providing oral care, making sure the client is as comfortable as possible, and responding to the clients when they call.

to the client. All right, as a quick recap mechanical ventilation is used to move are in and out of the lungs of clients who can't breathe on their own invasive mechanical ventilation involves artificial Airways, including endotracheal tubes, which go through the mouth into the trachea and tracheostomy tubes, which goes through a surgically created opening on the front of the neck.

Call the tracheotomy, non-invasive mechanical ventilation or noninvasive. Positive pressure ventilation abbreviated as nippv uses nasal plugs face masks or helmets to deliver positive pressure into the Airways and force them open.

It. Includes CPAP, which delivers the same amount of pressure in both inspiration and expiration and BiPAP which delivers to different amounts of pressure.

As a nursing assistant. You'll be responsible for tasks, like, making sure the mask and other equipment are in place, providing Oral Care.

Making sure the client is as comfortable as possible and responding to the clients when they