Ventilator

INDIVIDUAL ASSIGMENT
CRITICAL NURSING COURSES
CRITICAL NURSING PRACTICE REPORT
SUPPORTING LECTURER:
Wenny Trisnaningtyas, S. Kep, Ns, M. Kep
ARRAGED BY:
Name : Rizka Yuliasih Kussanty
Him : P1337420620039
Class : 3A3 RKI
BACHELOR OF APPLIED NURSING IN SEMARANG
NURSING DEPARTEMENT
HEALTH POLYTECHNIC OF HEALTH MINISTRY SEMARANG
2023
Practice Report
Ventilator Installation
I. Practicum goals
Installing a ventilator is an act of installing a breathing apparatus to help the patient

breathe mechanically. The goals of installing a ventilator include: provides
mechanical strength to the lungs to maintain physiological O2 and CO2 exchange,
takes over (manipulates) airway pressure and breathing patterns to improve efficient
O2 and CO2 exchange and adequate oxygenation, reduces cardiac muscle work by
reducing lung work.
II. Necessary Tools
Personal protective equipment, complete and ready-to-use ventilator, HME (Heat,

Moisturizers and Exchange), Endotracheal Tube (ETT), Cuff inflator or 10 cc syringe,
spirometer, Secretion suction set
III. Practicum Work Procedure
1. Patient Assessment / Indications
Before being given a ventilator, there are certain indications that meet the
requirements that the patient may be placed on a ventilator, including:
Mechanical indications: Respiratory rate 35 x/minute, Tidal volume less than 5

cc/kg body weight , Maximum inspiratory force less than 20 mmHg
Indications for oxygenation: Pa O2 less than 60 mmHg with 21% FiO2 Room Air ,
Pa O2 less than 70 mmHg with 40% FiO2, Pa O2 less than 100 mmHg with 100%
FiO2
Ventilation Indications : Pa CO2 more than 50 mmHg with FiO2 Room Air 2
2. Planning and execution
Before installation, make sure the patient's medical record, patient's identity,
explain to the family about the purpose of installing this ventilator. Prepare the
necessary tools
In patients with controlled breathing: first suction secretions then cooperate with
the doctor in determining controlled breathing patterns by: determining tidal
volume (TV) 8-12 cc/kg body weight, determining minute volume (MV) = RR
XTV, determining respiratory frequency 12 times/minute, Determine the oxygen
concentration (Fi O2) as needed, Set the sensitivity towards control according to
the type of ventilator used. Assess the volume of incoming air by reading the guide
needle on the ventilator needle, or looking at the monitor screen d. Determine the
incoming air volume/air pressure alarm system according to the type of ventilator
used. Determine the sensitivity towards negative 20 cm H2O for a patient with
cerebral resuscitation. Then connect the ventilator to the patient using the
connector
In Patients with Assisted Breathing: First explain the procedure to the patient then
wash hands before and after performing the procedure. Suction secretions and
cooperation with doctors in determining assisted breathing patterns by: determining
the sensitivity according to the type of ventilator used, adjusting the ventilator with
a respiratory rate of 10 times/minute, so that if the patient is apneic the ventilator
can help breathing, determine the tidal volume according to the respiratory
frequency prepared , Determine the oxygen concentration, Connect the ventilator
to the patient using a connector, Make observations every 30 minutes including:
Ventilator work, Tension, pulse, respiration, cyanotic signs, Signs of fighting
(refusal of ventilator assistance)
In patients with "Syncronize Intermitten Mindatory Ventilator" (SIMV) breathing:

explain the procedure to be performed. Wash hands before and after performing the
action. Suction secretions. Collaborate with the doctor in determining the SIMV
breathing pattern by: Adjusting the ventilator according to the breathing pattern
(SIMV), Adjusting the respiratory frequency of the ventilator with the respiratory
frequency of the patient according to the ventilator used, Connect the ventilator to
the patient using a connector. Then make observations every 30 minutes, including:
ventilator work, blood pressure, pulse, respiration, and cyanotic signs, signs of
fighting (refusal of ventilator assistance)
The first "Possitive End Expiratory Pressure" (PEEP) breathing patient. Determine
the positive pressure according to the patient's condition. Control breathing patterns
with PEEP, the way it works is the same as in controlled breathing patients, plus
the installation of a valve on the expiration hose. The pattern assisted with PEEP,
the way it works is the same in patients with assisted breathing plus the installation
of a valve on the expiratory hose. SIMV breathing pattern with PEEP, the way it
works is the same as in patients with SIMV, plus the installation of a valve on the
expiratory stirrup
Patient with first continuous positive airway pressure (CPAP) breathing Set the
ventilator toward CPAP in a patient who is already breathing spontaneously.
Connect the expiratory tube to the bottle filled with water for patients who are off
the ventilator but still require positive pressure at the end of expiration. The
amount of positive pressure in the alveoli is equal to the length of the expiratory
hose that enters the water
3. Documentation
IV. Practicum Results and Discussion
Things that need to be considered include the function of the ventilator during use,
Adjust the use of the ventilator with the patient's breathing pattern, If there is an alarm
sound, immediately take actions according to the signal on the ventilator, Monitor
breathing patterns according to those regulated by the ventilator.
V. Conclusion
Installing a ventilator really helps patients in critical condition with serious breathing
problems, so they need a tool that can support the process of inspiration and
expiration by the lungs, one of which is pulmonary edema.
VI. Reference
Bello, G., De Santis, P., & Antonelli, M. (2018). Non-invasive Ventilation in

Cardiogenic Pulmonary Edema. Annals of Translational Medicine. 6(18), pp. 355.
American Thoracic Society (2017). Mechanical Ventilation. American Journal of

Respiratory and Critical Care Medicine. 196, P3-4.
Chen, L., Gilstrap, D., & Cox, C.E. (2016). Mechanical Ventilator Discontinuation
Process. Clinic in Chest Medicine. 37(4), pp. 693-699.
Hadjiliadis, D. National Institutes of Health (2019). U.S. National Library of

Medicine MedlinePlus. Learning About Ventilators.
Cleveland Clinic (2014). Mechanical Ventilation.

Amitai, A. Medscape (2018). Drugs & Diseases. Ventilator Management.
Jackson, C.D. Medscape (2019). What Are the Indications for Mechanical
Ventilation?
Patel, B.K. Merck Manual Professional Version (2018). Overview of Mechanical

Ventilation.
Whitlock, J. Verywell Health (2019). When a Ventilator Is Necessary.

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INDIVIDUAL ASSIGMENT

CRITICAL NURSING COURSES

CRITICAL NURSING PRACTICE REPORT

Wenny Trisnaningtyas, S. Kep, Ns, M. Kep

Name : Rizka Yuliasih Kussanty

Class : 3A3 RKI

BACHELOR OF APPLIED NURSING IN SEMARANG

HEALTH POLYTECHNIC OF HEALTH MINISTRY SEMARANG

Installing a ventilator is an act of installing a breathing apparatus to help the patient

II. Necessary Tools

Personal protective equipment, complete and ready-to-use ventilator, HME (Heat,

III. Practicum Work Procedure

1. Patient Assessment / Indications

Mechanical indications: Respiratory rate 35 x/minute, Tidal volume less than 5

2. Planning and execution

In patients with "Syncronize Intermitten Mindatory Ventilator" (SIMV) breathing:

IV. Practicum Results and Discussion

Bello, G., De Santis, P., & Antonelli, M. (2018). Non-invasive Ventilation in

American Thoracic Society (2017). Mechanical Ventilation. American Journal of

Hadjiliadis, D. National Institutes of Health (2019). U.S. National Library of

Cleveland Clinic (2014). Mechanical Ventilation.

Patel, B.K. Merck Manual Professional Version (2018). Overview of Mechanical

Whitlock, J. Verywell Health (2019). When a Ventilator Is Necessary.

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