Chapter 16 Mechanical Vent.

Front 1

A mechansim that maintains blood pressurein normal individuals receving PPV

Back 1

compensatory

Front 2

A function that can be altered by mechanical ventilation

Back 2

Renal

Front 3

This decreases with the use of PPV (two words)

Back 3

cardiac output

Front 4

This pressure is increased by an inflation hold

Back 4

Mean Airway Pressure

Front 5

Reduction in perfusion to an organ

Back 5

Ischemia

Front 6

The structural and functional unit of the kidney

Back 6

nephrone

Front 7

The presssure that falls with spontaneous inspiration

Back 7

intrapleural

Front 8

A drug used to avoid gastrointestinal bleeding

Back 8

Cimetidine

Front 9

Gas always follows the path of ____ restance

Back 9

least

Front 10

When an alveolus is overfilled this capillary becomes thin

Back 10

pulomanary

Front 11

Spontaneous inspiration increases blood flow to this structure

Back 11

rt heart

Front 12

CPP + ICP

Back 12

MABP

Front 13

A reflex that blocked by polyneuritis

Back 13

Vascular

Front 14

Compression of the Heart

Back 14

Tamponade

Front 15

venous return reduction decrease this

Back 15

preload

Front 16

The vein that is visible when central venous pressure CVP is elevated

Back 16

Jugular

Front 17

Urinary output will dcrease when this capillary pressure decreased below 75mm Hg

Back 17

Glomerular

Front 18

The amount of blood flowing to the brains is determined by This

Back 18

CPP

Front 19

A reduction in this amount decrease preload to the heart

Back 19

Venous return

Front 20

Through the wall of an organ

Back 20

Transreturn

Front 21

Antidiuretic hormone release results in this

Back 21

oliguria

Front 22

The volume pumped out of the ventericle with one beat

Back 22

Stroke

Front 23

Measuring this provides information about a patient`s daily caloric requirements

Back 23

REE

Front 24

This maneuver will increase inspiration time

Back 24

Inflation hold

Front 25

Innflammation of many nerves simulaneously

Back 25

Polyneuritis

Front 26

List 5 bodily function that positive pressure wentilation can significantly alter

Back 26

cardiovascular, pulmonary neurological renal and gastroinstestinal

Front 27

The physiologic effect of positive pressure ventilation on the cardiovascular system depend on what 2 factors?

Back 27

The amount of intrapleural pressureapplied to the airways and the patient cardiopulomonary status

Front 28

Explain how spontaneous inspiration facilitates venous return to the rt heart

Back 28

The - intrapleural pressures that occur during spontaneous inspiration are transmitted to the intrathoracic vesels. a drop in pressure in the vena cava increases the pressure gradient back to the heart and venous return increases

Front 29

During what part of a spontaneous breath is rt ventricular prelaod increased? Why?

Back 29

Rt venticular preload is increased during inspiration because more blood is returning to the rt heart

Front 30

Durning what part of a spontaneous breath is left ventricular preload decreased and Why?

Back 30

Left venticular preload is decreased during passive expiration when intrapleural pressure became less -+ venous return is decreased and rt ventricular stroke volume also decreases which causes a decrease in lft ventricular preload

Front 31

An increased in venous pressure will do what to the pressure gradient systemicand the rt heart

Back 31

Increase the pressure gradient

Front 32

What effects dose alveolar overditention have on the pulmonary capillaries and rit ventricular afterload?

Back 32

the pulmonary capillaries are interlaced with the alveoliwhen the alveoli are overdistended thed pulmonary capillaries are stretched and narrowed as a result, resistance to blood flow through the pulomonary circulation increases. the increased resistance to blood flow through the pulmonary circulation increases the increased pulmonary vascular resistance increases rt ventricular afterload

Front 33

What conditions need to exist for the interventricular septum to move to the lft during PPV?

Back 33

High levels of positive pressure 15 cm or greater and volume depletion

Front 34

How can PPV cause myocardial ishemia?

Back 34

The reduction in cardic output created by decreased venous return reduces the coronary arty perfusion pressure gradient for both side of the heart. this plus the direct effect of compression of the coronary vessels caused by increases in intrathoracic pressure can ultimately lead to myocardial ischemia

Front 35

List the compensatory mechanisms responsibl for the maintence of systemic blood pressure during the ventilation of normal individuals

Back 35

Increase in sympathetic tone increase in systemic vascular resistance increase in peripheral venous pressure from arterial and venous constriction and peripheral shunting of blood away from the kidneys and lower exteremities

Front 36

What factors can block the body`s compensatory mechanisms for maitaining arterial blood pressure while a patient is receiving PPV

Back 36

Sympathetic blocked spinal anesthesia moderate levels of general anesthesia spinal cord transaction or severe polyneuritis

Front 37

How can a respiraroey therapist ensure that normal vascular reflexes are intact when PPV is being initiated

Back 37

The respiratory therapist should measure the blood pressure soon after PPV is initiated

Front 38

Normovolemic patients may experience decreases in cardic out put when positive end airway pressure PEEP levels of ________ are usd

Back 38

15 or greater

Front 39

What 3 factors can infulance cardic output during PPV?

Back 39

THe presence or absence of the normal compensatory mechanism for maintaining artial blood pressure the lung and chest wall compliance and airway resistance and the duration and magnitude of the positive pressure

Front 40

How dose PPV benefit the cardic function of a patient with left ventricular dysfunction

Back 40

PPV can reduce venous return and thus perload to the heart. This improves lengthtension relationship within the heart and improves stroke volume

Front 41

What pressure exerts the most infuluence on the extnt of harmful effects by PPV?

Back 41

Mean airway pressure

Front 42

Calculate the mean airway pressure using the following parameters peak inspiratory pressure PIP is 25 cm H2O TI is 1 second and respiratory rate is 12 bpm

Back 42

60/12=5
=1/2(25x(1 sec/5 sec)
=1/2(5)=2.5 cm H2O

Front 43

calculate the mean airway pressure using the same parameters as in the previous example but add a 1 second inspiratory hold

Back 43

add 1 second inspiratory hold increase the TI to 2 seconds so that mean airway pressure = 1/2(pip- Peep) xTI/TCT) TCT =60/12=5

Front 44

What type of inspiratory flow produces uneven ventilation?

Back 44

High inspiratory flow rates are likely to cause uneven ventilation

Front 45

The I:E ratio that are least likely to cause air trapping and significant hemodynamic complications are

Back 45

Values of 1:1,2:1 and higher may result in significant increases in air trapping and significant hemodynamic complications

Front 46

What type of TE allows for better alveolar emptying and less chance of developing auto PEEP

Back 46

A longer expiratory time

Front 47

The amount of mean airway pressure required to achieve a certain level of oxygenation may indicate

Back 47

The severity flow and pattern I:E ratio inflation hold PEEP ventilator mode

Front 48

List 5 factors that infulance mean airway pressure during mechanical ventilation

Back 48

Inspiratory flow and pattern I:E ratio inflation hold PEEP ventilator mode

Front 49

Explain why rapid inspiratory flow rates may produce lower mean airway pressure in patients with normal conducting airways

Back 49

rapid flow rates deliver the desired VT in a short time. The faster the flow the shorter the inspiratory time and the lower the mean airway pressure

Front 50

For peep levels to affect cardiac out put what circumstances would high levels of PEEP not cause a decrease in cardiac output

Back 50

High levels of PEEp would not cause a decrease in CO when the patient has stiff lungs. This situation could exist because the stiff lungs do not allow the transmission of pressure to the intrathorasic space and intrathorasic vessels

Front 51

In what circumstance would high levels of PEEP not cause a decrease in cardiac output

Back 51

High levels of PEEP would not cause a decrease in CO when the patient has stiff lungs this situation could exist because the stiff lungs do not allow the transmission of pressure to the interoracic space and intrathoracic vessels

Front 52

What is the cerebal perfusion pressure CPP when the intracranial pressure ICP is 18 cmH2O and the mean systemic arterial blood pressure MABP is 85 cm H2O

Back 52

CPP=MABP -ICP; 85-18mmHg = 67 mmHg

Front 53

How dose PPV increase ICP?

Back 53

PPV can increase centeral venous pressure making it more diffcult for blood to return to the rt side of heart from head. This cause as backup of pressure into the head increasing ICP

Front 54

How can an increased ICP be observed clinically?

Back 54

JVDis a clinical sing of ICP increased

Front 55

What effect dose hyperventilations have on cerebal vessel?

Back 55

Hyperventilation lowers PaCO2 which temperaly constrics cerebral vessels

Front 56

In What 3 ways is renal function altered by PPV?

Back 56

THe kidneys respond to hemodynamic changes resulting from high intrathoracic pressure humonal responses also occur with PPV including antidiurretic hormoneADH atrial natriuretic factor and renin agiotensin aldosterone changes and abnormal PH and PaO2 abnornmalities affect the kidneys

Front 57

At what glomerular capillary pressure will urinary output become severely reduced?

Back 57

urinary output is severely reduced when the glomerular capillary pressure drops below 75mm Hg

Front 58

Name 3 hormones that are involed in fluid and electrolight balance durning PPV

Back 58

Antidiurectic hormone aterial natriuretic factor rennin angiotensin alderstone

Front 59

PPV has what effects on each of thease 3 hormones

Back 59

blood pressure changes caused by PPV percipitate the release of ADH resulting in oliguria PPV and PEEP can reduce the atrial filling pressure by reducing atrial stretch this leads to decreased secretion of atrial natriuretic factor causing water and soidium retention plasma rennin activity is increased during PPV which activates the rennin angiontensin aldosterone cascade resulting in retention of both sodiumand water

Front 60

Describe the effects of abnormal arterial blood gases on renal function

Back 60

decreased PaO2 values in patients with respiratory failure cause a reduction in renalfunction and a decrease in urine flow. Severe hypoxemia dramatically interfers with normal renal function A PaCO2 greater than 65mm HGcan also severly impair renal function

Front 61

What effect dose ppv have on the Pharmokinetics of certin drugs?

Back 61

may druges EX seditives neromuscular blocking agents and their metabolites are excreated by the kidneys. The altered renal function caused by PPV can prolong the effects of these drugs and affect patient care

Front 62

How do PPV and PEEP affect the liver

Back 62

PPV and PEEP causes an evelation of serum bilirubin even when no evidence of pre existing liver disease is present. Several factor may lead to this effecton the liver. Liver malfunction may be a result of a drop in cardiac output an increaseddiaphragmatic force against the liver a decrease in portal venous flow or an increase in splanchinic resistance. any of thease changes can lead to hepatic ischemia and impaired liver function

Front 63

what causes gastric distention in patients receving PPV and how can it be reduced?

Back 63

Gastric distention during PPV can result from the swallowing of air that leaks around the ET tube cuff A gastic tube can be used to remove this air and decompress the stomach

Front 64

Why are medical and surgical patients subject to malnutrion during serious illness?

Back 64

Seriosly ill patient are at risk for malnutrition because of inadequate food intake and an increased metabolic rate associated with fevor and wound healing

Front 65

Name 3 deleterious effects that nutritional depletion can have on mechanically ventilated patients

Back 65

reduce response to hypoxia and hypercapnia muscle atrophy from prolong bed rest and lack of use muscel waisting including respiratory muscle from lack of nutrition respiratory track infections from impaired cell immunity and reduced or altered macrophage activity decreased surfactant production and development of atelectasis reduced ability of the pulmonary epithelium to replicateresulting in slow healing of damaged tissue lower serum albumin levels which affectr colloid oncotic pressures and can contribute to pulmonary edema formation

Front 66

Overfeeding can have what effects on machanical vent. Patients

Back 66

increased O2 consumption increased CO@ production and the need to increase MVincreasedd WOB

Front 67

Name 5 ways of assessing a patients nutritional status

Back 67

body concumption actual vs. perdicted body mass fat vs. lean muscle immunodeficiency and decreased skin response

Front 68

How can some of the complication associated with mechanical ventilation be reduced?

Back 68

through early recognition of the signs & symptoms of the problems associated with PPV follwed by appropriate intervention