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81 Cards in this Set
- Front
- Back
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Advantages of nasal CPAP mask
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Easy fit and secure
Decreased claustrophobic feelings Pt’s can walk, talk, and cough Less mechanical VD |
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Disadvantages of nasal CPAP mask
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Air leaks
Skin irritation |
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Advantages of full face mask
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Fewer leaks
Treatment of Acute Respiratory Failure |
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Disadvantages of full face mask
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Aspiration risk
Claustrophobia Increased VD rebreathing risk Risk of aphasia |
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Noninvasive Ventilator Classification
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Electrically Powered
Blower Driven Microprocessor Controlled |
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Initial IPAP setting
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8-12
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Initial EPAP setting
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3-5
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Complications from early extubation
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Ventilatory muscle fatigue
Compromised gas exchange Loss of airway protection |
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Premature weaning from a vent
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Ventilatory fatigue
Compromised gas exchange Compromised airway No humidity deficit |
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3 ways to increase oxygenation during mechanical ventilation
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Increase FIO2
Increase PEEP MAP |
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Type of CPAP generated during constant pressure
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Threshold resistor
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Type of CPAP generated from passing flow through a restricted orifice
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Flow resistor
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What affects MAP (PAW)
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PIP
PEEP Respiratory Rate I-time Flow RAW Compliance |
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Conditions that benefit from PEEP
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ALI/ARDS
Cardiogenic pulmonary edema(CHF) Bilateral diffuse pneumonia ( V/Q MISMATCH) Refractory hypoxemia Atelectasis |
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During weaning with Pressure Support _____ is reduced while maintaining spontaneous rate and no distress.
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Decrease Pressure Support
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Methods to gradually wean from mechanical ventilation
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SIMV/IMV
T-piece weaning PSV |
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Equipment needed to do SBT
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LVN
Corrugated Tubing Drain Bag T-piece adaptor with reservoir bag |
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In-home Backup ventilator equipment needed
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Back-up vent
Ambu bag Back-up battery O2 supply |
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Complications of frequent instilling of saline while suctioning
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Irritation of airway
Bronchospasm Infection if biofilm is dislodged |
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Positive results of proning an ARDS pt
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Increased oxygenation
Redistribution of ventilation and perfusion |
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Nutritional complications associated with positive pressure ventilation
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Inadequate intake and increased metabolism
`Unable to feed orally Decreased healing capabilities Gastric distension Increased splanchnic resistance, decreased splanchnic venous outflow and may contribute to gastric mucosal ischemia Gastric ulcers, gastro intestinal bleeding treated with antacids or histamine. See PG. 354 box16-2 |
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Preventative measures for ICU psychosis
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Orient pt to time and place
Allow pt to sleep as much as possible Sedate |
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Frequency of circuit change
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As needed
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Measures for an alarming vent
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Check that pt is ventilating
Manually bag pt |
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Initial pressure determined when changing from VC to PC
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Set peak pressure to what physician wants
PPlat – PEEP for PS or use the Plat pressure |
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Benefits of high flows for COPD pt’s
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Shorter TI
Longer TE to prevent air trapping Increased MAP Reduces auto-PEEP May help patients with increased resistance |
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Severe asthma is difficult to manage on a vent why
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Increased PIP
Increased RAW from bronchospasm Air-trapping Uneven hyper expansion of various lung units |
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What’s measured to assess bronchodilator effectiveness on a vent
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Decreased PIP
Decreased RAW Peak inspiratory flow |
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Detect auto-PEEP
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Exhalation Pause
Exhale waveform has no return to zero Flow – Time scalar or Place a respirometer inline between the ETT and the Y connector, if the respirometer needle is still rotating when the next breath occurs, air trapping is present. |
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Steps to decrease occurrence of VAP
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Keep pt head above 30˚
Give good oral care suction as needed Appropriate hand hygiene NPPV use when able Kinetic (rotating) beds/ positioning as needed Inline suctioning Use ETT with subglotic suction Keep cuff pressures at 18-25 Avoiding reintubation |
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High levels of PEEP cause
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Decreased Preload
Increased Afterload |
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Closed head injury pt’s need what changed on a vent to decreased ICP’s
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Increased frequency
No PEEP |
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Normal ICP pressure
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5-15
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Weaning on CMV
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Change to SIMV + PS
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Weaning on SIMV
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Decrease respiratory rate first
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Formula for CStat
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VT/PPlat - PEEP
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Formula for CDyna
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VT/PIP - PEEP
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If compliance decreases on pressure control ventilation VT does what
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Decreases
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The gold standard for NPPV is to treat
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COPD exacerbations
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What do you do if an increased PEEP decreases C.O.?
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Decrease PEEP to 10
Increase FIO2 to 50% |
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Before placing a pt on a NPPV mask, you must use what equipment to find the right size mask?
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Sizing gauge
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Indications for NPPV
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RR >35
Paradoxical breathing Accessory muscle use “Not for unconscious pts” need ventilatory drive Severe gas exchange impairment Refractory hypoxemia PaO2 / FiO2 ratio less than 200 |
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Weaning criteria
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Underlying cause resolved
Return of spontaneous breathing Adequate oxygenation Measurable criteria assessed to establish readiness to wean Spontaneous breathing trial for readiness to wean |
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Homecare vent pt gets what checked at home?
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Electrical power
Outlets Amperage |
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Definition of long term acute care facility
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Wound care, longest answer on the test
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Malnutrition affects what on a pt on a vent
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Increased risk of infection
Aspiration Decreased muscle weakness |
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Procedure for homecare
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Write report
Notify physician Give options for family care Provisions psych |
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Characteristics of VC-CMV
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Guaranteed VE
Breath pt/time triggered |
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Bronchodilation on a vent changes what
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Decreased PIP
Raw Peak expiratory flow |
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Measurements used to show vent effectiveness
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VD/VT
PaCO2 |
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Initial vent settings for COPD
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Flow = 80-100 Lpm
Mode = PC/VC-CMV VT = 8-10 mL/kg F = 8-12 bpm Waveform = descending / constant FIO2 = 50% or same as previous setting |
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Initial vent setting for ARDS
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Flow = _> 60 Lpm
Mode = PC/VC-CMV VT = 4-8 mL/kg F = 15-25 bpm Waveform = descending / constant FIO2 = 100% |
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Initial vent settings for Neuromuscular
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Flow = _> 60 Lpm
Mode = VC-CMV VT = 12-15 mL/kg F = 8-12 bpm Waveform = descending / constant FIO2 = 21% |
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Initial vent setting for Asthma
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Flow = 80-100
Mode = PC/VC-CMV VT = 4-80 mL/kg F = <8 bpm Waveform = descending FIO2 = 100% |
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Should a patient be awake or sedated when performing a static pressure volume loop maneuver?
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Sedated
No spontaneous breathing may occur during this test. |
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The value found 2cmH2O above the lower inflection point on a pressure volume loop is known as what?
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Optimal PEEP
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What measurements are used to evaluate the effectiveness of ventilation?
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MIP less than -20 (more negative)
VC 1liter or 2 x Vt Spontaneous Vt 400 to 800 SBT less than 105 |
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What measurements are used to evaluate the effectiveness of ventilation?
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MIP less than -20 (more negative)
VC 1liter or 2 x Vt Spontaneous Vt 400 to 800 SBT less than 105 |
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What criteria indicate NPPV is being successful?
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Decreased RR
Reduced accessory muscle use Vent synchronization Good mask fit |
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What criteria indicate NPPV is being successful?
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Decreased RR
Reduced accessory muscle use Vent synchronization Good mask fit |
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What are the 3 criterias for a successful weaning from the Evidence-Based Guidelines?
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The underlying cause is resolved
Measurable criteria assessed to establish readiness to wean Spontaneous breathing trial for readiness to wean |
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What are the 3 criterias for a successful weaning from the Evidence-Based Guidelines?
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The underlying cause is resolved
Measurable criteria assessed to establish readiness to wean Spontaneous breathing trial for readiness to wean |
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What are some signs that indicate that SBT is failing?
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RR greater than 30-35
Vt less than 250-300 |
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How are home ventilators different from acute care ventilators?
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Compact
Less sophisticated Portable Easy to use Light wieght |
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What are some signs that indicate that SBT is failing?
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RR greater than 30-35
Vt less than 250-300 |
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How are home ventilators different from acute care ventilators?
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Compact
Less sophisticated Portable Easy to use Light wieght |
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Why are homecare ventilators rented instead of being purchased?
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Rented ventilators come with a service contract.
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What should the family be educated about for ventilator dependent patients?
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Detailed instructions in the operation of the ventilator
CPR Use of manual resuscitators Asceptic suctioning techniques Tracheostomy care Tracheostomy collars and humidification systems Methods of disinfecting equipment Bronchial hygiene therapies such as chest physiotherapy Aerosolized medication administration Bowel and bladder care Bathing |
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A clinician sets a P-high and a P-low, as well as a T-high and a T-low, what mode of ventilation is being used?
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APRV- Airway Pressure Release Ventilation
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Describe how APRV works
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High pressure and low pressure are set and patients breath on both levels for a given periods
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A deliberate limitation of ventilatory support to avoid further lung injury is known as what?
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Permissive Hypercapnia
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What is the meaning of the acronym PRVC?
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Pressure Regulated Volume Controlled
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Describe how PRVC works
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It Deleivers a volume to get to a plat pressure and regulates that plat pressure.
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Why would a patient have a high PaCO2 and low pH and then after being ventilated to lower the PaCO2 to normal, the pH is alkalotic?
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The patient was hyperventilated past his/her normal CO2
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A COPD patient is on 5 L/min of Oxygen and is somnolent. What should be done?
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Decrease the O2
Change to a ventimask |
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What is Hypoxemic Respiratory Failure?
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When the patient is on O2 and CPAP but the PaO2 is still low
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What should be done to a patient suffering from Hypoxemic Respiratory failure?
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Put on BIPAP or intubate
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What are the 3 indications for Mechanical Ventilation?
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Apnea
Respiratory failure Impending Respiratory failure |
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What are the normal values for VC, MIP, Spont Vt, RSBI, Vd/Vt ratio?
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VC = 2 x Vt or 1 liter
MIP = less than -20 (more negative) Spont Vt = 400 to 800 RSBI = less than 105 Vd/Vt ratio = less than 0.6 or 60% |
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What are the values for P(A-a)O2?
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Normal = 25-65
V/Q mismatch = 65-300 Shunt = greater than 300 |
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What are the values for PaO2/FiO2 ratio?
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Normal = greater than or equal to 476
Critical = less than 200 Normal on RA = 380 -476 |
