Workbook Ch12 Mech Vent

Front 1

An overdose of this will cause metabolic acidosis

Back 1

salicylate

Front 2

Intentionally brought about

Back 2

iatrogenic

Front 3

This can increase metabolism & CO2 production (5 letter word)

Back 3

fever

Front 4

Normal ventilation

Back 4

normocapnia

Front 5

Medication given to keep pH from becoming acidotic

Back 5

tham

Front 6

Type of suctioning that can decrease VAPS in intubated pts (abbreviation-4 letters)

Back 6

cass

Front 7

CO2 causes vasodialation here (8 letters)

Back 7

cerebral

Front 8

Deficient blood flow to the cells (8 letters)

Back 8

ischemia

Front 9

type of aerosol device that delivers puffs (abbreviation-4 letters)

Back 9

pmdi

Front 10

A bag for colllecting a pt's exhaled air is (7 letters)

Back 10

douglas

Front 11

A rigid tonsil suctioning tip (8 letter word)

Back 11

yankauer

Front 12

In PVC increasing this time will increase volume deliverd without increasing pressure (11 letters)

Back 12

inspiratory

Front 13

"out of step" with the ventilator (12 letters)

Back 13

dyssynchrony

Front 14

A fluid filled with cellular debris 7 protein that accumulates as a result of inflammation (7 letters)

Back 14

exudate

Front 15

respiratory acidosis indicates that this type of ventilation is not adequate (8 letters)

Back 15

alveolar

Front 16

Part of the standard therapy to reduce increased intracranial pressure (12 letters)

Back 16

hyperosmolar

Front 17

Reduced urinary output (8 letter word)

Back 17

oliguria

Front 18

Enteral feeding route that reduces the risks of vomiting & aspiration. (12 letters

Back 18

transpyloric

Front 19

Overhydration causes this (12 letters)

Back 19

hemodilution

Front 20

Procedure for visualizing the bronchi (12 letters)

Back 20

bronchoscopy

Front 21

A type of acidosis caused by diabetes, alcoholism, or starvation. (4 letters)

Back 21

keto

Front 22

Suctioning can cause ulceration of the ___. (6 letters)

Back 22

mucosa

Front 23

Excessive urinary output (8 letters)

Back 23

polyuria

Front 24

Loss of bicarbonate can be caused by ___. (8 letters)

Back 24

diarrhea

Front 25

A thyroid that is overactive is __.(5 letters)

Back 25

hyper

Front 26

Hypercapnea used to help prevent lung injury (10 letters)

Back 26

permissive

Front 27

ventilation without perfusion (2 words- 9 letters)

Back 27

deadspace

Front 28

Calculate the desired Vt when the known paCO2 is 55mmHg, known Vt is 500, the known frequency is 14, & the desired PaCO2 is 40mmHg.

Back 28

(55 X 500)/40
(27500)/40
687.5 = 688 mL

Front 29

Calculate the desired frequency when the known paCO2 is 65mmHg, the known Vt is 600mL, the known frequency is 12 & the desired PaCO2 is 50mmHg.

Back 29

f=(kwnPaCO2)(kwn VT)/Des PaO2
(65 X 12)/50
(780)/50
15.6 = 16

Front 30

What 3 factors can affect PaCo2in pt's receivingmechanical ventilation ?

Back 30

total ventilation
dead space
CO2 production

Front 31

Identify 3 components of an ABG that reflect a pt's ventilatory status.

Back 31

pH
PaCO2
bicarbonate

Front 32

What happens to the PaCO2 and pH when alveolar ventilation decreases?

Back 32

pH decreases
PaCO2 increases

Front 33

List 6 pathologic processes thsat can lead to acute respiratory acidosis:

Back 33

parenchymal lung problem
airway disease
pleural abnormalities
CNS problems
chest wall abnormalities
neuromuscular disorders

Front 34

How does volume & pressure affect PaCO2 and pH?

Back 34

increase in vol(VC mode) & increase in press(PC mode) decreases PaCO2 & increases pH.
decrease in vol & pressure; increases PaCO2 & decreases pH.

Front 35

The recommended target Vt is?

Back 35

5 to 8 mL/kg IBW

Front 36

When increasing Vt it is important to maintain Pplat less than ___.

Back 36

30 cm H20

Front 37

List 2 methods of increasing Vt in pressure control ventilation.

Back 37

increase set inspiratory pressure
increase inspiratory time

Front 38

Respiratory alkalosis is characterized by what PaCO2?

Back 38

PaCO2 < 35 mm Hg
pH > 7.45

Front 39

List 7 common causes of respiratory alkalosis;

Back 39

hypoxia
parenchymal lung disease
medications
mechanical ventilation
CNS disorders
anxiety
metabolic disorders

Front 40

A pt with a PaCO2 of 25mmHg and a pH of 7.55 is sedated & ventilated in a volume controlled mode. IBW is 60kg. The frequency is set at 18, & the delivered Vt is set at 8mL/kg. what frequency would result in a PaCO2 of 40mmHg?

Back 40

(25 X 18)/40
450/40
11

Front 41

Is it more appropriate to change the frequency or Vt to correct a respiratory alkalosis when the delivered volume is set at 7mL/kg? Explain.

Back 41

Change the frequency. decreasing the set VT to less than 7 ml/kg may result in atelectasis as a result of a low VT.

Front 42

A pt on VC-CMV has a frequency set at 10, with the total respiratory rate being 20 breaths/min. The PaCO2 is 25mmHg witha pH of 7.52. Will decreasing the set rate correct the respiratory alkalosis?

Back 42

No. As long as the pt continues to trigger breaths, reducing the set frequency will have no effect.

Front 43

A pt on VC-CMV has a frequency set at 10, with the total respiratory rate being 20 breaths/min. The PaCO2 is 25mmHg with a pH of 7.52. What modes of ventilation may be appropriate for this patient? Why?

Back 43

SIMV & PSV may be more appropriate, because the pt will not trigger a mechanical breath each time.

Front 44

List 6 common causes of hyperventilation in pt's receiving mechanical ventilation :

Back 44

hypoxemia
pain
anxiety
fever
agitation
patient-ventilatory asynchrony

Front 45

What is the body's physiologic response to a metabolic alkalosis?

Back 45

the body tries to compensate for metabolic acidosis by increasing alveolar ventilation (hyperventilation) which results in decreased PaCO2.

Front 46

I.d. 2 causes of metabolic alkalosis & an example of each:

Back 46

/

Front 47

What are the pH & bicarbonate levels that i.d. metabolic alkalosis?

Back 47

pH < 7.35
HCO3 < 22 mEq/L

Front 48

What are 5 common causes of metabolic alkalosis?

Back 48

loss of gastric fluid & stomach acid
acid loss in urine
acid shift into the cells
lactate, acetate, or citrate administration
excessive bicarbonate loads

Front 49

What 2 formulas are needed to predict the change in pressure necessary to achieve a desired PaCO2?

Back 49

Desired VT= Actual VT X Actual PaCO2/Desired PaCO2
Desired P= Desired VT/Cs

Front 50

How can mechanical ventilation cause an increase in a Pt's dead space?

Back 50

increased deadspace may be caused by high alveolar pressures from high PEEP levels or by air trapping caused by high min ventilation, high inspiratory flows, or inverse I:E ratios

Front 51

Give 2 examples of pathologic processes that would result in an increase in physiologic dead space.

Back 51

pulmonary embolism
low cardiac output

Front 52

What is the normal range for Vd/Vt ratio?

Back 52

Vd/Vt = 0.2 to 0.4

Front 53

Calculate the Vd/Vt ratio based on the following information: Vt=800mL, PaCO2=45mmHg & PeCO2=36mmHg.

Back 53

Vd = VT(PaCO2-PeCO2)/PaCO2
800(45-36)/45
7200/45
Vd = 160mL
Vd-Vt = 160/800 = 0.2

Front 54

List 8 clinical disorders that may result in a hypermetabolic state:

Back 54

fever
burns
multiple trauma
sepsis
hyperthyroidism
muscle tremors
agitation
multiple surgical procedures

Front 55

What effect does hyperventilation have on cerebral blood flow?

Back 55

hyperventilation is believed to cause constriction of cerebral blood vessels

Front 56

What is permissive hypercapnia?

Back 56

deliberate limitation of vent support. It is designed to reduce the risk of lung injury from high pressures and volumes

Front 57

What is the effect of permissive hypercapnia on pt's with head trauma?

Back 57

CO2 is a powerful vasodilator of cerebral vessels. In the presence of head trauma, elevated CO2 levels can cause cerebral edema & increased ICP

Front 58

The suction pressure ranges for adults, children & infants are:

Back 58

adults -100 to -120 mm Hg
children -80 to -100 mm Hg
infants -60 to -100 mm Hg

Front 59

The maximum length of suction time is ___.

Back 59

15 seconds

Front 60

Estimate the correct suctioning catheter size for a size 9.5 ET?

Back 60

ET tube size X 3 / 2
9.5 X 3 / 2 = 14.25
14 french

Front 61

List at least 5 indications for the endotracheal suctioning of mechanically ventilated patients with artificial airways according Clinical Practice Guidelines.

Back 61

Inablility to generate effective spont. cough
Changes in monitered flow-vol graphs
deterioration of O2 saturation
increased PIP with vol. ventilation
decreased Vt with pressure ventilation

Front 62

What are the contraindications for suctioning?

Back 62

no absolute contraindications

Front 63

Suction pressure can cause this complication:

Back 63

tracheal/mucosal trauma

Front 64

Reduction in lung volume can cause this complication:

Back 64

atelectasis

Front 65

Airway trauma can cause this complication:

Back 65

bleeding

Front 66

A patient or caregiver can cause this complication:

Back 66

infection

Front 67

Hypoxemia/vagal stimulation can cause this complication:

Back 67

cardiac arrhythmias

Front 68

An extreem response to suctioning and vent disconnect can cause this complication:

Back 68

Cardiac/respiratory arrest

Front 69

A reaction to tracheal stimulation can cause this complication:

Back 69

bronchospasm

Front 70

What are the FIO2 and time frame for pre- & post- suctioning hyperoxygenation?

Back 70

presuctioning hyperoxygenation with 100% O2 / or 30 sec. postsuction with 100% O2 for 1min.

Front 71

What are the advantages of in-line suction catheters?

Back 71

decreased likelihood of hypoxia and alveolar collapse
decreased risk of airway contamination
decreased risk of caregiver of airway contamination
decreased incidence of vent/assoc PNA

Front 72

What are the disadvantages of in-line suction catheters?

Back 72

increased tension on ET tube
high cost
possible migration of catheter in the airway affecting Vt delivery during pressure ventilation
decrease in pressure during procedure, which can trigger ventilator.
risk of saline entering airway when catheter is rinsed

Front 73

What are the high ventilator requirements that indicate the use of an in-line suction catheter?

Back 73

high PEEP (>/= 0cmH2O)
high mean airway pressure (>/= 20 cmH2O)
long insp time (>/= 1.5 sec)
high FiO2 (>/= 0.6)

Front 74

List 4 reasons why silent aspiration & ventilator associated pneumonia (VAP) can occur with cuffed ET tubes?

Back 74

injury to mucosa during insertion & with manipulation of tube after insertion.
interference with normal cough reflex.
aspiration of contaminated secretions that pool above ET tube cuff.
Development of a contaminated biofilm around the ET tube.

Front 75

Describe how silent aspiration & ventilatory associated pneumonia occur.

Back 75

Large ET tube cuffs can develop longitudal flods when inflated. Despite increased cuff pressures, liquid pharyngeal secretions leak past there folds, leading to VAP

Front 76

What is the benefit of using a Hi-Lo Evac ET tube?

Back 76

This tube is designed to provide continuous aspiration of subglottic secretions, which has been shown to reduce risk of VAP

Front 77

What pressure should be used with a CASS ET tube?

Back 77

20 mm Hg

Front 78

what are some of trhe consequences of instilling saline prior to performing endotracheal suctioning?

Back 78

increased risk of dislodging bacteria-laden biofilm from ET tube. Resulting in nosocomical PNA & can increase volume of secretion in airway which can worsen obstruction & decrease oxygenation. can cause brochospasm.

Front 79

How can ET suctioning be assessed while a patient is receiving mechanical ventilation?

Back 79

Breath sounds, decreased PIP with reduced transairway pressure, decreased airway resistance measurement or increased dynamic compliance. increased Vt during PC vent. improved ABG values, or SpO2 & removal of pulm secretions.

Front 80

What parameters should be monitored prior to, during & after suctioning?

Back 80

Breath sounds, SpO2, resp rate, & pattern, pulse rate, BP, ECG, sputum, vent parameters, AGBs, cough effort, & ICP

Front 81

Following suctioning of an intubated patient, the respirtory therapist notices that the sputum is rust in color. The patient's potential problem may be a ___.

Back 81

Klebsiella infection

Front 82

What size suction catheter should be used for a size 4 ET tube?

Back 82

4 X 3 / 2
6 french

Front 83

Severity of airway obstruction, mechanism of airway obstruction, the presence of auto-PEEP and ____ all influence aerosol deposition in a mechanically ventilated patient.

Back 83

patient ventilatory synchrony

Front 84

SVN's, pMDI's, ultrasonic neb's &___ are aerosol-generating devices that can be used to administer aerosolized medications during mechanical ventilation?

Back 84

vibrating mesh neb's

Front 85

____ mode is more effective for aerosol delivery?

Back 85

VC-CMV

Front 86

How do ventilator Vt and RR affect aerosol delivery?

Back 86

The set Vt needs to be large enough to ensure that all the dead space is cleared of the aerosol. Lower RR's improve the aerosol delivery.

Front 87

What technical problems are associated with the use of SVN using an external gas source?

Back 87

Expiratory monitors display higher volumes & flows , this may cause activation of alarms. when the expiratory valve closes, the added flow increases pressure & volume within the circuit & patient. The patient may experience difficulty triggering a breath, & the apnea alarm will not activate, because the expiratory flow monitors detect the flow from the external gas source. The FIO2 can be altered & the expiratory valve may be exposed to the aerosol (altering its function).

Front 88

In the ventilator circuit, the SVN should be placed ___ & the UVN & VM should be placed in the inspiratory line about 15cm from the Y connector.

Back 88

proximal to the humidifier

Front 89

To optimize the aerosol deposition of bronchodilator therapy during mechanical ventilation, the neb should be placed closest to the pt(between the leak port & the face mask). Also, a high insp pressure of ___ is necessary. Don't forget a low expiratory pressure of 5 cmH2O is also needed.

Back 89

20cmH2O

Front 90

Positive patient responses to bronchodilator therapy during mechanical ventilation include: reduced PIP, reduced Pta, reduced auto-PEEP & ___.

Back 90

increased PEFR

Front 91

A mechanically ventilated patient is given albuterol via pMDI. The pre- & post-treatment findings are:
Pre: PIP 32cmH2O, Pplat 8cmH2O
Post: PIP 23, Pplat 10cmH2O
Was the treatment effective? Why or why not?

Back 91

First, determine the difference of PIP & Pplat pre & post txt.
Pre(32-8=24), Post(23-10=13)
This shows a decrease in the Pta, therefore a positive response to the therapy.

Front 92

The goal of performing chest physiotherapy is to help ____ & improve distribution of ventilation.

Back 92

clear airway secretions

Front 93

Chest physiotherapy includes percussion of the chest wall &___.

Back 93

postural drainage

Front 94

What is the sequence of the 4 recommended positions that aid in secretion clearance for ventilated patients:

Back 94

supine, 45 degree rotation prone w/ L side up, 45 degree rotation prone w/R side up, and finally return to supine

Front 95

Possible hazards of performing chest physiotherapy on patients requiring mechanical ventilation include: accidental extubation, patient discomfort & ___.

Back 95

loss, stretching and kinking of catheters

Front 96

There are 3 channels found in a flexible fiberoptic bronchoscope. A light transmitting channel that contains optical fibers to conduct light into the airway. A ___ channel that uses optical fibers to conduct an image of the airway to an eyepiece. There is also an open multipurpose channel that can be used for aspiration, tissue sampling or O2 administration.

Back 96

visualization

Front 97

___ can be given to a ventilated patient prior to a bronchoscopy to reduce secretion production and block the vagal response.

Back 97

Atropine

Front 98

Indications for the frequent changing of body position in mechanically ventilated patients include: ____ , prevention of hypoxemia & reducing risk of skin breakdown.

Back 98

preventing atelectasis

Front 99

Placing an ARDS patient in a prone position is done to decrease shunt & improve oxygenation. The therapist would see this as an increase in ____.

Back 99

PaO2

Front 100

Patient positioning is awsome! There are 6 mechanisms believed to improve oxygenation with the prone position.
(1)blood is redistributed to better ventilated areas
(2)blood redistribution may improve alveolar recruitment in previously closed areas of the lung
(3)redistribution of fluid & gas movement improves the relationship between ______
(4)the position of the heart no longer puts weight on underlying tissues
(5)Pleural pressure is more uniformly distributed(which could improve alveolar recruitment)
(6)change in regional diapragmatic movement

Back 100

ventilation & perfusion

Front 101

Prone positioning is a ___contraindication for patients with hemodynamic abnormalities & cardiac rhythm disturbances.

Back 101

strong-relative

Front 102

Prone positioning is a ___ contraindicationfor patients who have had Thoracic and/or abdominal surgery.

Back 102

relative

Front 103

Prone positioning is a ___ contraindication for patients who have spinal cord instability.

Back 103

absolute

Front 104

The procedure for placing a patient in the prone position is as follows: first tilt the patient to the side, then unhook the ECG leads, turn the pt prone, _____, and finally reattach the ECG leads.

Back 104

turn the pt's head toward the ventilator

Front 105

After the patient is in the prone position, you should:
Check all lines, check ventilator ___, monitor vital signs & reposition/recalibrate pressure transducers

Back 105

pressures & volumes

Front 106

There are potential problems associated with placing a patient in a prone position. They include:
Accidental extubation
loss of ____
facial 7 eyelid edema
hemodynamic instability
O2 desaturation
decreased chestwall compliance

Back 106

IV lines &/or urinary catheters

Front 107

There are the 2 methods of improving the ventilatory status of patients with unilateral lung disease. One method is independent lung ventilation, the other is____.

Back 107

done by placing the pt in a lateral position with the "good" lung down(or in the dependent position)

Front 108

____ should be suspected when the patient's cardiac output & renal output are decreased & the PAOP is increased?

Back 108

Left Heart Failure (LHF)

Front 109

The normal urinary output is ___ or aproximately 1mL/kg/hr.

Back 109

50-60mL/hr

Front 110

PPPV can lead to an _____, causing fluid retention.

Back 110

increase in plasma antidiuretic hormone

Front 111

When considering fluid balance: Fluid retention can cause a dilution effect, called hemodilution, which leads to ___. Dehydration can cause hemo concentration & falsely high readings of the same variables.

Back 111

low hemoglobin hemacrit & cell counts

Front 112

Thhe objective of patient-centered mechanical ventilation is to improve the pt's safety, chances of survival, & reduce ___.

Back 112

pt's distress/fear.

Front 113

Ventilatory parameters such as;Flow rate, flow waveform, sensitivity levels, pressure target, rise time% & flow cycle criteria in PSV or switch from ___ can be adjusted by the respiratory therapist to improve patient comfort.

Back 113

VC-CMV to PRVC

Front 114

What equipment is needed for the in-house transport of a mechanically ventilated patient?

Back 114

Emergency airway management supplies, sthethescope, self-inflating manual resuscitator bag & mask, pulse-ox, ECG monitor, sphygmomanometer & a hand held spirometer

Front 115

4 contraindications to the in-house transport of a mechanically ventilated patient include: inability to provide adequate oxygenation & ventilation for the duration of transport, inability to maintain acceptable hempdynamic stability, inability to monitor the pt's cardiopulmonary status during transport & inability to ___.

Back 115

maintain a patent airway during transportation