Mod 9 suction

Question 1

When not to use NPPV?

Answer 1

• Apnea
• Pt. can’t get it on
• others lol

Question 2

What are predictors of NIPPV success in the acute setting?

Answer 2

improvement can be seen within 30-120 mins

• improved RR and HR
• just guidelines.

Question 3

Criteria for terminating NPPV

Answer 3

Worsening pH and CO2
-RR > 30bpm
-hemodynamics instability
-inabiltiy to clear secretions
-decreased LOC

Question 4

Are big (A-a) gradients good or bad?

Answer 4

Bad, you wan’t them low.

Reflect the offloading of O2 to tissues.

Question 5

NPPV modes

Answer 5

CPAP

NPPV

EPAP

IPAP

Question 6

Does PEEP or CPAP increased FRC?

Answer 6

Yes, both do.

Question 7

what increases FRC? How does do they increase FRC?

Answer 7

PEEP and CPAP (they both do the same thing)

it opens up the alveoli increasing the bed for gas exchange.

It can be over distended though if too much pressure is going (think babies)

Question 8

what are the benefits and primary function of: EPAP

Answer 8

Increases FRC
-recruits alveoli (improve v/q)
-reverses atelectasis
-improves compliance

reducing intrinsic PEEP
-Causes mech. bronchodilation, decreasing airway resistance

Question 9

What is intrinsic PEEP?

Answer 9

intrinsic PEEP is air trapping?

Question 10

IPAP function

Answer 10

Pressure supports patients own spontaneous breath.
- decrease WOB
-used as a CSV (pressure support device)

Question 11

What is the critical component of NIVM?

Answer 11

Pt compliance.

Question 12

What does pinky frothy sputum indicate?

Answer 12

heart failure or a pulmonary edema

Question 13

W/pneumonia which mask would you use?

Answer 13

A nasal mask so they can continue to clear secretions.
-if possible; try to avoid a full face mask so they don’t need to remove it to clear secretions

Question 14

Normal airway clearance is defined by the which traits?

Answer 14

-An effective cough

-a functional mucociliary escalator

Question 15

Airway mucus is the secretory product of which glands/cells?

Answer 15

Goblet cells

Submucosal glands

Clara cells

Question 16

What makes up mucus?

Answer 16

mucin + water

Question 17

What is mucus?

Answer 17

A superficial “gel” or mucous layer compromised of 95% water and 5% mucin (glycoproteins)

Question 18

What are 3 types of secretions found in the respiratory tract?

Answer 18

-Mucus
-Surfactant
-Periciliary fluid

Question 19

What is the function of mucus?

Answer 19

Protect airways by trapping foreign bodies

Question 20

Surfactant function

Answer 20

A thin layer of fluid that lubricates and reduces surface tension (prevents alveolar collapse)

Question 21

Periciliary fluid function

Answer 21

Covers and keeps the cilia from sticking together and helps them return to form/position.
-cilia help move mucus/foreign bodies out so it helps keep everything moving

Question 22

What is the “sol” layer between the mucous layer and epithelium?

Answer 22

Periciliary fluid

Question 23

What is the mucous blanket made up of?

Answer 23

A Gel layer and a Sol layer

Question 24

Why are the elements of the mucous blanket important

Answer 24

They work together to not only protect airways, but to transport fluids (mucus layer) from the sol layer.

Question 25

Where are the Gel layer and Sol layer located within the realm of the respiratory tract?

Answer 25

Gel layer = present @ luminal surface

Sol layer = makes contact w/cilia

Question 26

Function of mucus

Answer 26

Protect resp. tract including;
-humidification & warming of insp. gas
-mucociliary transport of debris
-waterproofing
-insulation
-antibacterial activity

Question 27

How is mucus transported from the lower resp. tract into the pharynx?

Answer 27

Airflow and mucociliary clearance

Question 28

why is clearance of mucus important?

Answer 28

If not cleared, the risk of infection increases

Question 29

What is the main characteristic of a partial airway obstruction caused by retention of secretions?

Answer 29

over-distention and ventilation/perfusion imblanaces

Explanation:
Restricts airflow; increasing WOB and air trapping.

Question 30

What is the main characteristic of a full airway obstruction caused by retention of secretions?

Answer 30

Mucus plugging, leading to to atelectasis and impaired oxygenation due to shunting

Question 31

Retention of secretions if pathogens are present lead to what?

Answer 31

Infection.

-could be derived from failed cough reflex.

Question 32

What are problems/symptoms that are derived from retained secretions?

What can they cause as a result?

Answer 32

Increased airway resistance and WOB

Leads to:
-Atelectasis
-hypoxemia
-infection

Question 33

Left off at slide 20