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I POLY > Performing a PAP Titration > Flashcards

Performing a PAP Titration Flashcards

1
Q

______
therapy remains the preferred and most widely used therapy for the treatment of sleep-related breathing disorders (SRBDs).

A

Positive airway pressure (PAP)

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2
Q

PAP therapy is noninvasive and
includes three main equipment
components: a _____,
_____, and an _____.

A

blower unit,
corrugated tubing, and an
interface.

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3
Q

The therapy works by pulling in
and filtering normal room air (21% oxygen) and applying it to a
blower.

A

Positive airway pressure (PAP)

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4
Q

The blower sends air through the tubing to an interface, most
commonly a ____, at a set
pressure that is measured in
______

A

nasal mask / centimeters of water pressure
(cm2HO).

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5
Q

The air pressure that is delivered
can be adjusted to act as a
_______ to hold the patient’s airway open, assist with
ventilating the patient while the
patient sleeps, or both.

A

mechanical splint

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6
Q

____ remains the preferred and
most widely used therapy for
obstructive sleep apnea (OSA).

A

CPAP

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7
Q

_______ is characterized by a complete or partial obstruction in the upper airway during sleep that results in frequent arousals, among other deleterious consequences.

A

Obstructive sleep apnea

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8
Q

_____ is characterized
by two separate pressures
corresponding with inhalation and exhalation.

A

Bi-level therapy

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9
Q

The ___ and ___ settings serve
different purposes.

A

EPAP and IPAP

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10
Q

____ acts to maintain
the patency of the airway.

A

EPAP

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11
Q

____ provides a means to provide ventilatory support and increased tidal volumes.

A

IPAP

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12
Q

_____ is used to treat
patients with complex SRBDs, like hypoventilation disorders or
Cheyne–Stokes respiration, and
those who have difficulty tolerating high CPAP pressures.

A

Bi-level therapy

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13
Q

____ allows the
patient to exhale more easily
without having to push as hard
against the incoming positive
pressure.

A

lower EPAP

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14
Q

_____ allows the patient to inhale larger volumes of air with greater ease.

A

increased IPAP

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15
Q

(PAP)
Pressures are measured in
______

A

centimeters of water (cmH2O).

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16
Q

PAP levels can be verified by a
device called a ______.

A

water column
manometer

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17
Q

_____ typically include
options for remote monitoring and controlling, live output data for recording on the polysomnograph, leak measurements, and the ability to switch modes among CPAP, bi-level PAP, and auto positive airway pressure (auto PAP).

A

Diagnostic units

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18
Q

_____ mode automatically
adjusts CPAP as needed, based
on detected airflow and vibrations from the upper airway.

A

Auto PAP

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19
Q

If the system detects vibrations in the upper airway from snoring or a decrease or absence of airflow, then the pressure ____.

A

increases

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20
Q

After a period of time without
detected vibrations or changes in airflow, the pressure ____.

A

decreases

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21
Q

Bi-level units include settings for
backup ______ and
timing of the _____.

A

respiratory rates / respiratory cycle

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22
Q

A _______ does not
detect the changes in patient
respirations but switches between IPAP and EPAP on a specific time base as defined by the user.

A

timed bilevel mode

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23
Q

A ______ automatically shifts between IPAP and EPAP when it detects a change in the patient’s
respirations.

A

spontaneous bi-level mode

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24
Q

A third option available on many bi- level machines is a _____

A

spontaneous mode with a timed backup.

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25
Q

This allows the patient to determine the change of respirations but with the safety of a timed backup in case the patient does not breathe on his or her own.

A

spontaneous mode with a timed backup

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26
Q

As noted previously, advanced
forms of _____ have
been developed to address more
complex SRBDs.

A

bi-level therapies

27
Q

____ is a positive pressure mode of ventilation that can automatically adjust respiratory rate, tidal volume, and inspiratory time based on the patient’s requirements.

A

ASV

28
Q

It collected information on a
breath-by-breath basis and adjusts pressure support to optimize a patient’s breathing pattern.

A

ASV

29
Q

_____ are used to treat
central sleep apnea, mixed sleep
apnea, and Cheynes–Stokes
respiration, an abnormal waxing
and waning breathing with central apneic events.

A

ASV machines (adaptive servo ventilation)

30
Q

_____ is a positive pressure mode of ventilation that automatically
adapts the pressure support
(IPAP) a patient needs to maintain an average tidal volume.

A

Average Volume-
Assured Pressure Support

31
Q

____ uses an algorithm to
estimate tidal volume at each
breath, compares it to the target
volume, and adjusts IPAP
accordingly.

A

AVAPS

32
Q

These units are commonly used to treat patients with complex SRBDs such as obesity hypoventilation syndrome and chronic obstructive pulmonary disease. The prescribed settings would include the target
tidal volume and IPAP limits.

A

AVAPS

33
Q

____ are typically much
simpler and easier to use.

A

Home units

34
Q

The pressure on these units
cannot be changed without an
interface device or a combination of key entries on the machine.

A

Home units

35
Q

_____ include
memory cards, data storage, or
Wi-Fi capabilities with
downloadable data, for use at
patient follow-ups.

A

home PAP devices

36
Q

Many have pressure reliefs at the end of inhalation and the beginning of exhalation to allow for a more comfortable transition. Many patients find this option much more comfortable and tolerable.

A

Home units

37
Q

A common side effect of PAP
therapy is ___ and _____.

A

nasal and upper airway dryness.

38
Q

Adjustments in _____ and
____ can be tailored to
improve patient comfort.

A

humidity levels and temperature

39
Q

Many ____ machines have
integrated heated humidifiers,
whereas others use external
humidifiers.

A

PAP

40
Q

When _____ is
used, water sometimes pools
inside the hose when the room air temperature is significantly cooler than the hose temperature.

A

heated humidification

41
Q

Adverse Effects

A

• Nasal dryness
• difficulty tolerating
the air pressure that is
delivered.
• Facial soreness at various
pressure points

42
Q

This is most appropriately
addressed by confirming that the correct size interface is being used and readjusting the head straps for comfort. If the problem persists, a different style interface should be considered.

A

Facial soreness

43
Q

___ refers to the gradual
process of adjusting the strength or dose of a medication or treatment until an acceptable or optimal treatment level is achieved.

A

Titration

44
Q

The hookup procedure for a PAP
titration study mirrors that of the
diagnostic study with one
exception: The two airflow sensors used in a PSG are replaced with a ____ for the titration.

A

PAP mask

45
Q

The montage selected for these
two studies are nearly identical,
usually with the addition of a ______ and ______.

A

PAP pressure channel and PAP flow channel.

46
Q

The PAP flow is detected
by the PAP machine rather than, or in addition to, a _____, ______, or _____.

A

thermistor, thermocouple, or pressure transducer.

47
Q

During a CPAP titration study,
_____ is used as a splint to
maintain the patency of the upper airway.

A

pressure

48
Q

Pressures should be titrated
upward in ___ increments over at least 5-minute periods of time

A

≥1 cm

49
Q

the following breathing
events:

A

a. Two or more obstructive
apneas
b. Three or more hypopneas
c. Five or more respiratory
effort–related arousals (RERAs)
d. Three or more minutes of loud snoring

50
Q

According to the AASM clinical
guidelines for the manual titration of PAP therapy, an _____ is defined as:
a) A respiratory disturbance
index (RDI) of less than
five events for a period of
15 minutes
b) SpO > 90%
c) Fewer than five
electroencephalogram
(EEG) arousals per hour
in supine rapid eye
movement (REM)
d) Snoring eliminated.

A

optimal titration

51
Q

According to the AASM Clinical
Guidelines, the recommended
minimum starting IPAP should be _____, whereas EPAP should be set at ____.

A

8 cmH2O / 4 cmH2O

52
Q

If a patient is uncomfortable or
intolerant of high CPAP above 14
cmH20, then the mode may be
switched over from CPAP to ____

A

bi-level.

53
Q

The recommended minimum IPAP– EPAP differential is _____, while the maximum differential is _____.

A

4 cm H2O / 10 cmH2O

54
Q

The titration of bi-level therapy
should include upward titration of the IPAP and EPAP by at least ____ for apneic events and
upward titration of the IPAP
pressure only by at least ___ in response to hypopnea, RERAs, or snoring.

A

1 cmH2O / 1 cm H2O

55
Q

___ can also be increased to
correct for hypoxemia that persists despite a patent airway.

A

IPAP

56
Q

• If treatment-emergent central
apneas are observed, a decrease
in IPAP or a switch to
______ may be helpful.

A

spontaneously timed mode with
backup rate

57
Q

The recommended maximum IPAP pressure is ____ for patients 12 years of age and older.

A

30 cmH2O

58
Q

An optimal bi-level titration is defined the same as for a _____

A

CPAP titration.

59
Q

_____ is often used in the sleep lab to address hypoxemia.

A

Supplemental oxygen

60
Q

Technologists should check the
baseline oxygen saturation at the beginning of the night by using a ____ (SpO2).

A

pulse oximeter

61
Q

If a patient demonstrates
decreased SpO2 levels, the
technologist should notify the
physician to make him or her
aware and obtain an order for
______.

A

supplemental O2

62
Q

For patients with SRBDs that
demonstrate decreased SpO2
levels during the study, it is most
often recommended to correct the respiratory events via ____ first.

A

PAP therapy

63
Q

Once the SRBD is addressed, if
oxygen desaturation persists, then _____ may be indicated.

A

supplemental oxygen

64
Q

_____ can be introduced into the PAP circuit by connecting oxygen tubing to one of the small outlet holes on the PAP interface.

A

supplemental O2

I POLY (6 decks)

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