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Pediatric/Neonatal Respiratory Care > Ch. 18 Management of the Pt-Vent System > Flashcards

Ch. 18 Management of the Pt-Vent System Flashcards

1
Q

The immediate indication of MV is

A

respiratory failure

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2
Q

Respiratory failure is divided into three classifications:

A
  • hypoxemia respiratory failure
  • hypercapnic respiratory failure
  • mixed respiratory failure
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3
Q

Hypoxemic respiratory failure is commonly manifested by a

A

PaO2 ≤50 mmHg on a FiO2 of ≥60%, Despite the use of CPAP, or a decreasing PaO2

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4
Q

Clinical features include

A

agitation, cyanosis, tachycardia, or bradycardia (late), tachypnea (>70–80 breaths/min in neonates; >50 breaths/min in children).

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5
Q

Classic signs of distress in neonates also include

A

nasal flaring, grunting, and marked thoracic retractions (substernal, sternal, intercostal, supraclavicular, and suprasternal)

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6
Q

Hypercapnic Respiratory Failure is commonly manifested by a PaCO2

A

PaCO2 ≥60 mmHg, accompanied by acidemia ((pH ≤7.25)

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7
Q

During Hypercapnic Respiratory Failure the infant may appear (3)

A

apneic, listless, and cyanotic

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8
Q

Bradycardia or tachycardia may be present depending on the presence of asphexia (primary or secondary apnea) in the newborn, that is, decelerations recognized in fetal heart monitoring and prolonged periods of bradycardia as asphexia progresses

A

**

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9
Q

Mixed Respiratory Failure is manifested by both

A

hypoxemia and htpercapnia

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10
Q

Causes of Depressed Respiratory Drive

A
  • Drug overdose
  • Acute Spinal cord injury
  • Head trauma
  • Neurologic dysfunction
  • Sleep disorders
  • Metabolic alkalosis
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11
Q

Diagnoses in which the decision is made to withhold life support include

A
  • birth weight less than 800 g,
  • severe intracranial hemorrhage
  • periventricular leukomalacia
  • severe necrotizing enterocolitis
  • hypoxic-ischemic encephalopathy
  • intractable respiratory failure
  • major congenital anomalies
  • chromosomal abnormalities.
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12
Q

A mode of ventilation is described as the combination of

A

control, phase, and conditional variables

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13
Q

The control variable is that which does not

A

change when compliance or resistance changes

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14
Q

In volume-controlled ventilation, if compli- ance or resistance changes in the lung, volume does not change; pressure changes.

A

**

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15
Q

In pressure-controlled ventilation, when compliance or resistance changes, pressure remains constant. This means that when compliance decreases or resistance increases, tidal volume necessarily decreases.

A

**

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16
Q

What are 4 phase variables?

A
  • trigger
  • limit
  • cycle
  • baseline
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17
Q

A trigger variable refers to how a breath is (3)

A

intiated ( how the breath is triggered, by time, pressure or flow)

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18
Q

The limit variable is that which is reached before

A

the end of inspiration and may include time, pressure, volume or flow

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19
Q

The cycle variable is

A

the variable that ends inspiration

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20
Q

Cycle variables include:(4)

A
  • time
  • pressure
  • volume
  • flow
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21
Q

The baseline variable defines

A

expiration, which is usually measured by pressure

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22
Q

Partial ventilatory support includes those modes indicated for pts who are capable of

A

maintaining all or part of the minute ventilation spontaneously

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23
Q

What are some partial vent support modes?

A
  • CPAP
  • PSV
  • IMV
  • SIMV
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24
Q

Continuous positive Airway Pressure (CPAP) is the application of a

A

continuous positive distending pressure to the airways while the pt is spontaneously breathing

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25
Q

(CPAP) It accomplishes this by increasing the functional residual capacity (FRC), increasing compliance, decreasing total airway resistance, and decreasing respiratory rate, which are the desired outcomes of nasal CPAP

A

**

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26
Q

What are indications for CPAP (5)

A
  • Decreased FRC
  • Airway collapse
  • Weaning
  • Abnormal physical examination
  • Abnormal ABG
27
Q

CPAP breaths are classified as

A

pressure controlled, pressure triggered, pressure limited and pressure cycled

28
Q

Hazards of CPAP (3)

A
  • barotrauma
  • pulmonary blood flow is diminished
  • cardiac output may be reduced
29
Q

Additional hazards include renal effects such as a decrease in glomerular filtration rate, sodium excretion, and reduced urine output. CPAP also elevates intracranial pres- sure, increasing the incidence of cerebral hemorrhage. Further hazards include pneu- mothorax, nasal obstruction, gastric distention, and necrosis or erosion of the nasal septum. Nasal deformities from the use of nasal prongs has also been recognized

A

**

30
Q

Contradictions of CPAP

A

upper airway abnormalities such as choanal atresia, cleft palate, or tracheoesophageal fistula, because it could be ineffective or dangerous

31
Q

CPAP increases intrapulmonary pressure; therefore, it should not be used in cases of untreated air leaks such as

A

pneumothorax, pneumomediastinum, pneumopericardium, and pulmonary interstitial emphysema

32
Q

As soon as the patient begins to show signs of clinical improvement, the FiO2 is decreased in

A

5% decrements until the FiO2 reaches 40% to 60%

33
Q

Once Fio2 is lowered then CPAP can be lowered in decrements of

A

2-5 cm H2O and is lowered until it reaches 2 to 3 cm H2O

34
Q

When is PSV indictated?

A

Any pt in whom a greater tidal volume (5- 8 mL/ kg) and decreased spontaneous ventilatory rate are desired during spontaneous breaths in SIMV or CPAP modes

35
Q

SIMV the breaths are

A

synchronized with the pt’s inspiratory effort and breath stacking is avoided

36
Q

First, breath stacking is avoided. Breath stacking occurs when the ventilator gives a mandatory breath arbitrarily during a patient’s spontaneous breath, leading to discomfort, excessive tidal volume, and possibly, barotrauma.

A
37
Q

Because there are several breath types during SIMV, each breath type is individually classified:
Mandatory breaths
Volume-controlled breaths
Pressure- controlled breaths

A
  • Mandatory breaths may be volume or pressure-controlled
  • Volume-controlled breaths are usually time, pressure, or flow triggered
  • Pressure-controlled breaths are time, pressure, or flow triggered
38
Q

Full vent support provides all of the required

A

minute ventilation for a particular pt

39
Q

Full vent support modes include

A
  • SIMV
  • CMV
40
Q

Continuous mandatory ventilation (CMV) is indicated when all of the minute ventilation must be supplied by mandatory breaths. Each breath, regardless of trigger variable, has the same tidal volume or peak pressure depending on the patient compliance)

A
41
Q

In CMV breaths may be

A

pressure or volume controlled

42
Q

VC-CMV breaths may be

A

time, pressure, or flow triggered;
flow-limited;
time-cycled

The RT sets the mandatory rate and Vt

43
Q

PC-CMV (PCV) may be

A

time, pressure, or flow triggered;
pressure-limited;
flow or time cycled

The RT sets the mandatory rate and peak pressures

44
Q

Indications for PCV

A

ARDS that result in Pplat ≥35 cm H2O or a peak pressure ≥40 cm H2O while on volume ventilation.

45
Q

Once it is determined that the patient is in respiratory failure, the ______ is often the first setting made on the ventilator.

A

mode

46
Q

Modes that increase Pmean such as _______ are employed for ____________ ___________ failure

A

CPAP;
hypoxemic respiratory

47
Q

Modes that increase Ve such as _____ and ______ are employed for ___________ ____________ failure

A

SIMV, CMV;
hypercapnic respiratory

48
Q

The inspiratory hold promotes distrubution of

A

ventilation and increases Pmean

49
Q

PIP is usually maintained at the pressure used during resuscitation at

A

15 to 20 cm H2O

50
Q

Initial vent parameters: PIP

A

15 to 20 cm H2O

51
Q

Initial vent parameters: PEEP

A

3 to 5 cm H2O

52
Q

Initial vent parameters: FiO2

A

set to keep pt pink, or SpO2 90- 92%

53
Q

Initial vent parameters: Rate

A

30 - 40 bpm

54
Q

Initial vent parameters: Flow

A

6-8 L/min

55
Q

Initial vent parameters: I-time

A

Low birth weight infants 0.25- 0.5 sec
Term infants 0.5 - 0.6 sec

56
Q

Initial vent parameters: I:E ratio

A

1:1.5 to 1:2

57
Q

Initial vent parameters:Vt

A

6 to 8 mL/kg
Term- 8 mL/kg
Low birth weight- 6 mL/kg
Very- low birth weight- 4 to 6 mL/kg

58
Q

MR.SOPA

A
  • mask
  • reposition
  • suction
  • open mouth
  • increase pressure
  • alternate airway
59
Q

Catheters according to size
Meconium, term, preterm

A
  • meconium 10 F
  • term 8F
  • preterm 5F and 6F
60
Q

Rule of 6

A

Lbs divided by 2 + 6

61
Q

When is prophylactic administration of surfactant indicated ?

A

Infants who are at high risk of developing RDS. Included are those infants born before 32 weeks, those who weigh less than 1300 g, those with an LS ratio less than 2:1 or those with an absent of PG in the amniotic fluid

62
Q

When is therapeutic administration (also called rescue) indicated?

A

It is not given until the patient develops signs of RDS. This includes those benefits who require mental assistance due to increase record of breathing, grunting, nasal flaring retractions, increase in oxygen requirements, and having chest x-ray evidence of RDS.

63
Q

How do you administer or surfactant? (14)

A

1st- check, baby weight, brand-name, and determine how much you need for the dose
2nd- those should be divided into two doses keep it warm to room temperature
3rd- check and prepare equipment (multi axis catheter)
4th-intubate baby in place midline
5th- verify intubation
6th- increase FiO2 to 100%
7th- multi access catheter ( bag 60 bpm keep PIP to 20 to 25 cm H2O
8th-advanced catheter down
9th- Push meds in slowly and steady
10th- Continue bagging for 1 minutes until meds are clear of ET tube
11th- Roll the baby to the side
12th- Place baby midline and repeat process of advancing catheter, and placing meds
13th- roll the baby to the opposite side bag until ETT is clear of meds, place the baby midline
14th- reduce the FiO2 to where it was prior to giving info surf if baby is on a ventilator

Pediatric/Neonatal Respiratory Care (9 decks)

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