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RET 2934 > Chapter 11 > Flashcards

Chapter 11 Flashcards

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1
Q

Pressure controlled ventilation is used for adults
with what lung condition?

A

ARDS

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2
Q

on delivered VT in a neonate receiving pressure-
limited ventilation?

A

Decrease VT

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3
Q

for weaning so that airway resistance is

A

5-10cmH2O

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4
Q

As the oxygenation status of a patient worsens
while using an oxygen mask at what point

A

Patient who cannot maintain normal limits
using a 50 to 60% oxygen mask and has normal

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5
Q

should CPAP be started?

A

or low CO2 levels.

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6
Q

How is minute volume calculated?

A

VT x RR

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7
Q

On the initial ventilator set up at what range
should the ventilator rate be?

A

10 to 16

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8
Q

How should the appropriate ventilator title
volume be determined?

A

6 to 8 mL/kg of IBW

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9
Q

List indications for the use of PEEP?

A

Decreased FRC

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10
Q

List 4 hazards of PEEP?

A

Decreased venous return
Decrease cardiac output

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11
Q

Define optimal PEEP?

A

The level of peep that improves compliance
without cardiac compromise

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12
Q

determined that cardiac output has been

A

Decreased PVO2 < 35 and drop in BP

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13
Q

How may the ventilator low pressure alarm be

A

Ruptured ET tube cuff

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14
Q

activated?

A

Inadequate cuff pressure

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15
Q

List ways that the vent high pressure alarm may
be activated?

A

Decreased compliance
Increased airway resistance

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16
Q

How should the high pressure alarm be set?

A

10 above PIP

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17
Q

List some factors that affect airway resistance?

A

Condensation in the vent circuit

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18
Q

What is normal PeTCO2?

A

35-45

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19
Q

List four conditions that result in decreased

A

Apnea

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20
Q

PeTCO2?

A

Total airway obstruction

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21
Q

List 2 conditions that result in increased

A

Hypoventilation

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22
Q

PeTCO2?

A

Hyperthermia

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23
Q

List criteria that indicate mechanical ventilatory
assistance is necessary?

A

VC < 10-15 (normal 65-75)
A-a gradient > 450 with use of 100% FiO2
(normal 25-65)

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24
Q

List complications of mechanical ventilation?

A

Pulmonary O2 toxicity

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25
List some conditions that result in decreased
Atelectasis
26
compliance?
Air-trapping
27
What is indicated if PIP pressures are increased but Pplat is not?
Increased static compliance
28
List 3 advantages of high frequency ventilation?
Reduced risk of cardiac side effects
29
On a volume time waveform, if tracing does not return to baseline, what does this indicate?
Air-trapping (auto PEEP)
30
What are some indications for mechanical
Acute ventilatory failure
31
ventilation?
Impending acute ventilatory failure
32
What is acute ventilatory failure?
PaCO2 > 50 mmHg and pH < 7.30
33
What might the rate be for impending acute ventilatory failure?
30-40/min
34
In a patient with neuromuscular disease what should be monitored?
Muscle involvement
35
How do we do parameters?
We measure the MIP and the VC to help determine muscle strength
36
A patient who’s on an O2 mask of 50-60% but is not oxygenated enough is experiencing what?
Large intrapulmonary shunt
37
What are some common criteria for initiation of mechanical ventilation?
VC < 10-15 P(A-a)O2 > 450 with the use of 100% O2; (normal 25-65)
38
normal for ambient conditions and the patient’s
Hypoventilation
39
When the PaO2 is low and the P(A-a)O2 is high for ambient conditions and the patient’s age, hypoxemia is most likely the result of…
ventilation/perfusion (V/Q) mismatch diffusion defect shunting In this situation, the patient may be hyperventilating to compensate for the hypoxemia
40
What is dead space normal ratio?
60% (25-35)
41
What is the formula for VD?
PaCO2 -PeCO2/PaCO2
42
What MIP should the patient obtain and what is
-20
43
the normal?
-50 to -100
44
What are some lung protective strategies for ARDS?
Maintain VT between 6-8mL/kg of IBW Maintenance of plateau pressure < 30
45
What is the initial IPAP setting?
10-15
46
What is the initial EPAP setting?
4-5
47
What is the difference between IPAP and EPAP?
Pressure Support
48
A patient triggered, pressure limited, flow cycled breath is augmented with what?
SIMV & CPAP
49
How much pressure support is needed to overcome tubing resistance.
5-10
50
The A/C mode is what?
Patient triggered, & time triggered
51
Patients who cannot maintain O2 sats of 50- 60% must be placed on what?
CPAP
52
CPAP is also indicated for what patients?
They gain benefit from the positive airway pressure
53
In volume controlled ventilation increased VT increases _____?
Ti
54
Exhaled VT is measured by what?
Respirometer placed between ETT and vent Y adapter on exhalation valve
55
To most accurately measure the VT delivered by the vent what should you do?
Place a respirometer directly on the vent outlet.
56
What is the normal rate for ARDS pt?
20-35
57
What is normal rate for COPD pt?
10-12
58
What is the formula for I:E ratio?
I:E ratio = Inspiratory flow rate (L/min)/MVe (L/min) - 1 (for inspiration)
59
What is the formula for I-time?
1 time = TCT/ sum of I:E ratio parts
60
What is normal PvO2?
35-45
61
A PvO2 < 35 indicates what?
decreased cardiac output
62
If the PvO2 decreases after the initiation of PEEP,
Reduced venous return and cardiac output
63
it is an indicator of what?
caused by PEEP.
64
The PvO2 value indicates what?
The adequacy of tissue oxygenation.
65
PaO2 does not determine what?
Optimal PEEP
66
What is the formula for dynamic compliance?
VT/PIP-PEEP
67
What is the formula for static compliance?
VT/Pplat-PEEP
68
What is the formula for OI?
FiO2 x MAP/PaO2 x 100
69
Generally, an OI less than _____ is acceptable?
5
70
An OI index of 10 to 20 indicates what?
Impaired oxygenation
71
An OI > 25 indicates what?
Severe oxygenation issues with poor clinical outcomes
72
You should maintain the CO2 between 25 and 30 to reduce what?
ICP by vasoconstriction of cerebral vessels.
73
ICP should be maintained below what?
15mmHg
74
What is normal ICP?
< 10mmHg
75
To decrease CO2 level you should always increase what?
Ventilator rate
76
What should the respiratory rate be in order to wean?
< 35
77
What is HFV?
A type of mechanical ventilation that utilizes high respiratory frequencies usually specified in
78
Decreasing the frequency or hertz for HFV increases what?
Delivered VT which increase PaO2
79
To decrease the CO2, the amplitude or strength of oscillation should be____?
Increased
80
Flow settings range from_____?
10-20L/min
81
What is the formula for desired FiO2?
PaO2 (desired)x FIO2 (current)/ PaO2 (current)
82
What is the formula for desired rate?
Rate (current) x PaCO2 (current)/ PaCO2 (desired)
83
What is the formula for desired Mve?
Ve(current) x PaCO2 (current)/ PaCO2 (desired)
84
What is the formula for desired alveolar MVe?
Va (current) x PaCO2 (current)/ PaCO2 desired
85
What is the formula for alveolar ventilation?
VT-VDxRR
86
What is the formula for desired VT?
VT(current) x PaCO2 (current)/ PaCO2 (desired)
87
What wave form is this?
Changes in airway resistance and compliance do not change the
88
What wave form is this?
increased airway resistance, because airway turbulence
89
What wave form is this?
The flow never decreases more
90
What wave form is this?
turbulence to flow in the beginning of inspiration,
91
What wave form is this?
Volume wave
92
What does this wave form indicate?
Air trapping because the tracing did not go back to baseline.
93
What type of wave form is this?
Pressure waveform
94
What does this waveform indicate?
Obstruction
95
What does this waveform show?
Pressure with an assisted breath
96
What type of wave form is this?
Flow wave form with air trapping
97
how soon will VAP occur?
Within the first two weeks of mechanical ventilation
98
What is the mortality rate for VAP?
5 to 40%
99
What are some common pathogens responsible
Escherichia coli
100
for VAP?
Serratia marccesans
101
What are the symptoms for VAP?
3. Increased white blood cell count (.11,000/mL)
102
For VAP how do you position the patient?
Semi-Fowler (30-45 degrees)
103
What are some antibiotics used to treat VAP?
Tobramycin Cefepime

RET 2934 (13 decks)

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