Exam 3 Flashcards
(95 cards)
1
Q
CMV can either be ___________________ triggered.
A
Time or patient triggered
2
Q
CMV can either be ___________________ targeted.
A
Volume or pressure targeted
3
Q
What does PEEP help improve?
A
Oxygenation (Increased PaO2), Keeps alveoli open
4
Q
What does widening of the PV loop mean?
A
Decreased compliance
5
Q
We automatically intubate when __________ is present.
A
Apnea
6
Q
Indications for MV
A
- Refractory hypoxemia
- Inadequate alveolar ventilation
- Inadequate muscle strength
- Increased WOB
7
Q
What increases airway resistance?
A
- ET tube size
- Secretions
8
Q
Increased compliance in P-V loop means _________.
A
Decreased airflow resistance
9
Q
What does dynamic compliance deal with?
A
Airflow resistance
10
Q
If the loop is shifting toward the P-axis, towards increased PIP what is happening to compliance as airway pressure gets higher?
A
Decreased compliance - Lungs become less compliant
11
Q
Head trauma patients may need to be intubated to monitor _____________.
A
ICPs
12
Q
If the patients need to be intubated for a short amount of time, what mode would you use?
A
SIMV
13
Q
What is SIMV used for?
A
- Weaning
- Do some of the breathing on their own
- Prevent breath stacking
14
Q
A high tidal volumes increases what?
A
PIP
15
Q
PIP should always be less than _______
A
30
16
Q
Increased PIP may be due to what?
A
Secretions
17
Q
Pressure control setting is used to control what?
A
Pressure and allows patient to chose their own volume
18
Q
What is the requirement for using CPAP?
A
Patient must be spontaneously breathing
19
Q
What are CPAP parameters?
A
- Pressure Support Ventilation
- PEEP
- FiO2
20
Q
What is the difference between SIMV and IMV?
A
They both are able to take breaths in-between mandatory breaths
IMV can cause breath stacking, SIMV cannot
21
Q
Sometimes patients with high ICPs will get put into an alkalotic state (high RR), because…..
A
It reduces ICPs because it restricts blood vessels
22
Q
If pressure triggered, what is starting the breath?
A
Pressure
23
Q
What does CPAP stand for?
A
Continuous Positive Airway Pressure
24
Q
What does SIMV stand for?
A
Synchronized Intermittent Mandatory Ventilation
25
What does CMV stand for?
Continuous Mandatory Ventilation
26
What does IMV stand for?
Intermittent Mandatory Ventilation
27
What does PEEP stand for?
Positive End-Expiratory Pressure
28
What does Pmean stand for?
Mean Airway Pressure
29
What does PIP stand for?
Peak Inspiratory Pressure
30
What is the cycle variable used as?
Used to end expiration
31
In I:E times, what does I stand for?
Inspiratory time
32
In I:E times, what does E stand for?
Expiratory time
33
What does TCT stand for?
Total cycle time
34
What is the initial tidal volume range for the ventilator?
6-8 mL/kg
35
What is the initial respiratory rate range on the ventilator?
10 to 20 breaths/min
36
What is the initial PEEP setting on the ventilator?
5 cmH2O
37
What is the IBW for **females?**
105+5 (Height - 60) divided by 2.2
38
What is the IBW for **males?**
106+6 (Height - 60) divided by 2.2
39
What ventilator parameter would you expect if your patient is coughing? How can the therapist fix that problem?
The PIP would be increased; the RT can suction the patient
40
With ARDS patients, are we more worried about ventilation or oxygenation?
Oxygenation
41
What are some reasons the low-pressure alarm would be sounding on the ventilator?
- Patient disconnection
- Leaks in the system
42
When would a patient benefit from a lower tidal volume?
When the patient has ARDS or restrictive disease
43
Name 3 trigger variables.
- Flow
- Time
- Patient
44
Name 4 cycle variables.
- Volume
- Time
- Flow
- Pressure
45
Which acid-base imbalance cannot be fixed by a vent?
Metabolic acidosis
46
To wean a patient off the vent, which setting would you start manipulating FIRST?
FiO2
47
What does an increased VE mean?
Increased WOB is present
48
What does a decreased VE mean?
Patient not breathing efficiently enough
49
What is the minute ventilation equation?
Tidal volume x Respiratory rate
50
A VE above _______ is a cause for concern.
10 L/min
51
What is the normal range for minute ventilation?
5 to 6 L/min
52
What is the RR range for ARDS patients?
15-25 breaths/min
53
What is the tidal volume range for ARDS patients?
4-6 mL
54
What does a low-pressure alarm indicate?
Patient disconnection or leak in the breathing circuit
55
What does a high-pressure alarm indicate?
Kinks in the tubing, retained secretions and coughing, decrease in compliance
56
Why do we as RRTs like the assist control mode?
- Allows patient to participate in WOB
- Gives assistance to decrease the patient's WOB
- We set the rate and tidal volume but the patient can do more if they want to
57
What is a disadvantage of assist control mode?
It gives set breaths which can cause breath stacking.
58
What would the PEEP look like on an ARDS patient?
It would be higher; 10 or greater. It depends on the patient
59
What would be the initial vent settings on a patient you know nothing about?
VT: 6-8 mL/kg
RR: 10-20 breaths/min
PEEP: 5
60
What are some things to remember when putting an ARDS patient on the ventilator?
- Small tidal volume
- High RR
- High FiO2
- High PEEP
61
What is the minute ventilation equation?
Vt x f (frequency)
62
What ventilator mode would we put a post-surgical patient on?
SIMV
63
What mode should we switch a patient on whenever we are weaning? What must the patient be doing?
- CPAP mode
- Must be spontaneously breathing
64
What are the initial vent setting for CPAP mode?
- Pressure support: 5
- PEEP: 5
- FiO2: Less than 40
**We need a lower FiO2 when weaning patients to get them closer to the normal room air FiO2 of 21%**
65
If we're weaning a patient and their tidal volumes are too low, what can we do to make the tidal volume higher?
Increase pressure support
66
What is the RSBI equation?
RR divided by VT
67
What is the normal P1.0 range?
0 to -2
68
What are two noninvasive positive pressure modes?
- CPAP
- BiPAP
69
What is the difference between IPAP and EPAP called?
Pressure support
70
What is VAP and what are some ways to prevent it?
Ventilator-acquired pneumonia
**Ways to prevent it:**
- Closed in-line suctioning
- Oral care
- Head of the bed 30 degrees
- Handwashing
- Changing filters regularly
71
What are some sources of VAP?
- Poor hand hygiene
- Not changing equipment regularly
72
What ABG values indicate respiratory failure?
- CO2 greater than 50
- pH less than 7.3
73
High pressure alarms are set about _____ **above PIP.**
10 cmH2O
74
Low pressure alarms are usually set about _________ **below PIP.**
5-10 cmH2O
75
What are audible alarm systems designed for?
To alert the clinician of potential dangers related to the patient-ventilator interaction.
76
What is the highest accepted maximum for an apnea period?
20 seconds
77
When a ventilator malfunction occurs, what must the clinician do first?
Ensure that the patient is receiving ventilation.
When in doubt, the practitioner should disconnect patient from ventilator, begin manual bag resuscitation, silence alarms and call for help.
78
A deep breath that occurs regularly as part of a normal breathing pattern.
Sigh
79
Ventilator checks are generally performed how often?
Every 4 hours
80
Cuff pressures should not exceed ________.
20-25 mmHg.
81
Why is it important to frequently reposition a patient’s endotracheal tube?
To prevent pressure injuries to the gums, mouth, lips, or nose that can occur as a result of the constant pressure of the tube.
82
Manual ventilation must be performed cautiously to avoid things like:
- Inappropriate patterns of ventilation
- Excessive pressures
- Barotrauma
83
Explain the phrase “fighting the ventilator”
It describes an individual who is apparently doing well while receiving mechanical ventilation but suddenly develops acute respiratory distress.
**This is particularly challenging for most clinicians because the patient is not able to verbalize his or her discomfort.**
84
The sudden onset of dyspnea can be identified by _________.
Observing the physical signs of distress.
85
What are some of the common causes of sudden respiratory distress in patients receiving mechanical ventilation?
- Artificial airway problems
- Bronchospasm
- Secretions
- Pulmonary edema
- Pulmonary embolus
- Dynamic hyperinflation
- Abnormal respiratory drive
- Alteration in body posture
- Drug-induced posture
- Abdominal distention
- Pneumothorax
- Anxiety
86
What are the most common patient-related problems encountered during mechanical ventilation?
It involves the placement and patency of the artificial airway, the presence of a pneumothorax, bronchospasm and excessive secretions.
87
What are some clinical benefits of NIV?
- Reduces the need for endotracheal intubation
- Reduces incidence of ventilator-associated pneumonia
- Shortens stay in the ICU
- Shortens hospital stay
- Reduces mortality
- Preserves physiological airway defenses
- Improves patient comfort
- Reduces need for sedation
88
When can mechanical ventilation be discontinued?
When the need for mechanical ventilation has been resolved.
89
About _____% of patients requiring temporary mechanical ventilation do not require a gradual withdrawal process and can be disconnected with a few hours or days of initial support.
80
90
The term _______ is frequently used to describe the gradual reduction of ventilatory support from a patient whose condition is improving.
Weaning
91
What was ATC designed for?
Specifically to reduce WOB associated with increased ET resistance.
92
The level of PSV used during IMV typically ranges from _____.
5-10 cmH2O
93
Successful weaning is more likely if the RSBI is less than _____.
105 (Norma range: 60-105)
94
Patient who tolerate an SBT of ______ minutes should promptly be considered for ventilator discontinuation.
30-120
95
Patient who tolerate an SBT of ______ minutes should promptly be considered for ventilator discontinuation.
30-120
