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RTH 132 > Initial Settings > Flashcards

Initial Settings Flashcards

1
Q

what are the goals for choosing a type of ventilator and mode

A

airway mgmt
ventilation
oxygenation disturbance

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2
Q

non-invasive accomplished in 3 ways

A

NPV
CPAP
NPPV

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3
Q

where is negative pressure ventilators most often used

A

used in home and for long term

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4
Q

where does negative pressure ventilation pressure go

A

across chest wall

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5
Q

what must be stable in patients who use negative pressure ventilation

A

compliance and resistance , airway protection, ability to swallow

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6
Q

why is negative pressure ventilation not good for acute exacerbation of COPD

A

they can have changes with compliance and resistance

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7
Q

is negative pressure ventilation good for obstructive sleep apnea

A

no

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8
Q

what are some negative pressure ventilation disadvantages

A 
pt access difficult
may cause tank shock
no spontaneous breathing
no control
hot and noisy
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9
Q

where do set the rate for negative pressure ventilaiton

A

set 5-10 below patients rate

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10
Q

where do you increase negative pressure till

A

till patient can’t talk

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11
Q

why is it good that a patient can’t talk when ventilating with negative pressure

A

means there is enough flow to the patient

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12
Q

what is the max pressure that can be achieved with negative pressure ventilaiton

A

35

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13
Q

what do you use to measure volume with negative pressure ventilation

A

spirometer

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14
Q

how do you increase volume with negative pressure ventialton

A

increase pressure or I time

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15
Q

what are some hazards of an iron lung

A

abdominal pooling

large and in the way for nursing

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16
Q

what is a benefit to using a chest curaiss

A

eliminates abdominal pooling

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17
Q

why are chest cuirasses difficult to use

A

difficult to maintain a seal

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18
Q

where does a chest cuirass apply pressure

A

applies negative pressure to thorax

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19
Q

what are the indications for NIV/NPPV

A

pts with acute on chronic respiratory failure who require short term ventilation
terminally ill pts
pts who tolerate nasal/mask long term
pts with acute resp failure

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20
Q

when is bipap mostly used

A

patients with CHF

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21
Q

when do you not use NPPV/NIV

A

severe acidosis
shock bp <90 mmhg
uncontrolled arrhythmias
upper airway obstruction/trauma

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22
Q

NPPV for chronic RF

A

chest wall deformities
neuromuscular disorders
central alveolar hypoventilation
COPD

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23
Q

what does NPPV cause

A

gastric distention, skin pressure sores, facial pain, dry nose, eye irritation, poor sleep, and discomfort

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24
Q

what is the overall goal of ventilation

A

support the minute ventilation in order to meet the oxygen need

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25
what is full ventilatory support
all work is coming from the machine, even if pt is doing something it isn't good enough to not be in FVS
26
what is partial ventilatory support
weaning, lower amount that machine does
27
what mode ventilates pts with disease more - pressure or volume
pressure
28
when is volume mood good for
iatrogenic hyperventilation in control head injuries
29
why do you want alveolar hyperventilation in control head injuries
guaranteed a minute ventilation
30
how does pressure mode help improve distribution of ventiliation
descending flow pattern
31
which mode of ventilation has more control over minute ventilation - pressure or volume
volume
32
lower compliance or higher resistance results in higher what pressures
peak and plateau pressures
33
when is peak pressure higher with what type of flow
constant flow
34
when is peak pressure lower with what type of flow
descending flow
35
what do high volumes do to peak/plat pressures
make them high
36
what is the goal of volume ventilation
goal of a minute ventilation that matches the patients metabolic needs
37
how do you find tidal volume with F and MV
MV=F x VT
38
how do you determine total cycle time
TCT = 60/F
39
how do you calculate flow from VT and I Time
flow = vt/ti (l/sec)
40
how do you estimate body surface area
by the dubois BSA chart
41
what can calculate vt and f
radford nomogram
42
where should you keep platue pressure at to prevent alveolar overdistension
<30 cmh2o
43
what is tubing compliance usually
3-4 ml/cmh2o
44
how do you calculate delivered VT
tubing factor x peak pressure = what is lost in tubing and then subtract out peep
45
how much deadspace does an HME add
20-90mL
46
how much deadspace is there b/w the wye and endotracheal tube
75 mL
47
what does driving force equal
pressure gradient
48
in normal lungs what selection do you make for rates/vt
large VT, and slow frequency with flow to meet demand
49
in lungs with COPD what selection do you make for rates/vt
high compliance and raw - moderate VT and low frequency and high flow to meet demand
50
in lungs with restrictive disease what selection do you make for rates/vt
smaller VT, high frequency, and slower flow
51
flow and flow patterns have what relationship with i time
inverse relationship
52
what happens if you have high flow
high flow shortens I time and increase PAP
53
what happens if you have slower flow
slower flow increases I time and decreases PAP but may lead to air trapping and shorter E time
54
what are the 3 types of flow patterns
constant sine descending
55
what is sine
it gives better distribution than constant, PAW and PEAK equal to constant peak higher when raw is high
56
descending
occurs naturally in pressure ventilation, peak press is lower, paw is higher, vd is lower, oxygenation is better
57
which is more important high paw or pip
high paw
58
what happens to MAP with descending flow
it increases
59
what happens to MAP with ascending flow
decreases
60
what happens to PIP with ascending flow
increases
61
what happens to PIP with descending flow
decreases
62
what does descending flow improve
gas distribution and arterial oxygenation
63
what are the goals of PSV
increase VT decrease RR decrease WOB associated with artificial airway
64
what muscle is an indicator of adequate PSV
sternocleidomastoid muscle
65
what should you set PSV with lung dx
8-14
66
what should you set psv without lung dx
about 5

RTH 132 (11 decks)

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