Overview of Interventions

Question 1

Therapeutic Actions (Order of Importance)

Answer 1

1. Ventilation
2. Oxygenation
3. Circulation and Perfusion
4. Underlying disease/problem

Question 2

Ventilation

Answer 2

moving oxygen molecules into the alveolar spaces and carbon dioxide out of those same spaces

Question 3

Oxygenation

Answer 3

oxygen molecule passes through the alveolar capillary membrane into the blood stream

Question 4

Circulation

Answer 4

must occur to deliver the oxygen molecule to the tissues, through contraction of the heart and the descending pressure gradient that exists in the vascular system

Question 5

Perfusion

Answer 5

oxygen crosses from the blood into the tissues through pressure gradients; occurs due to difference in partial pressure of oxygen between blood stream and the tissue

Question 6

Optimal Breathing Pattern

Answer 6

1. Inspire slowly and deeply
2. Pause at the top of inspiration for 1-3 seconds
3. Exhale slowly and passively
4. Totally relax between breaths

Question 7

SMI

Answer 7

Sustained Maximal Inspiration

Question 8

Incentive Spirometry

Answer 8

incentive spirometer - procedure
SMI - maneuver name

done every 1-2 hours, 8-10 breaths each time

Question 9

Inspiratory Capacity

Answer 9

VT + IRV

Question 10

Incentive Spirometry - Indications

Answer 10

1. prevent atelectasis (only in conscious pts)
2. Help post-operative patients achieve pre-operative values
3. Most helpful at preventing post-operative pulmonary complications

Question 11

Two Types of Incentive Spirometers

Answer 11

1. Flow-oriented

2. Volume-oriented (easier)

Question 12

IPPB

Answer 12

assist, pressure-limited device via mask, closed system

Question 13

IPPB - Indications

Answer 13

decreases work of breathing, helpful post-operatively for unconscious patients or patients too sedated to perform IS, CORRECT AND/OR PREVENT ATELECTASIS, IMPROVE COUGH EFFECTIVENESS, provide bronchodilation (mechanical), mobilize secretions, delivery medications, treat/prevent pulmonary edema

Question 14

IPPB - Contraindications

Answer 14

1. untreated pneumothorax
2. current pulmonary hemorrhage
3. active tuberculosis

Question 15

IPPB - Hazards

Answer 15

1. pneumothorax
2. /\ air trapping (COPD and severe asthma)
3. \/ venous return and potentially decreased C.O.
4. Excessive elimination of CO2 - light headedness, dizzy
5. Gastric distention

Question 16

NIV characteristics

Answer 16

1. It is done by mask (pt NOT INTUBATED)

2. may be provided W/O a rate (pt must initiate all breaths)

Question 17

NIV is ideal for:

Answer 17

1. COPD, CHF
2. Assisting ventilation temporarily
3. DNR and DNI patients

Question 18

NIV vs Mechanical Ventilation

Answer 18

Although a patient may have only slightly elevated CO2 and may benefit from NIV, if the patient is unable to protect his or her own airway, intubation and mechanical ventilation is preferable.

Question 19

Patients should be intubated rather than use NIV

Answer 19

1. unable to respond appropriately to commands
2. unable to produce an effective cough
3. evidence of aspiration
4. obtunded
5. unconscious and not arousable

Question 20

IPAP

Answer 20

inspiratory positive airway pressure, primary control used to blow off CO2; pressure support, ventilation

Question 21

EPAP

Answer 21

expiratory positive airway presure - like PEEP or CPAP - used primarily to address oxygenation

Question 22

The amount of ventilation is NOT determined by the IPAP pressure setting alone. RATHER:

Answer 22

it is determined by the distance between the IPAP and EPAP pressure settings

Question 23

Initial NIV Settings

Answer 23

IPAP 10-12 cm H2O
EPAP 4-6 cm H2O

FiO2 as low as possible to maintain SpO2 of 90% or >

Question 24

Increasing IPAP does what to CO2?

Answer 24

decrease

Question 25

Increasing EPAP does what to the change in pressure?

Answer 25

decrease

Question 26

What results from decreasing the EPAP?

Answer 26

lower the resulting PaO2 AND will increase the distance between the IPAP and EPAP pressures

Question 27

Indications for Full Ventilatory Support

Answer 27

Acute ventilatory failure; impending ventilatory failure - determined by serial ABGs, shows a degration of ventilation (/\ PaCO2, \/ pH), do not wait until absolute ventilatory failure - look for a downward trend; observed cessation of breathing (APNEA)