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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
(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
**
26
What are indications for CPAP (5)
- Decreased FRC - Airway collapse - Weaning - Abnormal physical examination - Abnormal ABG
27
CPAP breaths are classified as
pressure controlled, pressure triggered, pressure limited and pressure cycled
28
Hazards of CPAP (3)
- barotrauma - pulmonary blood flow is diminished - cardiac output may be reduced
29
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
**
30
Contradictions of CPAP
upper airway abnormalities such as choanal atresia, cleft palate, or tracheoesophageal fistula, because it could be ineffective or dangerous
31
CPAP increases intrapulmonary pressure; therefore, it should not be used in cases of untreated air leaks such as
pneumothorax, pneumomediastinum, pneumopericardium, and pulmonary interstitial emphysema
32
As soon as the patient begins to show signs of clinical improvement, the FiO2 is decreased in
5% decrements until the FiO2 reaches 40% to 60%
33
Once Fio2 is lowered then CPAP can be lowered in decrements of
2-5 cm H2O and is lowered until it reaches 2 to 3 cm H2O
34
When is PSV indictated?
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
SIMV the breaths are
synchronized with the pt's inspiratory effort and breath stacking is avoided
36
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.
***
37
Because there are several breath types during SIMV, each breath type is individually classified: Mandatory breaths Volume-controlled breaths Pressure- controlled breaths
- 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
Full vent support provides all of the required
minute ventilation for a particular pt
39
Full vent support modes include
- SIMV - CMV
40
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)
***
41
In CMV breaths may be
pressure or volume controlled
42
VC-CMV breaths may be
time, pressure, or flow triggered; flow-limited; time-cycled **The RT sets the mandatory rate and Vt**
43
PC-CMV (PCV) may be
time, pressure, or flow triggered; pressure-limited; flow or time cycled **The RT sets the mandatory rate and peak pressures**
44
Indications for PCV
ARDS that result in Pplat ≥35 cm H2O or a peak pressure ≥40 cm H2O while on volume ventilation.
45
Once it is determined that the patient is in respiratory failure, the ______ is often the first setting made on the ventilator.
mode
46
Modes that increase Pmean such as _______ are employed for ____________ ___________ failure
CPAP; hypoxemic respiratory
47
Modes that increase Ve such as _____ and ______ are employed for ___________ ____________ failure
SIMV, CMV; hypercapnic respiratory
48
The inspiratory hold promotes distrubution of
ventilation and increases Pmean
49
PIP is usually maintained at the pressure used during resuscitation at
15 to 20 cm H2O
50
Initial vent parameters: PIP
15 to 20 cm H2O
51
Initial vent parameters: PEEP
3 to 5 cm H2O
52
Initial vent parameters: FiO2
set to keep pt pink, or SpO2 90- 92%
53
Initial vent parameters: Rate
30 - 40 bpm
54
Initial vent parameters: Flow
6-8 L/min
55
Initial vent parameters: I-time
Low birth weight infants 0.25- 0.5 sec Term infants 0.5 - 0.6 sec
56
Initial vent parameters: I:E ratio
1:1.5 to 1:2
57
Initial vent parameters:Vt
**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
MR.SOPA
- mask - reposition - suction - open mouth - increase pressure - alternate airway
59
Catheters according to size Meconium, term, preterm
- meconium 10 F - term 8F - preterm 5F and 6F
60
Rule of 6
Lbs divided by 2 + 6
61
When is **prophylactic** administration of surfactant indicated ?
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
When is therapeutic administration (also called rescue) indicated?
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
How do you administer or surfactant? (14)
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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