Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Topics of Respiratory Care > Ch. 20 Weaning and Discontinuation from MV > Flashcards

Ch. 20 Weaning and Discontinuation from MV Flashcards

1
Q

Box 20.8 Physical Signs and measurements of Increased WOB

A
  • Use of Accessory Muscles
  • Asynchronous breathing (chest wall diaphragm)
  • Nasal flaring
  • Diaphoresis
  • Anxiety
  • Tachypnea
  • Substernal & Intercostal retraction
  • Pt asynchronous w/ the vent
  • Measured WOB >1.8 kg/m/min or 0.8 J/L
  • Measured WOB greater than or equal to 15 of total O2 consumption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is discontinuation of the vent

A
  • the pt still has an airway but no longer getting support from the vent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is extubation?

A

The removal of the airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

About ___% of pt requiring temporary MV, do not require weaning

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define weaning

A

the gradual reduction of ventilatory support from a pt whose condition is improving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The decision to wean a pt from the ventilator depends on

A

the level of recovery from the medical problems that imposed the need for MV and the pt overall condition and psychological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 3 common methods for weaning which are used to reduce ventilatory support and gradually place more of the WOB on the respiratory muscles?

A
  • IMV
  • PSV
  • T-piece
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a common weaning practice w/ IMV?

A

To reduce the mandatory rate progressively usually in steps of 1 or 2 breaths/min and at a pace that matches the pt’s improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What else can be added to IMV? (2)

A

PSV ( 5 to 10 cm H20)
PEEP (3 to 5 cm H20)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does the pt control with PSV?

A
  • RR
  • timing
  • depth of each breath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PSV is

A
  • patient triggered
  • pressure limited
  • flow cycled
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PSV allows the RT to adjust the

A

ventilatory workload for each spontaneous breath to enhance endurance conditioning of respiratory muscles w/o causing fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When PSV is reduced to about 5 cm H20, the pressure level is not

A

high enough to contribute significantly to ventilatory support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The weaning process started when the pt was able to breathe spontaneously for brief periods w/o ventilatory support and the criteria for weaning had met

A

T- Piece Weaning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T-piece system includes

A

a heated humidifier w/ a large reservoir. The humidifier is connected to a blended gas source (at least 10 L/min of FiO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the humidified gas source connected to?

A

a T-piece (Briggs adapter) w/ large-bore tubing which is attached to the pt’s ET

17
Q

Pt less like to tolerate T-piece weaning include (4)

A
  • underlying heart disease
  • severe muscle weakness
  • pts who are inclined to panic b/c of psychological problems
  • preexisting chronic lung conditions
18
Q

What pt population will benefit from a trache

A
  • pt who requires high levels of sedation to tolerate ETs
  • pts w/ marginal respiratory mechanics and who may have tachypnea as a result
  • pt’s who have lower resistance, may reduce the risk for muscle overload
  • pt who may gain psychological benefits from the ability to eat, talk, and have greater mobility
  • pts who increased mobility may aid physical therapy
  • The most important beneficial outcome of a trache is the potential to facilitate discontinuation of mechanical ventilatory support
19
Q

Box 20.13 Criteria for instituting NIV after failure to wean from invasive MV in extubated pts

A
  • Resolution of problems leading to respiratory failure
  • Ability to tolerate a spontaneous breathing trial for 10 to 15 min
  • Strong cough reflex
  • Hemodynamic stability
  • Low FiO2 requirements
  • Functioning gastrointestinal tract
  • Optimum nutritional status
20
Q

What are the measurements used to evaluate a pt’s ventilatory muscle function before weaning and extubation? (5)

A
  • VC
  • Ve
  • RR
  • Spontaneous Vt
  • RSBI
21
Q

The following three key points have evolved as criteria for weaning:

A
  1. The problem that caused the pt to require ventilation must be resolved
  2. Certain measurable criteria should be assessed to help establish a pt’s readiness for discontinuation
  3. An SBT should be performed to firmly establish readiness for weaning
22
Q

What are examples of pts who need temporary vent support and who do not require a gradual weaning process that can be disconnected within a few hours or days? (3)

A
  • Post-op, recovering from anesthesia
  • Treatment of uncomplicated drug overdose
  • Exacerbation of asthma
23
Q

Vent support and artificial airway should be removed ASAP to avoid? (4)

A
  • VAP
  • airway trauma from ETT
  • unnecessary sedation
  • ventilatory- induced injury
24
Q

Premature withdraw of vent support or airway can result in (4)

A
  • Ventilatory muscle fatigue
  • Compromised gas exchange
  • Loss of airway protection
  • High mortality rate
25
Q

Standard 3 for weaning

A
  • RSBI
  • VC
  • NIF

Topics of Respiratory Care (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions