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RET 2934 > Chapter 11 > Flashcards

Chapter 11 Flashcards

1
Q

Pressure controlled ventilation is used for adults
with what lung condition?

A

ARDS

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2
Q

on delivered VT in a neonate receiving pressure-
limited ventilation?

A

Decrease VT

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3
Q

for weaning so that airway resistance is

A

5-10cmH2O

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4
Q

As the oxygenation status of a patient worsens
while using an oxygen mask at what point

A

Patient who cannot maintain normal limits
using a 50 to 60% oxygen mask and has normal

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5
Q

should CPAP be started?

A

or low CO2 levels.

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6
Q

How is minute volume calculated?

A

VT x RR

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7
Q

On the initial ventilator set up at what range
should the ventilator rate be?

A

10 to 16

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8
Q

How should the appropriate ventilator title
volume be determined?

A

6 to 8 mL/kg of IBW

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9
Q

List indications for the use of PEEP?

A

Decreased FRC

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10
Q

List 4 hazards of PEEP?

A

Decreased venous return
Decrease cardiac output

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11
Q

Define optimal PEEP?

A

The level of peep that improves compliance
without cardiac compromise

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12
Q

determined that cardiac output has been

A

Decreased PVO2 < 35 and drop in BP

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13
Q

How may the ventilator low pressure alarm be

A

Ruptured ET tube cuff

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14
Q

activated?

A

Inadequate cuff pressure

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15
Q

List ways that the vent high pressure alarm may
be activated?

A

Decreased compliance
Increased airway resistance

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16
Q

How should the high pressure alarm be set?

A

10 above PIP

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17
Q

List some factors that affect airway resistance?

A

Condensation in the vent circuit

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18
Q

What is normal PeTCO2?

A

35-45

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19
Q

List four conditions that result in decreased

A

Apnea

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20
Q

PeTCO2?

A

Total airway obstruction

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21
Q

List 2 conditions that result in increased

A

Hypoventilation

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22
Q

PeTCO2?

A

Hyperthermia

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23
Q

List criteria that indicate mechanical ventilatory
assistance is necessary?

A

VC < 10-15 (normal 65-75)
A-a gradient > 450 with use of 100% FiO2
(normal 25-65)

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24
Q

List complications of mechanical ventilation?

A

Pulmonary O2 toxicity

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25
Q

List some conditions that result in decreased

A

Atelectasis

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26
Q

compliance?

A

Air-trapping

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27
Q

What is indicated if PIP pressures are increased
but Pplat is not?

A

Increased static compliance

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28
Q

List 3 advantages of high frequency ventilation?

A

Reduced risk of cardiac side effects

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29
Q

On a volume time waveform, if tracing does not
return to baseline, what does this indicate?

A

Air-trapping (auto PEEP)

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30
Q

What are some indications for mechanical

A

Acute ventilatory failure

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31
Q

ventilation?

A

Impending acute ventilatory failure

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32
Q

What is acute ventilatory failure?

A

PaCO2 > 50 mmHg and pH < 7.30

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33
Q

What might the rate be for impending acute
ventilatory failure?

A

30-40/min

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34
Q

In a patient with neuromuscular disease what
should be monitored?

A

Muscle involvement

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35
Q

How do we do parameters?

A

We measure the MIP and the VC to help
determine muscle strength

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36
Q

A patient who’s on an O2 mask of 50-60% but is
not oxygenated enough is experiencing what?

A

Large intrapulmonary shunt

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37
Q

What are some common criteria for initiation of
mechanical ventilation?

A

VC < 10-15
P(A-a)O2 > 450 with the use of 100% O2;
(normal 25-65)

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38
Q

normal for ambient conditions and the patient’s

A

Hypoventilation

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39
Q

When the PaO2 is low and the P(A-a)O2 is high
for ambient conditions and the patient’s age,
hypoxemia is most likely the result of…

A

ventilation/perfusion (V/Q) mismatch
diffusion defect
shunting
In this situation, the patient may be
hyperventilating to compensate for the
hypoxemia

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40
Q

What is dead space normal ratio?

A

60% (25-35)

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41
Q

What is the formula for VD?

A

PaCO2 -PeCO2/PaCO2

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42
Q

What MIP should the patient obtain and what is

A

-20

43
Q

the normal?

A

-50 to -100

44
Q

What are some lung protective strategies for
ARDS?

A

Maintain VT between 6-8mL/kg of IBW
Maintenance of plateau pressure < 30

45
Q

What is the initial IPAP setting?

A

10-15

46
Q

What is the initial EPAP setting?

A

4-5

47
Q

What is the difference between IPAP and EPAP?

A

Pressure Support

48
Q

A patient triggered, pressure limited, flow cycled
breath is augmented with what?

A

SIMV & CPAP

49
Q

How much pressure support is needed to
overcome tubing resistance.

A

5-10

50
Q

The A/C mode is what?

A

Patient triggered, & time triggered

51
Q

Patients who cannot maintain O2 sats of 50-
60% must be placed on what?

A

CPAP

52
Q

CPAP is also indicated for what patients?

A

They gain benefit from the positive airway
pressure

53
Q

In volume controlled ventilation increased VT
increases _____?

A

Ti

54
Q

Exhaled VT is measured by what?

A

Respirometer placed between ETT and
vent Y adapter on exhalation valve

55
Q

To most accurately measure the VT delivered by
the vent what should you do?

A

Place a respirometer directly on the vent outlet.

56
Q

What is the normal rate for ARDS pt?

A

20-35

57
Q

What is normal rate for COPD pt?

A

10-12

58
Q

What is the formula for I:E ratio?

A

I:E ratio = Inspiratory flow rate (L/min)/MVe
(L/min) - 1 (for inspiration)

59
Q

What is the formula for I-time?

A

1 time = TCT/ sum of I:E ratio parts

60
Q

What is normal PvO2?

A

35-45

61
Q

A PvO2 < 35 indicates what?

A

decreased cardiac output

62
Q

If the PvO2 decreases after the initiation of PEEP,

A

Reduced venous return and cardiac output

63
Q

it is an indicator of what?

A

caused by PEEP.

64
Q

The PvO2 value indicates what?

A

The adequacy of tissue oxygenation.

65
Q

PaO2 does not determine what?

A

Optimal PEEP

66
Q

What is the formula for dynamic compliance?

A

VT/PIP-PEEP

67
Q

What is the formula for static compliance?

A

VT/Pplat-PEEP

68
Q

What is the formula for OI?

A

FiO2 x MAP/PaO2 x 100

69
Q

Generally, an OI less than _____ is acceptable?

A

5

70
Q

An OI index of 10 to 20 indicates what?

A

Impaired oxygenation

71
Q

An OI > 25 indicates what?

A

Severe oxygenation issues with poor clinical
outcomes

72
Q

You should maintain the CO2 between 25 and
30 to reduce what?

A

ICP by vasoconstriction of cerebral vessels.

73
Q

ICP should be maintained below what?

A

15mmHg

74
Q

What is normal ICP?

A

< 10mmHg

75
Q

To decrease CO2 level you should always
increase what?

A

Ventilator rate

76
Q

What should the respiratory rate be in order to
wean?

A

< 35

77
Q

What is HFV?

A

A type of mechanical ventilation that utilizes
high respiratory frequencies usually specified in

78
Q

Decreasing the frequency or hertz for HFV
increases what?

A

Delivered VT which increase PaO2

79
Q

To decrease the CO2, the amplitude or strength
of oscillation should be____?

A

Increased

80
Q

Flow settings range from_____?

A

10-20L/min

81
Q

What is the formula for desired FiO2?

A

PaO2 (desired)x FIO2 (current)/ PaO2 (current)

82
Q

What is the formula for desired rate?

A

Rate (current) x PaCO2 (current)/ PaCO2
(desired)

83
Q

What is the formula for desired Mve?

A

Ve(current) x PaCO2 (current)/ PaCO2 (desired)

84
Q

What is the formula for desired alveolar MVe?

A

Va (current) x PaCO2 (current)/ PaCO2 desired

85
Q

What is the formula for alveolar ventilation?

A

VT-VDxRR

86
Q

What is the formula for desired VT?

A

VT(current) x PaCO2 (current)/ PaCO2 (desired)

87
Q

What wave form is this?

A

Changes in airway resistance and
compliance do not change the

88
Q

What wave form is this?

A

increased airway resistance,
because airway turbulence

89
Q

What wave form is this?

A

The flow never decreases more

90
Q

What wave form is this?

A

turbulence to flow in the
beginning of inspiration,

91
Q

What wave form is this?

A

Volume wave

92
Q

What does this wave form indicate?

A

Air trapping because the tracing
did not go back to baseline.

93
Q

What type of wave form is this?

A

Pressure waveform

94
Q

What does this waveform indicate?

A

Obstruction

95
Q

What does this waveform show?

A

Pressure with an assisted breath

96
Q

What type of wave form is this?

A

Flow wave form with air trapping

97
Q

how soon will VAP occur?

A

Within the first two weeks of mechanical
ventilation

98
Q

What is the mortality rate for VAP?

A

5 to 40%

99
Q

What are some common pathogens responsible

A

Escherichia coli

100
Q

for VAP?

A

Serratia marccesans

101
Q

What are the symptoms for VAP?

A
  1. Increased white blood cell count
    (.11,000/mL)
102
Q

For VAP how do you position the patient?

A

Semi-Fowler (30-45 degrees)

103
Q

What are some antibiotics used to treat VAP?

A

Tobramycin
Cefepime

RET 2934 (13 decks)

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