Brainscape's Knowledge GenomeTM

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


See full index

131 > chapter 5 pb > Flashcards

chapter 5 pb Flashcards

1
Q

Your patient has amyotrophic lateral sclerosis (Lou Gehrig’s disease) and is being released from the hospital to be taken care of at home. What form of ventilation would you suggest for this patient?

A

noninvasive ventilation

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

Your patient has amyotrophic lateral sclerosis (Lou Gehrig’s disease) and is being released from the hospital to be taken care of at home. What form of ventilation would you suggest for this patient?

A

noninvasive ventilation

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

Your patient has post-polio syndrome and is having problems breathing. What would you suggest?

A

NPV, most often a Chest Cuiras.

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

A patient can be connected to a positive-pressure ventilator by what two commonly used methods.

A

positive-pressure mask

an artificial airway

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

What does CPAP stand for?

A

Continuous positive airway pressure

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

CPAP and NPPV are most commonly administered by what means?

A

a face or nasal mask

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

CPAP has been shown to be an effective method to improve what aspect of the patients respiratory efforts?

A

oxygenation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diseases such as COPD and (asthma exacerbations) Asthma often cause air trapping. What does air-trapping do to the FRC?

A

Increases

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

You are trying to wean your COPD patient off the ventilator. You have him on a pressure trigger of -2. You notice the patient unable to trigger. What would you do?

A

Perform an exhalation hold maneuver to determine the patients auto-peep.

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

You determine your COPD patient has auto-peep and is unable to trigger. How do you fix this?

A

You determine how much auto-peep the patient has and subtract it from the patients given PEEP. Then add the difference to the given peep.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does increased RAW affect the flow

A

Flow will become limited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How would you set Mask CPAP to reduce diaphragmatic work, dyspnea, and improve gas exchange if the patient’s issued was caused by auto-peep?

A

80% to 90% of the measured auto-PEEP

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

Your patient has acute cardiogenic pulmonary edema, RR > 35 You notice diaphoresis, the use of accessory muscles. pH 7.44, PaCO2 26, PO2 75. What would you do?

A

NIV, BiPAP. Patient is impending respiratory failure. Intervene before pt gets worse!

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

How much can NIV reduce the need for Intubation?

A

60-75%

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

Two types of ventilators can be used to provide NIV

A

BiPAP , Critical-care ventilators that have a variety of available modes, including in many cases NIV.

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

What mode is BiPAP

A

Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the Trigger for BiPAP.

A

Pressure Trigger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the Cycle for BiPAP

A

Flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Do you have to heavily sedate a patient on NIV

A

No. That is considered one of the benefits of using NIV over PPV.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does NIV preserve?

A

airway defense, speech, and swallowing mechanisms.

This is because the patient does not have an artificial airway down their throat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

FVS has the energy to provide normal PaCO2 in the patient. What kind of breathing is this?

A

Eucapnic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In FVS what kind of Frequency do you set for the patient?

A

High, 8 or more.

High being in regards to PSV, (6/m or less)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Is A/C FVS or PSV?

A

FSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why are PSV rates set 6/min or less

A

To allow the patient to take part in the WOB.

This helps prevent diaphragm atrophy, and aids in efforts to help wean the patient off the vent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

PSV (Partial support ventilation) modes include?

A

SIMV, IMV, PSV(pressure support ventilation), MMV, PAV

proportional assist ventilation (PAV),
mandatory minute volume (MMV)

Don’t feel bad about not knowing those ^

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Your already intubated patient has ventilatory muscle fatigue and HIGH wob. Would you use Partial support ventilation?

A

No.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When treating patients with acute respiratory failure, the initial goal of mechanical ventilation is to

A

is to supply all the necessary ventilation.

This gives the patient time to rest their ventilatory muscles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

A patient receives a breath that is patient triggered, volume-targeted, and time cycled. What type of breath is it?

A

A/C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

the patient controls the timing and the tidal volume. The volume or pressure (or both) delivered is not preset by the clinician but rather is based on patient demand and the patient’s lung characteristics.

A

spontaneous breaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

characteristics of both mandatory and spontaneous breaths, all or part of the breath is generated by the ventilator, which does part of the WOB for the patient.

A

assisted breaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

If the airway pressure rises above baseline during inspiration, the breath is

A

assisted

For example, during the pressure support mode the clinician sets the target pressure but the patient initiates the breath (patient triggered). The ventilator delivers the set pressure above baseline pressure to assist the patient’s breathing effort.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Reductions in lung or chest wall compliance will do what do the patients PEAK and PLAT pressure?

A

higher peak and plateau pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Your patient has Emphysema and is on A/C what levels would you expect their peak and plat to be?

A

Lower

increased compliance produces lower peak and plateau pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Your patient has bronchitis with thick secretions in his airway. What levels would you expect their peak pressure to be?

A

High

Increased airway resistance produces a higher peak pressure; reductions in airways resistance produce lower peak pressures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

You want your patient to have a higher PEAK pressure. What kind of flow pattern would you give them?

A

Peak pressure is higher with a constant flow

and lower with a decelerating flow pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How will a decelerating flow pattern affect MAP

A

Increases it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What pattern generates the lowest mean airway pressure

A

Constant flow pattern.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

High volumes do what to peak and plat pressure?

A

produce higher peak and plateau pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What does high level of peep effect?

A

Increasing PEEP increases the PEAK and MEAN pressures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Increases in auto-PEEP increase

A

the peak inspiratory pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Definition: A situation in which the patient breathing pattern and ventilator breathing pattern are not harmonious

A

Patient-ventilator asynchrony

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

It has been suggested that limiting the peak pressure spares more normal areas of the lungs from being?

A

overinflation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What control mode is said to be a component of lung protective strategies

A

Pressure-control modes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

You ARDS patient is on A/C. Their PLAT pressure is 40 mmgh, and you notice they are diaphoretic. You can not decrease their VT anymore. What should you do?

A

Switch to a Pressure Limit

When the patient makes an inspiratory effort, the negative pressure produced at the upper airway causes the ventilator to vary gas flow to match the patient’s need. This helps reduce WOB, particularly in patients with ARDS, compared with volume-control ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

If a patient actively participates in inspiration, how will that effect volume delivery?

A

Increase volume delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

if flow returns to zero before inspiration ends, further increases in TI can decrease volume delivery if adequate time is not provided for exhalation. WHY?

A

Because the patient would not be able to exhale residual volume, and this would not allow more volume to be delivered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

A physician wants to ensure that a patient’s PaCO2 remains at the person’s normal level of 50 mm Hg. Would volume-control ventilation or pressure-control ventilation best meet this requirement?

A

Volume Control

When it is desirable to target PaCO2, volume-control ventilation may be used because it can guarantee volume delivery and minute ventilation. With pressure-control ventilation changes in lung compliance or Raw will result in changes in VT which can ultimately affect PaCO2.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Ventilating pressure can become very high in patients with acute respiratory distress syndrome. To prevent excessive pressures, what independent variable would be most appropriate, volume or pressure?

A

Pressure-control ventilation should be used when the goal is to avoid high pressures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Patients who are obtunded because of drugs, cerebral malfunction, spinal cord or phrenic nerve injury, or motor nerve paralysis may be unable to make voluntary efforts. What Mode would you select?

A

controlled ventilation

50
Q

You’re patient has a high ICP >15mmhg. What would you suggest?

A

Use volume-control

(iatrogenic) hyperventilation occasionally is used to induce respiratory alkalosis to reduce ICP.

Also has been used in Reye syndrome and after neurosurgery but is controversial.

51
Q

if an inspiratory effort shows a pressure reading of −3 to −5 cm H2O or more below the baseline before an inspiration is initiated, what does this indicate about the trigger sensitivity?

A

the machine is too insensitive to the patient’s effort, and WOB increases

In this case the sensitivity level is set too low and must be increased

52
Q

Definition: is the time increment between when a patient effort is detected and when flow from the ventilator to the patient begins

A

Response Time

53
Q

in VC-CMV. If the pressure does not rise smoothly and rapidly to peak during inspiration, what does this tell you?

A

flow is inadequate

A concave pressure curve indicates active inspiration. Flow must be increased until the patient’s demand is met and the curve assumes a slightly convex shape

54
Q

in VC-CMV inspiration is active and the set gas flow does not match the patient’s inspiratory flow demand. How would you detect this?

A

Clinically, this can be observed by watching the pressure manometer or the pressure-time curve on the graphic display.

55
Q

PC-CMV - Several studies have shown that the decelerating ramp flow curve does what for the patient?

A

improve gas distribution and allows the patient to vary inspiratory gas flow during spontaneous breathing efforts

56
Q

Your patient has ARDS patient is not ventilating due to air trapping. You have tried with VC-CMV with PEEP or PC-CMV with PEEP. You have no ventilator with APRV. What should you do?

A

pressure-control inverse ratio ventilation. PCRIV

it has been shown that a longer TI provides better oxygenation to some patients by increasing mean airway pressure.

57
Q

Your patient has ARDS patient is not ventilating due to air trapping. You have tried with VC-CMV with PEEP or PC-CMV with PEEP. You have no ventilator with APRV. What should you do?

A

pressure-control inverse ratio ventilation. PCRIV

58
Q

Your patient has post-polio syndrome and is having problems breathing. What would you suggest?

A

NPV, most often a Chest Cuiras.

59
Q

A patient can be connected to a positive-pressure ventilator by what two commonly used methods.

A

positive-pressure mask

an artificial airway

60
Q

What does CPAP stand for?

A

Continuous positive airway pressure

61
Q

CPAP and NPPV are most commonly administered by what means?

A

a face or nasal mask

62
Q

CPAP has been shown to be an effective method to improve what aspect of the patients respiratory efforts?

A

oxygenation.

63
Q

Diseases such as COPD and (asthma exacerbations) Asthma often cause air trapping. What does air-trapping do to the FRC?

A

Increases

64
Q

You are trying to wean your COPD patient off the ventilator. You have him on a pressure trigger of -2. You notice the patient unable to trigger. What would you do?

A

Perform an exhalation hold maneuver to determine the patients auto-peep.

65
Q

You determine your COPD patient has auto-peep and is unable to trigger. How do you fix this?

A

You determine how much auto-peep the patient has and subtract it from the patients given PEEP. Then add the difference to the given peep.

66
Q

How does increased RAW affect the flow

A

Flow will become limited

67
Q

How would you set Mask CPAP to reduce diaphragmatic work, dyspnea, and improve gas exchange if the patient’s issued was caused by auto-peep?

A

80% to 90% of the measured auto-PEEP

68
Q

Your patient has acute cardiogenic pulmonary edema, RR > 35 You notice diaphoresis, the use of accessory muscles. pH 7.44, PaCO2 26, PO2 75. What would you do?

A

NIV, BiPAP. Patient is impending respiratory failure. Intervene before pt gets worse!

69
Q

How much can NIV reduce the need for Intubation?

A

60-75%

70
Q

Two types of ventilators can be used to provide NIV

A

BiPAP , Critical-care ventilators that have a variety of available modes, including in many cases NIV.

71
Q

What mode is BiPAP

A

Pressure

72
Q

What is the Trigger for BiPAP.

A

Pressure Trigger

73
Q

What is the Cycle for BiPAP

A

Flow

74
Q

Do you have to heavily sedate a patient on NIV

A

No. That is considered one of the benefits of using NIV over PPV.

75
Q

What does NIV preserve?

A

airway defense, speech, and swallowing mechanisms.

This is because the patient does not have an artificial airway down their throat.

76
Q

FVS has the energy to provide normal PaCO2 in the patient. What kind of breathing is this?

A

Eucapnic

77
Q

In FVS what kind of Frequency do you set for the patient?

A

High, 8 or more.

High being in regards to PSV, (6/m or less)

78
Q

Is A/C FVS or PSV?

A

FSV

79
Q

Why are PSV rates set 6/min or less

A

To allow the patient to take part in the WOB.

This helps prevent diaphragm atrophy, and aids in efforts to help wean the patient off the vent.

80
Q

PSV (Partial support ventilation) modes include?

A

SIMV, IMV, PSV(pressure support ventilation), MMV, PAV

proportional assist ventilation (PAV),
mandatory minute volume (MMV)

Don’t feel bad about not knowing those ^

81
Q

Your already intubated patient has ventilatory muscle fatigue and HIGH wob. Would you use Partial support ventilation?

A

No.

82
Q

When treating patients with acute respiratory failure, the initial goal of mechanical ventilation is to

A

is to supply all the necessary ventilation.

This gives the patient time to rest their ventilatory muscles.

83
Q

A patient receives a breath that is patient triggered, volume-targeted, and time cycled. What type of breath is it?

A

A/C

84
Q

the patient controls the timing and the tidal volume. The volume or pressure (or both) delivered is not preset by the clinician but rather is based on patient demand and the patient’s lung characteristics.

A

spontaneous breaths

85
Q

characteristics of both mandatory and spontaneous breaths, all or part of the breath is generated by the ventilator, which does part of the WOB for the patient.

A

assisted breaths

86
Q

If the airway pressure rises above baseline during inspiration, the breath is

A

assisted

For example, during the pressure support mode the clinician sets the target pressure but the patient initiates the breath (patient triggered). The ventilator delivers the set pressure above baseline pressure to assist the patient’s breathing effort.

87
Q

Reductions in lung or chest wall compliance will do what do the patients PEAK and PLAT pressure?

A

higher peak and plateau pressures

88
Q

Your patient has Emphysema and is on A/C what levels would you expect their peak and plat to be?

A

Lower

increased compliance produces lower peak and plateau pressures

89
Q

Your patient has bronchitis with thick secretions in his airway. What levels would you expect their peak pressure to be?

A

High

Increased airway resistance produces a higher peak pressure; reductions in airways resistance produce lower peak pressures.

90
Q

You want your patient to have a higher PEAK pressure. What kind of flow pattern would you give them?

A

Peak pressure is higher with a constant flow

and lower with a decelerating flow pattern

91
Q

How will a decelerating flow pattern affect MAP

A

Increases it.

92
Q

What pattern generates the lowest mean airway pressure

A

Constant flow pattern.

93
Q

High volumes do what to peak and plat pressure?

A

produce higher peak and plateau pressures

94
Q

What does high level of peep effect?

A

Increasing PEEP increases the PEAK and MEAN pressures.

95
Q

Increases in auto-PEEP increase

A

the peak inspiratory pressure.

96
Q

Definition: A situation in which the patient breathing pattern and ventilator breathing pattern are not harmonious

A

Patient-ventilator asynchrony

97
Q

It has been suggested that limiting the peak pressure spares more normal areas of the lungs from being?

A

overinflation

98
Q

What control mode is said to be a component of lung protective strategies

A

Pressure-control modes

99
Q

You ARDS patient is on A/C. Their PLAT pressure is 40 mmgh, and you notice they are diaphoretic. You can not decrease their VT anymore. What should you do?

A

Switch to a Pressure Limit

When the patient makes an inspiratory effort, the negative pressure produced at the upper airway causes the ventilator to vary gas flow to match the patient’s need. This helps reduce WOB, particularly in patients with ARDS, compared with volume-control ventilation

100
Q

If a patient actively participates in inspiration, how will that effect volume delivery?

A

Increase volume delivery.

101
Q

if flow returns to zero before inspiration ends, further increases in TI can decrease volume delivery if adequate time is not provided for exhalation. WHY?

A

Because the patient would not be able to exhale residual volume, and this would not allow more volume to be delivered.

102
Q

A physician wants to ensure that a patient’s PaCO2 remains at the person’s normal level of 50 mm Hg. Would volume-control ventilation or pressure-control ventilation best meet this requirement?

A

Volume Control

When it is desirable to target PaCO2, volume-control ventilation may be used because it can guarantee volume delivery and minute ventilation. With pressure-control ventilation changes in lung compliance or Raw will result in changes in VT which can ultimately affect PaCO2.

103
Q

Ventilating pressure can become very high in patients with acute respiratory distress syndrome. To prevent excessive pressures, what independent variable would be most appropriate, volume or pressure?

A

Pressure-control ventilation should be used when the goal is to avoid high pressures.

104
Q

Patients who are obtunded because of drugs, cerebral malfunction, spinal cord or phrenic nerve injury, or motor nerve paralysis may be unable to make voluntary efforts. What Mode would you select?

A

controlled ventilation

105
Q

You’re patient has a high ICP >15mmhg. What would you suggest?

A

Use volume-control

(iatrogenic) hyperventilation occasionally is used to induce respiratory alkalosis to reduce ICP.

Also has been used in Reye syndrome and after neurosurgery but is controversial.

106
Q

if an inspiratory effort shows a pressure reading of −3 to −5 cm H2O or more below the baseline before an inspiration is initiated, what does this indicate about the trigger sensitivity?

A

the machine is too insensitive to the patient’s effort, and WOB increases

In this case the sensitivity level is set too low and must be increased

107
Q

Definition: is the time increment between when a patient effort is detected and when flow from the ventilator to the patient begins

A

Response Time

108
Q

in VC-CMV. If the pressure does not rise smoothly and rapidly to peak during inspiration, what does this tell you?

A

flow is inadequate

A concave pressure curve indicates active inspiration. Flow must be increased until the patient’s demand is met and the curve assumes a slightly convex shape

109
Q

in VC-CMV inspiration is active and the set gas flow does not match the patient’s inspiratory flow demand. How would you detect this?

A

Clinically, this can be observed by watching the pressure manometer or the pressure-time curve on the graphic display.

110
Q

PC-CMV - Several studies have shown that the decelerating ramp flow curve does what for the patient?

A

improve gas distribution and allows the patient to vary inspiratory gas flow during spontaneous breathing efforts

111
Q

The maximum pressure limit during PC-CMV should be set at about how much above the target

A

+10 cmh20

because the set pressure level is not the maximum pressure possible on most ventilators

112
Q

Your patient has ARDS patient is not ventilating due to air trapping. You have tried with VC-CMV with PEEP or PC-CMV with PEEP. You have no ventilator with APRV. What should you do?

A

pressure-control inverse ratio ventilation. PCRIV

113
Q

The patient can breathe spontaneously through a ventilator circuit without receiving any mandatory breaths, that mimics having the patient’s endotracheal tube connected to a Briggs adapter and a humidified oxygen source using large-bore tubing. What is this method called?

A

What is the T-piece method.

114
Q

Your patient has a shunt, and a PF ratio of 285. What would you suggest to help this patient?

A

CPAP

115
Q

What type of ventilation would you try first with a patient with COPD and right lower-lobe pneumonia with respiratory acidosis and increased WOB

A

NIV

116
Q

What would you use for a trauma victim with crushed chest injuries

A

VC-CMV

you can control VT, and help reduce the chances of over-distention

117
Q

A patient with hiccups is ventilated in the VC-CMV mode. Every time he hiccups, he triggers the ventilator. What would you recommend?

A

VC-SIMV

118
Q

A patient with severe tetanus needs ventilatory support. Which of the following modes would you recommend?

A

Paralyze and sedate the patient; control ventilation using volume control (VC-CMV)

119
Q

In which of these four circumstances is it appropriate to select PSV?

1As a method of weaning
2To overcome the WOB through the endotracheal tube and the circuit
3For patients on PSV using the SIMV mode
4For long-term patient support

A

1,2,3,4

120
Q

A patient on PC-CMV has widely fluctuating changes in Raw because of secretions and bronchospasm. The low tidal volume alarm is activated every few hours; the set pressure is 18 cm H2O. The physician is concerned about consistency in ventilation. What would you recommend?

A

Switch to VC-CMV

121
Q

A patient with acute respiratory distress syndrome has a Pplateau of 30 cm H2O and a peak inspiratory pressure of 39 cm H2O. VT is 0.7 on VC-CMV. The decision is made to switch to PC-CMV (PCV) to keep pressures at a safe level. What pressure would you set and why?

A

pressure of 30 cm H2O to start would provide approximately the same VT delivery in VC-CMV and would be a safe starting point. This patient requires high pressures for delivery of VT. Palv should be kept below 30 cm H2O.

122
Q

A patient receiving VC-CMV is actively triggering every breath. The respiratory therapist notices that the patient is using accessory muscles (sternocleidomastoid muscles) during the entire inspiratory phase. The therapist also sees that the pressure-time curve has a negative deflection before inspiration and has a concave appearance during inspiration. What is the apparent problem in this situation?

A

the ventilator has a fixed flow rate and pattern during inspiration that is not adequate for the patient’s needs. The therapist should increase the inspiratory flow and see whether this solves the problem. Another solution is to switch to a newer generation ventilator that allows additional flow on demand during VC-CMV.

131 (4 decks)

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