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chapter 6 pb Flashcards

1
Q

The most common reason for instituting mechanical ventilation is

A

to treat respiratory distress in patients who are unable to achieve effective gas exchange

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2
Q

What is the primary goal of volume-controlled continuous mandatory ventilation (VC-CMV

A

To achieve a minute ventilation to match the patients metabolic needs.

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3
Q

T/F Metabolic rate is in-directly related to body mass and surface area.

A

False

Metabolic rate is DIRECTLY related to body mass and surface area.

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4
Q

Indirect calorimetry uses what measurements to estimate energy expenditure

A

inspired and expired O2 and CO2

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5
Q

BSA constant used for Men?

A

4

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6
Q

BSA constant used for Women

A

3.5

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7
Q

Formula for (F)

A

F=Ve/VT

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8
Q

To overcome system resistance in the spontaneous mode what would you do?

A

Set PIP below plat pressure.

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9
Q

What are some abnormal conditions that effect Ve

A

presence of hypothermia or hyperthermia, hypermetabolism, and metabolic acidosis

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10
Q

Your patient has developed a pulmonary emboli, how should you adjust their Ve?

A

Increase it.

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11
Q

Your patient is a male, 5’9 and has a BSA of 2.2. They have a temperature of 38 degrees celcius. What should their MV be? and what should their F be set to?

A

Ve =9.68 l/m F=17

2.2 x 4= 8.8
9%+8.8= 9.6

106 + 6(69-60)= 160
160/2.2= 72.72
72.72x8= 582ml
9.68/0.582= 17

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12
Q

With every degree over 99F you would add how much % to your BSA?

A

5%

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13
Q

with metabolic alkalosis you would add how much % to your BSA?

A

20%

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14
Q

35C-37C, what changes do you make to bsa?

A

bsa - 9%

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15
Q

With every degree over 37F you would add how much % to your BSA?

A

9%

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16
Q

Patients with restrictive disease how would you want to set the VT

A

Lower. and set higher RR

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17
Q

What should you add to a patients vent settings if the VT is low

A

peep

low VT can cause atelectasis.

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18
Q

If you have low VT and high peeps what’s an important factor to consider?

A

keep PLAT below 30cmh20

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19
Q

The patients VT is set at 500 Ct is 3, and there peak is 40. How much VT are they loosing? and what should you do?

A

Vt lost=120
Should increase VT to 620.

3x40=120
500-120=380

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20
Q

If the patients tubing was cold, how would that effect the Ct?

A

Decrease it.

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21
Q

defined as the volume of gas that is rebreathed during ventilation

A

Mechanical Dead space

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22
Q

In contrast, the addition of a Y-connector between the ventilator and the patient may add about how much dead space?

A

75 mL

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23
Q

HME can add up to how much dead space?

A

20-90 ml

depending on where it’s at on the patient. inserted between the endotracheal tube and Y-connector.

high volume HME can increase it to 90ml

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24
Q

Even though questionable, what pathophysiological condition would an RT add mechanical dead space?

A

Neuromuscular disorders.

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25
Q

what will happen to gas distribution and peak pressures with high flows shortened TI

A

higher peak pressures and poor gas distribution

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26
Q

slower flows may reduce peak pressures, improve gas distribution, and increase PAW, at the expense of increasing TI. What harm can this cause?

A

This can shortens Etime and may cause air-trapping. Longer I times can cause cardiovascular effects.

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27
Q

What kind of patients would benefit from longer TI?

A

ARDS patients

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28
Q

What kind of patients would benefit from shorter TI?

A

COPD

Shorter I-times generate faster flow. This allows the E time to become longer, and helps prevent air trapping.

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29
Q

What kind of flow demands would a postoperative patients recovering from anesthesia

A

Low flow demands

30
Q

What kind of flow demands would a young adult with pneumonia and a strong hypoxemic drive

A

high flow demands

31
Q

What flow pattern provides the shortest TI of all the available flow patterns with an equivalent peak flow rate setting.

A

Constant flow pattern (square/rectangle)

32
Q

Which flow pattern produces a tapered flow at the end of inspiratory phase

A

SINE

33
Q

With patients with hypoxemia and low lung compliance, what wave form would you suggest?

A

the descending flow pattern may be beneficial by keeping peak pressures low and high
PAW, and improving gas distribution

34
Q

In patients with high Raw, what wave form would you suggest?

A

the descending pattern is more likely to deliver a set VT at a lower pressure and provide for better distribution of air through the lung than a constant or an accelerating flow.26–29

35
Q

Consider a situation where a patient’s PaO2 falls and his PaCO2 rises while his Ve increases. What are some reasons that can account for this?

A

the presence of auto-PEEP, poor ventilation-to-perfusion (V/Q) matching in the nonhomogeneous lung, and changes in venous return

36
Q

What frequently happens to FRC when the patient is intubated or placed in a supine position

A

Decreases.

37
Q

Pressure-support ventilation

Trigger/Cycle?

A

Patient/Flow

38
Q

Pressure-control continuous mandatory ventilation

Trigger/Cycle?

A

Time or Patient/Time

39
Q

Pressure-regulated Volume control

Trigger/Cycle?

A

Time/Time

40
Q

Volume support

Trigger/Cycle?

A

Time or Patient/Flow

41
Q

To help preserve FRC in COPD what should you do?

A

Give low peep!

42
Q

In a pressure mode, what are two ways you determine how much PIP is needed to gain the desired VT?

A

Switch to a Volume-control breath mode, and set the VT you want to establish. Measure the PLAT pressure, and baseline pressure. Going by the same base-line set the PIP to the PLAT.

OR you can always start low (10-15), and keep going up till you get what you want…

43
Q

A patient on PSV is not getting enough pressure support. What would you be able to observe?

A

the patient’s use of the sternocleidomastoid muscle during inspiration. Increased use of this accessory muscle of inspiration may indicate that the level of PSV is inadequate

44
Q

A patient on PC-CMV needs a VT of 650. He is set on 10 cmh20 and his VT is 450. What EXACTLY would you increase the pressure to?

A

set it to 14 cmh20

450/10=45
650/45=14.444

45
Q

The goal of adjusting PSV is threefold.

What is it?

A
  1. To help increase VT (4-8 mL/kg)
  2. To decrease respiratory rate (to <30 breaths/min)
  3. To decrease the WOB associated with breathing through an artificial airway
46
Q

On PSV, patients with lung disease, what levels of pressure are typically used to compensate for additional work associated with breathing through a tube and ventilator system.

A

8 to 14 cm H2O

47
Q

on PSV, patients without lung disease, how much pressure should be adequate to compensate for the additional work of breathing

A

about 5 cm H20

48
Q

T/F When patients with COPD are ventilated with PSV, it may be prudent to use graphic displays of pressure and flow versus time to monitor their status

A

TRUE

These patients are known to have active short inspirations. In addition, if the patient begins to exhale actively during flow delivery from the ventilator, the flow may not drop to the necessary cycling value. Consequently, the ventilator breath may not end as normally expected, resulting in a sudden rise in the pressure curve at the end of the breath

49
Q

A cycle criteria of what % of peak flow is an appropriate starting point for a patient with COPD

A

40%

50
Q

Using a low-flow cycling value of what % may be appropriate for patients with restrictive disorders

A

10%

51
Q

In PC-CMV The patient’s Palv can be estimated by observing

A

the flow curve.

52
Q

In PC-CMC. You are looking at the flow curve, The flow drops to zero before inspiration ends, What does this indicate?

A

the applied pressure is reaching the alveolar level by the end of inspiration

53
Q

In PC-CMC. You are looking at the flow curve, If inspiration ends before the flow reaches zero, then Palv is less than applied pressure. What should you do?

A

TI may need to be adjusted (increased) depending on patient need and VT delivery.

54
Q

T/F PC-CMV has been shown to improve oxygenation and gas exchange, decrease PAW , and facilitate lung healing. PC-CMV also increases the PIP, the amount of applied PEEP, VE, respiratory work, the need for sedation, and the duration of mechanical ventilation.

A

False

All is true except. It INCREASES PAW
Decreases PIP, because it controls it!

55
Q

During PSV, a patient’s peak flow is 50 L/min. At what flow level will inspiration end if the ventilator has a 25% flow cycle criterion?

A

The breath will end when the flow drops below 12.5 l/m.

56
Q

Settings for VT and f should reflect a Ve that is derived from the initial calculation based on?

A

on gender and BSA and the patient’s pathology

57
Q

reflects the volume of gas compressed in the ventilator circuit during the inspiratory phase

A

The tubing compliance, or system compressibility

58
Q

During VC-CMV where patient-triggered breaths are present, the patient’s respiratory rate may actually vary depending .

A

on flow and TI setting

59
Q

A variety of flow patterns are available on most ventilators, including constant flow, ascending ramp, sine flow, and descending ramp patterns. The most common are

A

constant and descending ramp patterns.

60
Q

PSV is used to support spontaneous breaths in a patient with an artificial airway when what modes are used?

A

SIMV or spontaneous/CPAP

61
Q

A respiratory therapist is determining the tubing compliance of a ventilator before use. A volume of 100 mL delivers a pressure of 33 cm H2O. What is the compliance of the circuit?

A

3cm h20

100/33= 3.03

62
Q

Circuit compliance is 3cm h20 the PIP is 15 cm H2O and the VT set is 250 mL. About how much volume is actually reaching the patient?

A

Vt= 205 ml

(volume lost in circuit) 45= 3 x 15
250-45= 205

63
Q

A patient being ventilated has a set VT of 700 mL, and f is at 12 breaths/min on the A/C mode. The patient is initiating another 3 breaths/min so that the total f is 15 breaths/min. What is the patient’s actual Ve?

A

Ve= 10.5 l/m

.7 x 15= 10.5

64
Q

If the flow is set at 30 L/min using a constant flow pattern, what is the flow in L/s?

A

0.5 l/s

30/60=0.5

65
Q

What is the TCT based on the set machine f of 12 breaths/min?

A

TCT=5 seconds

60/12

66
Q

What is the TCT based on the actual machine f of 15 breaths/min?

A

TCT= 4 seconds

60/15= 4

67
Q

What is the TI based on the set f (12), flow (0.5 l/m), and VT (700)?

A

TI= 1.4 seconds

(VT) 0.7/ (flow) 0.5= 1.4

68
Q

What is the TE when the f is 12? and TI=1.4 Vt=700, flow=0.5 l/m

A

TE= 3.6 seconds

69
Q

What is the TE when the f is 15? and TI=1.4 Vt=700, flow=0.5 l/m

A

TE= 2.6 seconds

70
Q

A therapist wants to select a flow waveform and flow setting for a patient with severe asthma. Which of the following is a good initial setting?

a) Constant flow, 60 L/min
b) Ascending flow, 80 L/min
c) Descending flow, 70 L/min
d) Sine flow, 40 L/min

A

C

71
Q

A practitioner sets an inspiratory pause of 1.0 seconds to obtain a Pplateau reading and to calculate the patient’s static compliance. During the measurement, a stable plateau is not seen on the pressure-time graph. What could be the problem?

A

The patient is trying to breath during plat period.

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