CP Exam 3: Assisted Ventilation

Question 1

Why do patients need mechanical ventilation?

Answer 1

respiratory failure due to: apnea, hypercarbia, PaO2 less than 50, MIP less than 25 cmH2O

Question 2

In essence what does a mechanical ventilation do?

Answer 2

taking over the mechanics of breathing for a pt

Question 3

What is an Ambu bag?

Answer 3

used to temporarily ventilate a person with positive pressure, always attached to supp oxygen

Question 4

What is a face mask?

Answer 4

used to avoid mechanical ventilation and non invasive positive pressure supported breathing

used more frequently to avoid intubation

Question 5

What is CPAP?

Answer 5

setting on face mask for continuous positive airway pressure, pt is spontaneously breathing

keeps airways open with 4-20 cmH2O

Question 6

What else doesCPAP do?

Answer 6

increases Vt while decreasing RR while decreasing WOB

Question 7

What type of population usually uses this?

Answer 7

sleep apnea and babies

Question 8

What is BiPAP?

Answer 8

biphasic positive airway pressure, patient is spontaneously breathing

commonly used for patients with COPD or with ventilator settings when weaning mechanical vent

Question 9

What NIV PT implications?

Answer 9

BiPAP and CPAP can decrease PaCO2, muscle fatigue and fatigue due to sleep apnea

Question 10

Why are pts less likely to adhere to a NIV mask?

Answer 10

they are loud and uncomfortable while you are sleeping

Question 11

What can pts do while wearing a NIV mask?

Answer 11

aerobic training

Question 12

What is an endotracheal tube?

Answer 12

external appliance used to access a patient’s airways

watch out for it causing sores

after 10 days like need tracheostomy

Question 13

What is difference between tracheotomy and trecheostomy?

Answer 13

otomy- procedure

ostomy- the actual hole

Question 14

What is a tracheostomy?

Answer 14

incision of the second or third tracheal ring to create a stoma

preferred for prolonged vent support

Question 15

What are the mechanics behind a tracheostomy?

Answer 15

it may decrease the pressure required for ventilation as it decreases the functional length of the trachea thus decreasing resistance

Question 16

What are main issues with tracheostomy?

Answer 16

1. changes cough mechanics- coughing through trachea not mouth, can’t clear mucus
2. usually requires humidified air
3. must maintain good oral hygiene to reduce dryness or infection

Question 17

What are two kins of trach- tubes?

Answer 17

1. cuff (less)- inflation/ deflation

2. (non) fenestrated- allow for talking

Question 18

Why would someone have a nasal tracheostomy?

Answer 18

unable to get an airway for multitude of reasons

Question 19

What determines what type of invasive ventilation a pt has?

Answer 19

ABG, vital signs, airway pressure, lung volumes, physiological condition of pt

Question 20

What is normal minute ventilation of mechanical ventilator?

Answer 20

6-8 liters is normal

Question 21

What is normal I:E ratio?

Answer 21

1:2, 1:1 if pt is hypercapnea

Question 22

What is PEEP?

Answer 22

positive end expiratory pressure

usually just around 5 before extubation

Question 23

If PEEP is decreased what will pt need more of?

Answer 23

O2 through supplemental O2 because it is harder for them to breath

Question 24

What is inspiratory flow rate?

Answer 24

speed at which the ventilator breath is given, higher speed can increase expiratory time

Question 25

What is the sensitivity setting?

Answer 25

pressure change required to trigger a breath

normal is -1-3

Question 26

What is PIP?

Answer 26

peak inspiratory pressure normal is 25

Question 27

What if PIP is over 40?

Answer 27

pt is likely fighting vent by either biting tube, tube may be broken or mucus has plugged it up

Question 28

What is patient stacking?

Answer 28

pt is trying to breathe over a ventilator breath or with it but this actually makes each of their breathes less effective

Question 29

What are the five settings for a mechanical ventilator?

Answer 29

1. Continous mechanical ventilation- CMV most assistance
2. Assist control ventilation
3. Synchronous Intermittent mandatory ventilation/ Intermittent Mandatory Ventilation
4. Pressure support ventilation
5. CPAP

Question 30

What is CMV?

Answer 30

pt is likely sedated or paralyzed so ventilator controls all aspects of ventilation with preset numbers

Question 31

What is A/C?

Answer 31

the vent is set with timed intervals along with patient spontaneously breathing

will still get total tidal volume

Question 32

What is IMV?

Answer 32

patient initiates all of the breaths, but vent is set for volume

used for when patient has stiff lungs

Question 33

What is SIMV?

Answer 33

often chosen over IMV

mandatory breaths are given to pt when they are not initiating high enough RR

rate is usually set low to encourage pt breathing

Question 34

What is PSV?

Answer 34

commonly used for weaning off a ventilator

pt initiates breath and they are augmented by the positive pressure on inhalation set by vent

Question 35

What are two drugs often used for sedation of pt?

Answer 35

Propofol -short acting

Versed- long acting

Question 36

What does PT do on CMV/ A-C?

Answer 36

nothing really just make sure nurse is doing PROM and scheduled positional changes

Question 37

What do PT do on IMV?

Answer 37

educate and assist with deepening of breaths through segmental breathing

Question 38

What do PT do with CPAP?

Answer 38

after the first trial with CPAP, PT will try to mobilize pt to see how they responded before full extubation