CP: PERME LEC 5+6 Flashcards by Chavez Girls

With higher flow rate devices, you need increased ______

Humidification

If flow rate is more than 3L/m -> needs humidification

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Nasal canula can give up to 6L/m what can happen if it is increased more than this?

Potentially damages nose

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What kind of mask can deliver the HIGHEST concentration of oxygen

Note: very serious if patient has this!

Nonrebreather mask (75-100%)

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What is the advantage of a venturi mask?

Can choose the oxygen percentage delivered based on colored valve

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For nonrebreather masks, the flow rate needs to be….

High enough to keep the bag 1/3 to 1/2 full!

8-15L/m

the bag should not be flat!

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A __________ mask is typically the last step after intubating OR the first step after a patient got off intubation

nonrebreather mask

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A patient will have a tracheostomy mask (T-collar) if they need….

Prolonged mechanical ventilation

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What is paradoxiccal breathing

More accessory muscles working/ diaphragm is tired

These patients must be mechanically ventilated

stomach will be sucked in with inspiration

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What are 4 mechanical ventilation indications

Acute respiratory failure
protection of airway and lung parenchyma
Relief of upper airway obstructions
Improvement of pulmonary toilet (basically improved ability to clear secretions)

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Before you work with an intubated patient what should you do?

Have nurse or doctor certify that the intubation is in the right location

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What are the 5 most important things to look at on a ventilator display

Mode of ventilation

FiO2

PEEP

Minute Ventilation

Respiratory Rate

EACH PARAMETER TELLS YOU ABOUT YOUR PATIENTS LAST BREATH

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What is PEEP

Positive end expiratory pressure

pressure applied by ventilator at the end of each breahte

PEEP applies extra pressure to the alveoli at the end of exhalation, keeping them partially inflated and preventing atelectasis (alveolar collapse).
This helps maintain better gas exchange by keeping more alveoli open and improving oxygen delivery to the blood.

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Excessive PEEP may cause….

Reduced cardiac output

Impair oxygen delivery system

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_____ helps expand collapsed alveoli

PEEP

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What is considered normal PEEP? Moderate PEEP? high PEEP?

3-5 is normal physiological PEEP

Moderate 5-15

High > 15

Note: High PEEP is used only for severe lung injury

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Assist Control ventilator

Every breathe is the same. Rate and tidal volume is pre-set. Patient can trigger the breathes

Note: not for weaning off ventilator

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adaptive pressure ventilation APV

ventilator automatically regulates inspiratory pressure and flow to maintain the target TV

AC ventilation

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Synchronized Intermittent Mandatory Ventilation

Pressure support is preset and tidal volume

Patient gets spontaneous breathes by triggering ventilator, these spontaneous breathes do not have a preset tidal volume

Rate of how many times the ventilator will help per minute is pre-set just like Assist-Control

Note: this mode is for weaning

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Pressure support ventilation

Additional pressure to assist with oxygen delivery

The patient controls respiratory rate and inspiratory time

Note: this mode is for weaning off ventilator

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What is the only method of ventilation where the rate is not preset

Pressure Support PSV/ CPAP

patient controls the RR and inspiratory time

usually set to 10cmH2O

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Non-invasive ventilation is only used when….

what types are NIV?

Short term ventilation is needed

-prevent intubation

-failed intubaiton

patient must be able to breathe spontaneously

CPAP or BI-PAP

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If patient does not tolerate being removed from Non Invasive Positive Pressure Ventilation then….

They may not tolerate any kind of physical activity

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What kind of ventilators can allow patients to take an extra breathe?

A/C and SIMV

PS has no preset rate so no breathes are “extra”

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What type of ventilator essentially breathes for the patient

A/C

Difference between Critical Illness myopathy vs clinical illness polyneuropathy? Sorry this is a lot!

Critical Illness Myopathy (CIM): CIM primarily affects the muscles. It is characterized by weakness and dysfunction of the **skeletal muscles.** CIM is often associated with muscle wasting and difficulty in weaning patients from mechanical ventilation. CIM is thought to be caused by a combination of factors including prolonged immobilization, systemic inflammation, and use of** certain medications such as corticosteroids** CIP primarily affects the peripheral nerves. It is characterized by weakness, sensory deficits, and loss of reflexes in a symmetric pattern affecting multiple limbs. CIP often presents as difficulty in weaning patients from mechanical ventilation and may also involve dysfunction of other organ systems such as the gastrointestinal tract. CIP is believed to be caused by systemic inflammation, microvascular dysfunction, and metabolic disturbances.

True or false: NO specific treatment has been shown to reduce the incidence of critical illness myopathy and critical illness polyneuropathy

TRUE

major feature of CIM is

diffuse flaccid weakness in all limbs

critical illness polyneuropathy and myopathy (together) show evidence of what?

acute and chronic denervation and primary muscle change

what is a major risk factor for ICU acquired weakness?

hyperglycemia! contributes to nerve damage and muscle damage

how does critical illness lead to CIM/CIP?

any illness = body releases cytokines in response, causing systemic inflammation which damages nerves and muscles

On average, patients lose nearly __% of muscle per day in the first week of ICU admission

how do we as PTs manage muscle weakness in the ICU?

early mobility and walking

Phase 1 of early mobility and walking program:

acutely critical, restricted to bedrest

Phase 2 of early mobility and walking program:

able to stand but not ambulate

Phase 3 of early mobility and walking program:

able to ambulate -focus on orthostatic tolerance and endurance

Phase 4 of early mobility and walking program:

higher levels of physical activity, preparing for discharge

Out of the 4 phases of the early mobility and walking program, which phase is it most important for PT to see the patient in?

Phase 2 when they can stand but not walk

What does Perme score measure

mobility status of patients in ICU takes into account ICU support, mental status, gait, endurance, functinal strength, bedmobility....

What is special about the perme ICU score? what does a higher score indicate?

able to capture very low levels of function higher score means higher mobility and less ICU support needed

a minimum clinically important difference of ____ points is set for the PERME score

6.5

IMPORANT: ______ is the main contributor to presistent disability whereas ______ can be associated with a full recovery

Critical illness polyneuropathy Critical illness myopathy

Out of critical illness myopathy and critical illness polyneuropathy, which is associated with severe septic shock, and organ failrue

critical illness polyneuropathy

When a ventilator alarm goes off what do you want to do?

-Rest patient -Check vent connection? "disconnected on patient's side" Reconnect. Can't figure it out? -Call RT or RN to assist ASAP

What is continous positive airway pressure usually used for?

Sleep apnea

Consequences of bed rest include ____ total blood volume, hemoglobin concentration, VO2max and ventilation, and _____ resting HR

decreased increased

an example of immobility is a pt who is

sedated, fixed, immovable, casting

muscle strength may decline at a faster rate for someone is on bed rest or who is immobile?

immobile (think casting)

what % of oxygen concentration is considered a drug?

21%

A resevoir nasal cannula is not as common, and is designed to do what?

conserve and reduce O2 use by collecting the O2 exhaled that didn't make it to the aveoli and provide 100% on next inhlation

Does a reservoir nasal cannula need humidification?

no since it retains the vapor (and its lower flow rates)

A high flow nasal cannula delivers flow rates of 1-15 L/m. What helps prevent mucosal damage with this flow rate?

star shape inside the cannula that changes th eflow of air so delivery is not straight on O2 concentration of 24-75%

a simple oxygen mask (delivers 30-70%) requires a minimum flow rate of 6 L/m to prevent what?

rebreathing the exhaled CO2

A face tent is a variation of a face mask for patients such as

mouth breathers or pts with facial trauma

What is the most important thing to monitor with an aerosol mask?

this mask turns liquid meds into mist to deliver to the lungs you should see the mist from the exhalation ports to ensure adequate flow rates

A high flow humidification system can deliver ___& of O2 at____ L/m.

100% at 60L/m may be used to wean patient off mechanical ventilation

an endotracheal tube (oral or nasal) is used ____ term while a tracheostomy is used ____ term.

short long

A doctor can order ventilator settings in two variations

pressure of volume

FiO2

amount of O2

PEEP