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Topics of Respiratory Care > FINAL!!! > Flashcards

FINAL!!! Flashcards

1
Q

What happens in volume control (3)

A
  • Volume and flow remain constant
  • Pressure varies based on lung mechanics
  • Guaranteed VE
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2
Q

Madatory Settings for volume control (5)

A
  • FIO2
  • Vt
  • PEEP
  • Flow
  • RR
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3
Q

What happens in pressure control (3)

A
  • Pressure remains constant
  • Volume and flow varies based on lung mechanics
  • Lung protection stratagey
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4
Q

Mandatory Settings for pressure control (5)

A
  • FIO2
  • Inspiratory time (I- time)
  • PEEP
  • RR
  • Inspiratory pressure
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5
Q

In pressure we set the

A

I-time and the pt can take whatever flow based on how they breathe

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6
Q

How can we use inspiratory pressure to manipulate Vt?

A

increase the PIP to get a higher Vt

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7
Q

Example: I want my pt to get 500 vt. My PIP is set to 20 cm H20, but the pt is only getting 400. I would increase the PIP, that way the pt can get the 500 vt

A

something to know

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8
Q

Increased Raw is

A

BAD

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9
Q

What happens with PIP and VT when raw is increased?

A
  • PIP goes UP
  • Vt goes DOWN
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10
Q

What can increase Raw? (6)

A
  • secretions
  • water in tubing
  • bronchospasm
  • COPD
  • kink in tubing
  • mucus plugging
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11
Q

Decreased Raw is

A

GOOD

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12
Q

If I’m in volume control, and I have decreased Raw, what should happen to the Vt and PIP?

A
  • Vt goes UP (but its constant b/c you’re in volume control)
  • PIP goes DOWN
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13
Q

If pt has bronchospasms Raw will increase, once you give them a bronchodilator Raw will decrease

A

something to know

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14
Q

If a pt is in pressure control and the pt has decreased Raw, what will happen to Vt and PIP?

A
  • Vt goes UP
  • PIP goes DOWN ( but it’s constant b/c you’re in pressure control)
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15
Q

Increased compliance is _______

A

GOOD

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16
Q

When a pt has increased compliance what happens with VT and PIP?

A
  • Vt goes UP
  • PIP goes DOWN
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17
Q

What is a disease process that has increased compliance?

A

Emphysema

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18
Q

Decreased compliance is ______

A

BAD

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19
Q

When a pt has decreased compliance what happens to Vt and PIP?

A
  • Vt goes DOWN
  • PIP goes UP
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20
Q

What is a disease process that has decreased compliance

A

ARDS

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21
Q

Triggers=

A

starts the breath

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22
Q

What are some triggers? (5)

A
  • time
  • pressure (most common)
  • flow (most common)
  • volume
  • Patient
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23
Q

Limit=

A

the maximum value that can be attained during the breath

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24
Q

LIMITS DO NOT END THE BREATH

A

something to know

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25
Q

Cycle=

A

ends the breath

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26
Q

Examples of cycle (4)

A
  • time
  • flow
  • pressure
  • volume
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27
Q

Baseline determines

A

what happens during exhalation

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28
Q

Baseline can either be

A

zero or PEEP

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29
Q

If a pt does not return back to baseline, what is occurring?

A

Air-trapping (auto-peep)

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30
Q

What type of pt is most likely to air trap?

A

COPD

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31
Q

What is Assist control?

A

Pt has mandatory breaths. The pt can trigger extra breaths but they don’t have to b/c it provides everything they need. Cannot have pressure support in this mode

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32
Q

Full support is when the vent

A

is doing majority of the WOB

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33
Q

Partial support

A

the vent does some of the WOB

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34
Q

SIMV

A

Synchronized breaths. The pt is expected to do some of the WOB on their own. Can have spontaneous breaths in between mandatory breaths

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35
Q

Spontaneous modes

A

CPAP/ pressure support

36
Q

APRV

A
  • 2 different pressure levels of CPAP
  • Both pressure levels are time triggered and time-cycled
  • P high and P low indicate the levels of pressure and T high and T low are the time spent in high and low airway pressures
  • The pt spends longer time at the higher-pressure level, followed by a short release to release CO2
37
Q

APRV intially was used for

A

improving oxygenation

38
Q

Mean Airway Pressure (Paw) affects oxygenation b/c

A

it is when the alveoli are expanded, but not overdistended, which allows more surface area and time for gas exchange (that is how increasing Paw improves oxygenation)

39
Q

PRVC

A
  • Controlling the Vt, and regulating the amount of pressure that is given to achieve the Vt
  • If the volume delivered is less than the set Vt, the vent increases pressure delivery progressively, over several breaths until the set and targeted Vt are about equal
40
Q

Example: If the pressure limit is 25 cm H20 and the vent requires more than 20 cm H20 to deliver a Vt of 500 mL, an alarm activates, and the pressure delivery is limited to 20 cm H20

A

!

41
Q

What does the flow setting on MV determine?

A

how fast the inspired gas or Vt will be delivered to the pt

42
Q

Example: In volume control, if I set the Vt to 500 mL, inspiratory flow is how fast can the vent delivers the 500 mL to the pt

A

!

43
Q

Once the flow is set, it then determines the

A

I-time

44
Q

The faster the flow

A

the shorter the Ti

45
Q

What is a disadvantage of a shorter Ti?

A

higher peak pressure

46
Q

What is an advantage of shorter Ti?

A

a longer Te

47
Q

Slower flows may reduce (3)

A

peak pressures, improve gas distribution, and increase Paw

48
Q

An advantage of a longer Ti is that it can

A

improve ventilation

49
Q

A disadvantage of a longer Ti is it can cause

A

cardiac side effects; also it if you have a longer Ti the pt is spending less time in expiration, which can cause air-trapping

50
Q

For I-time, The goal is to have the

A

shortest Ti possible

51
Q

An initial setting flow is normally set to

A

1 second (0.8- 1.2 seconds)

52
Q

Intial peak flow is

A

60 (40-80 L/m)

53
Q

What are the most common flow patterns?

A
  • constant (rectangular or square)
  • descending (decelerating)
54
Q

A constant flow pattern provides the

A

shortest Ti

55
Q

Descending ramp is most like (2)

A

natural breathing
- Flow is the greatest at the beginning of the breath

56
Q

What are the waveforms possible for pressure (2)

A
  • rectangle
  • exponential (rise)
57
Q

What are the waveforms possible for volume? (2)

A
  • ascending ramp
  • sinusodal
58
Q

What are the waveforms possible for flow? (5)

A
  • rectangular
  • sinusodal
  • ascending
  • descending
  • exponential (decay)
59
Q

What are the 4 types of hypoxemia

A
  • Hypoxemic
  • Anemic
  • Circulatory
  • Histotoxic
60
Q

Hypoxemic hypoxia (3)

A
  • lower than normal PaO2
  • ascent to altitude
  • hypoventilation
61
Q

Anemic hypoxia (3)

A
  • lower than normal RBC count (anemia)
  • abnormal hemoglobin
  • carbon monoxide poising
62
Q

Circulatory hypoxia (2)

A
  • reduced cardiac output
  • decreased tissue perfusion
63
Q

Histotoxic hypoxia

A

cyanide poisoning

64
Q

List 2 disadvantage of pressure control

A
  • volume and flow varies based on lung characteristics
  • Vt and Ve decreases when lung characteristics deteriorate
65
Q

List 2 disadvantage of volume control

A
  • when lung conditions worsen it can cause peak pressure to rise leading to overdistention
  • If the sensitivity level is not set appropriately for the pt, it can make it more difficult for a pt to trigger inspiration
66
Q

How should you instruct a pt to perform IPPB?

A

Slow and deep breaths

67
Q

What are indications for IPPB? (2)

A
  • pts with pulmonary atelectasis
  • inability to clear secretions
68
Q

What are contraindications of IPPB?

A
  • Tension pneumothorax
  • ICP > 15 mm Hg
  • Hemodynamic instability
  • Active hemoptysis
  • Tracheoesophageal fistula
  • Recent esophageal surgery
  • Radiographic evidence of blebs
  • Recent facial, oral, or skull surgery
  • singultus (hiccups)
  • Nausea
69
Q

What are some Hazards of IPPB (5)

A
  • Hyperventilation and respiratory alkalosis
  • discomfort secondary to inadequate pain control
  • pulmonary barotrauma
  • exacerbation of bronchospasm
  • fatigue
70
Q

MIP (NIF or Pimax) normal and critical

A

Normal: -100 to -50 cm H20
Critical: -20 - 0 cm H20

71
Q

VC normal and critical

A

Normal: 65 - 75 mL/kg
Critical: <40

72
Q

Vt normal and critical

A

Normal: 5- 8 mL/kg
Critical: <5

73
Q

Define Automatcity

A

The ability of the cardiac muscles to initiate a spontaneous electrical impulse (depolarization and repolarization)

74
Q

Define Contraction

A
75
Q

Define Autopolarization

A
76
Q

Define Polarization

A

No electrical activity takes place

77
Q

minute ventilation equation

A

VE= Vt x RR

78
Q

Alveolar minute ventilation

A

VA= (VT-VD) x RR

79
Q

Ideal Body Weight

A

M: 106+6 (H-60)/2
W: 105 +5 (H-60)/2

80
Q

Alveolar air equation

A

PAO2=(PB-PH20) x FiO2 - (PaCO2 x 1.25)

81
Q

A-a gradient

A

P(A-a)O2

82
Q

CaO2

A

(SaO2 x HB) x 1.34

83
Q

CVO2

A

(SvO2 x HB) x 1.34

84
Q

What are the intial settings for BiPAP

A

IPAP: 8 to 10 cm H20
EPAP: 4 to 5 cm H20

85
Q

What is the goal of NIV

A

To improve gas exchange by resting the respiratory muscles and increasing alveolar ventilation

86
Q

Goals for LTMV

A

To improve the pt’s quality of life by:
1. Enhancing the individual’s living potential
2. Improving physical and physiological levels of function
3. Reducing morbidity
4. Lessening hospitalizations
5. Extending life
6. Providing cost-effective care

Topics of Respiratory Care (20 decks)

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