FINAL!!! Flashcards
1
Q
What happens in volume control (3)
A
- Volume and flow remain constant
- Pressure varies based on lung mechanics
- Guaranteed VE
2
Q
Madatory Settings for volume control (5)
A
- FIO2
- Vt
- PEEP
- Flow
- RR
3
Q
What happens in pressure control (3)
A
- Pressure remains constant
- Volume and flow varies based on lung mechanics
- Lung protection stratagey
4
Q
Mandatory Settings for pressure control (5)
A
- FIO2
- Inspiratory time (I- time)
- PEEP
- RR
- Inspiratory pressure
5
Q
In pressure we set the
A
I-time and the pt can take whatever flow based on how they breathe
6
Q
How can we use inspiratory pressure to manipulate Vt?
A
increase the PIP to get a higher Vt
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
8
Q
Increased Raw is
A
BAD
9
Q
What happens with PIP and VT when raw is increased?
A
- PIP goes UP
- Vt goes DOWN
10
Q
What can increase Raw? (6)
A
- secretions
- water in tubing
- bronchospasm
- COPD
- kink in tubing
- mucus plugging
11
Q
Decreased Raw is
A
GOOD
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
13
Q
If pt has bronchospasms Raw will increase, once you give them a bronchodilator Raw will decrease
A
something to know
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)
15
Q
Increased compliance is _______
A
GOOD
16
Q
When a pt has increased compliance what happens with VT and PIP?
A
- Vt goes UP
- PIP goes DOWN
17
Q
What is a disease process that has increased compliance?
A
Emphysema
18
Q
Decreased compliance is ______
A
BAD
19
Q
When a pt has decreased compliance what happens to Vt and PIP?
A
- Vt goes DOWN
- PIP goes UP
20
Q
What is a disease process that has decreased compliance
A
ARDS
21
Q
Triggers=
A
starts the breath
22
Q
What are some triggers? (5)
A
- time
- pressure (most common)
- flow (most common)
- volume
- Patient
23
Q
Limit=
A
the maximum value that can be attained during the breath
24
Q
LIMITS DO NOT END THE BREATH
A
something to know
25
Cycle=
ends the breath
26
Examples of cycle (4)
- time
- flow
- pressure
- volume
27
Baseline determines
what happens during exhalation
28
Baseline can either be
zero or PEEP
29
If a pt does not return back to baseline, what is occurring?
Air-trapping (auto-peep)
30
What type of pt is most likely to air trap?
COPD
31
What is Assist control?
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
32
Full support is when the vent
is doing majority of the WOB
33
Partial support
the vent does some of the WOB
34
SIMV
Synchronized breaths. The pt is expected to do some of the WOB on their own. Can have spontaneous breaths in between mandatory breaths
35
Spontaneous modes
CPAP/ pressure support
36
APRV
- 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
APRV intially was used for
improving oxygenation
38
Mean Airway Pressure (Paw) affects oxygenation b/c
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
PRVC
- 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
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
!
41
What does the flow setting on MV determine?
how fast the inspired gas or Vt will be delivered to the pt
42
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
!
43
Once the flow is set, it then determines the
I-time
44
The faster the flow
the shorter the Ti
45
What is a disadvantage of a shorter Ti?
higher peak pressure
46
What is an advantage of shorter Ti?
a longer Te
47
Slower flows may reduce (3)
peak pressures, improve gas distribution, and increase Paw
48
An advantage of a longer Ti is that it can
improve ventilation
49
A disadvantage of a longer Ti is it can cause
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
For I-time, The goal is to have the
shortest Ti possible
51
An initial setting flow is normally set to
1 second (0.8- 1.2 seconds)
52
Intial peak flow is
60 (40-80 L/m)
53
What are the most common flow patterns?
- constant (rectangular or square)
- descending (decelerating)
54
A **constant** flow pattern provides the
shortest Ti
55
Descending ramp is most like (2)
natural breathing
- Flow is the greatest at the beginning of the breath
56
What are the waveforms possible for pressure (2)
- rectangle
- exponential (rise)
57
What are the waveforms possible for volume? (2)
- ascending ramp
- sinusodal
58
What are the waveforms possible for flow? (5)
- rectangular
- sinusodal
- ascending
- descending
- exponential (decay)
59
What are the 4 types of hypoxemia
- Hypoxemic
- Anemic
- Circulatory
- Histotoxic
60
Hypoxemic hypoxia (3)
- lower than normal PaO2
- ascent to altitude
- hypoventilation
61
Anemic hypoxia (3)
- lower than normal RBC count (anemia)
- abnormal hemoglobin
- carbon monoxide poising
62
Circulatory hypoxia (2)
- reduced cardiac output
- decreased tissue perfusion
63
Histotoxic hypoxia
cyanide poisoning
64
List 2 disadvantage of pressure control
- volume and flow varies based on lung characteristics
- Vt and Ve decreases when lung characteristics deteriorate
65
List 2 disadvantage of volume control
- 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
How should you instruct a pt to perform IPPB?
Slow and deep breaths
67
What are indications for IPPB? (2)
- pts with pulmonary atelectasis
- inability to clear secretions
68
What are contraindications of IPPB?
- 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
What are some Hazards of IPPB (5)
- Hyperventilation and respiratory alkalosis
- discomfort secondary to inadequate pain control
- pulmonary barotrauma
- exacerbation of bronchospasm
- fatigue
70
MIP (NIF or Pimax) normal and critical
Normal: -100 to -50 cm H20
Critical: -20 - 0 cm H20
71
VC normal and critical
Normal: 65 - 75 mL/kg
Critical: <40
72
Vt normal and critical
Normal: 5- 8 mL/kg
Critical: <5
73
Define Automatcity
The ability of the cardiac muscles to initiate a spontaneous electrical impulse (depolarization and repolarization)
74
Define Contraction
75
Define Autopolarization
76
Define Polarization
No electrical activity takes place
77
minute ventilation equation
VE= Vt x RR
78
Alveolar minute ventilation
VA= (VT-VD) x RR
79
Ideal Body Weight
M: 106+6 (H-60)/2
W: 105 +5 (H-60)/2
80
Alveolar air equation
PAO2=(PB-PH20) x FiO2 - (PaCO2 x 1.25)
81
A-a gradient
P(A-a)O2
82
CaO2
(SaO2 x HB) x 1.34
83
CVO2
(SvO2 x HB) x 1.34
84
What are the intial settings for BiPAP
IPAP: 8 to 10 cm H20
EPAP: 4 to 5 cm H20
85
What is the goal of NIV
To improve gas exchange by resting the respiratory muscles and increasing alveolar ventilation
86
Goals for LTMV
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
