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RTH 132 Hannah > Final Consideration > Flashcards

Final Consideration Flashcards

1
Q

Factors that affect NML expiratory gas flow

A
  • elastic recoil (+2) and intrathoracic (+3)
  • total pressure at alveolus (+5) > than that at mouth so air moves out of lung
  • some pressure (-1) is lost to Raw
  • intraluminal pressure is +5 -1 = +4
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2
Q

Factors that affect ABNML expiratory gas flow

A
  • aging and emphysema decrease elastic recoil to (+1). total exp (+4) not (+5)
  • more pressure is lost to Raw (-2)
  • intraluminal pressure is (+2)
  • because intrathoracic pressure of +3 is greater than intraluminal pressure, the airway collapses
  • pursed-lip breathing increases intraluminal press
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3
Q

Expiratory gas flow

A
  • ON vent, no pursed-lip breathing
  • expiratory retard used - not available now
  • low level of PEEP may help
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4
Q

What do post surgery patients develop?

A
  • atelectasis
  • shunting
  • decreased PaO2
  • reduced compliance with ventilation
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5
Q

What kind of breaths reduce atelectasis, shunting, and decreased PaO2 and compliance?

A

sigh

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6
Q

What causes a decreased in compliance and PaO2?

A
  • loss of FRC in the supine position

- may be improved by PEEP

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7
Q

What kind of patients want sigh breaths and why?

A

paralyzed patients want sigh breaths to feel like they’re getting giant breaths

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8
Q

What is the suggested time to give sigh breaths?

A

3-4 times per hour (once every 10 minutes)

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9
Q

How much VT do sigh breaths give?

A

1 and 1/2 times tidal breath

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10
Q

Other studies found that what reduced atelectasis?

A

large tidal breaths

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11
Q

Some other studies found that atelectasis is common with what mode and what may be helpful?

A

PSV; sigh breaths

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12
Q

Not indicated is ___ for hypoxemia

A

CPAP

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13
Q

Sensitivity

A
  • patient should be able to easily flow or pressure trigger a breath
  • watch for auto-PEEP
  • watch to see if accessory muscle use decreases
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14
Q

Settings for sensitivity

A
  • flow 1-10 L
  • pressure -1 to -2 cmH2O
  • watch for auto-PEEP (do an expiratory hold)
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15
Q

How should you increase PEEP?

A

until PIP rises

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16
Q

In pressure control, what determines the tidal volume?

A

driving pressure

17
Q

You want to make sure you don’t change the driving pressure when making ___ changes?

A

PEEP

18
Q

A patient with COPD is receiving PSV and seems to be having difficulty triggering the vent even though you have it set at -1 cmH2O. What must be causing this problem and can you do anything to correct it?

A
  • it could be auto-PEEP (do an expiratory hold to see)
  • make peep match auto-PEEP
  • to get rid of auto-PEEP, decrease rate and increase VT
19
Q

Selection of FiO2?

A
  • arterial tension between 60-100 mmHg
  • jf had ABG place on same oxygen
  • no ABG place 100% to restore oxygenation
  • no need to worry about hypoxic drive if vent MV is meeting patient’s needs
  • get ABG within 15-30 mins and adjust
20
Q

What kind of patients is SpO2 not accurate in?

A
  • smoke inhalation patients
  • someone with met hemoglobin
  • hypothermia patients
  • carbon monoxide poisoning patients
  • patients who smoke
21
Q

If FiO2 required is greater than 0.50 what should you consider?

A

PEEP

22
Q

Humidification

A
  • need to provide 30 mgs H2O/L of absolute humidity at a range of about 31-35 for flows up to VE of 20-30 L/min
  • Nml 100%
23
Q

What HME exceptions are noted?

A
  • thick, copious or bloody secretions
  • VT < 70% of inhaled VT
  • body temp 10L/min
  • with aerosolized medication
24
Q

Nebulization

A
  • should not add VT or change FiO2

- should not change alarm function

25
Q

What are the 3 alarm categories?

A
  • immediate life-threatening
  • potentially life-threatening
  • not life-threatening but a potential source of patient harm
26
Q

What could cause an immediate life-threatening alarm to go off?

A
  • electrical power failure
  • no gas delivery
  • exhalation valve failure
  • excessive gas delivery
  • timing failure
27
Q

What could cause a potentially life-threatening alarm to go off?

A
  • circuit leak
  • circuit obstruction
  • heater malfunction
  • I:E ratio inappropriate
  • inappropriate oxygen
  • autocycling
  • inappropriate PEEP
28
Q

What could cause a not life-threatening alarm to go off?

A
  • changes in compliance and resistance

- changes in vent drive

29
Q

Low pressure alarm

A
  • 10 below PIP
  • detects leaks and disconnection
  • MOST important
30
Q

High pressure alarm

A
  • 10 above PIP
  • usually ends inspiration
  • cough
  • secretions
  • bucking
  • bronchospasm
  • kinks
31
Q

Low CPAP/PEEP alarm

A

5 below, usually LP

32
Q

Apnea alarm

A

20 seconds

33
Q

I:E alarm

A

TI is > 1/2 TCT

34
Q

What are some critical alarms that cannot be silenced?

A
  • low gas source pressure
  • low battery
  • vent inoperative
  • exhalation valve leak
35
Q

What are some other alarms not already mentioned?

A
  • low VT
  • low/high VE
  • low/high F
  • low/high O2
36
Q

What are the steps of commitment?

A
  • prepare the patient
  • decide negative vs positive pressure
  • decide invasive vs non invasive
  • establish an airway
  • have manual vent bag at bedside
  • select ventilator
  • select mode

RTH 132 Hannah (12 decks)

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