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RTH 132 > Initial Settings > Flashcards

Initial Settings Flashcards

1
Q

what are the goals for choosing a type of ventilator and mode

A

airway mgmt
ventilation
oxygenation disturbance

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2
Q

non-invasive accomplished in 3 ways

A

NPV
CPAP
NPPV

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3
Q

where is negative pressure ventilators most often used

A

used in home and for long term

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4
Q

where does negative pressure ventilation pressure go

A

across chest wall

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5
Q

what must be stable in patients who use negative pressure ventilation

A

compliance and resistance , airway protection, ability to swallow

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6
Q

why is negative pressure ventilation not good for acute exacerbation of COPD

A

they can have changes with compliance and resistance

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7
Q

is negative pressure ventilation good for obstructive sleep apnea

A

no

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8
Q

what are some negative pressure ventilation disadvantages

A 
pt access difficult
may cause tank shock
no spontaneous breathing
no control
hot and noisy
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9
Q

where do set the rate for negative pressure ventilaiton

A

set 5-10 below patients rate

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10
Q

where do you increase negative pressure till

A

till patient can’t talk

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11
Q

why is it good that a patient can’t talk when ventilating with negative pressure

A

means there is enough flow to the patient

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12
Q

what is the max pressure that can be achieved with negative pressure ventilaiton

A

35

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13
Q

what do you use to measure volume with negative pressure ventilation

A

spirometer

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14
Q

how do you increase volume with negative pressure ventialton

A

increase pressure or I time

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15
Q

what are some hazards of an iron lung

A

abdominal pooling

large and in the way for nursing

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16
Q

what is a benefit to using a chest curaiss

A

eliminates abdominal pooling

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17
Q

why are chest cuirasses difficult to use

A

difficult to maintain a seal

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18
Q

where does a chest cuirass apply pressure

A

applies negative pressure to thorax

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19
Q

what are the indications for NIV/NPPV

A

pts with acute on chronic respiratory failure who require short term ventilation
terminally ill pts
pts who tolerate nasal/mask long term
pts with acute resp failure

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20
Q

when is bipap mostly used

A

patients with CHF

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21
Q

when do you not use NPPV/NIV

A

severe acidosis
shock bp <90 mmhg
uncontrolled arrhythmias
upper airway obstruction/trauma

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22
Q

NPPV for chronic RF

A

chest wall deformities
neuromuscular disorders
central alveolar hypoventilation
COPD

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23
Q

what does NPPV cause

A

gastric distention, skin pressure sores, facial pain, dry nose, eye irritation, poor sleep, and discomfort

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24
Q

what is the overall goal of ventilation

A

support the minute ventilation in order to meet the oxygen need

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25
Q

what is full ventilatory support

A

all work is coming from the machine, even if pt is doing something it isn’t good enough to not be in FVS

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26
Q

what is partial ventilatory support

A

weaning, lower amount that machine does

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27
Q

what mode ventilates pts with disease more - pressure or volume

A

pressure

28
Q

when is volume mood good for

A

iatrogenic hyperventilation in control head injuries

29
Q

why do you want alveolar hyperventilation in control head injuries

A

guaranteed a minute ventilation

30
Q

how does pressure mode help improve distribution of ventiliation

A

descending flow pattern

31
Q

which mode of ventilation has more control over minute ventilation - pressure or volume

A

volume

32
Q

lower compliance or higher resistance results in higher what pressures

A

peak and plateau pressures

33
Q

when is peak pressure higher with what type of flow

A

constant flow

34
Q

when is peak pressure lower with what type of flow

A

descending flow

35
Q

what do high volumes do to peak/plat pressures

A

make them high

36
Q

what is the goal of volume ventilation

A

goal of a minute ventilation that matches the patients metabolic needs

37
Q

how do you find tidal volume with F and MV

A

MV=F x VT

38
Q

how do you determine total cycle time

A

TCT = 60/F

39
Q

how do you calculate flow from VT and I Time

A

flow = vt/ti (l/sec)

40
Q

how do you estimate body surface area

A

by the dubois BSA chart

41
Q

what can calculate vt and f

A

radford nomogram

42
Q

where should you keep platue pressure at to prevent alveolar overdistension

A

<30 cmh2o

43
Q

what is tubing compliance usually

A

3-4 ml/cmh2o

44
Q

how do you calculate delivered VT

A

tubing factor x peak pressure = what is lost in tubing and then subtract out peep

45
Q

how much deadspace does an HME add

A

20-90mL

46
Q

how much deadspace is there b/w the wye and endotracheal tube

A

75 mL

47
Q

what does driving force equal

A

pressure gradient

48
Q

in normal lungs what selection do you make for rates/vt

A

large VT, and slow frequency with flow to meet demand

49
Q

in lungs with COPD what selection do you make for rates/vt

A

high compliance and raw - moderate VT and low frequency and high flow to meet demand

50
Q

in lungs with restrictive disease what selection do you make for rates/vt

A

smaller VT, high frequency, and slower flow

51
Q

flow and flow patterns have what relationship with i time

A

inverse relationship

52
Q

what happens if you have high flow

A

high flow shortens I time and increase PAP

53
Q

what happens if you have slower flow

A

slower flow increases I time and decreases PAP but may lead to air trapping and shorter E time

54
Q

what are the 3 types of flow patterns

A

constant
sine
descending

55
Q

what is sine

A

it gives better distribution than constant, PAW and PEAK equal to constant peak higher when raw is high

56
Q

descending

A

occurs naturally in pressure ventilation, peak press is lower, paw is higher, vd is lower, oxygenation is better

57
Q

which is more important high paw or pip

A

high paw

58
Q

what happens to MAP with descending flow

A

it increases

59
Q

what happens to MAP with ascending flow

A

decreases

60
Q

what happens to PIP with ascending flow

A

increases

61
Q

what happens to PIP with descending flow

A

decreases

62
Q

what does descending flow improve

A

gas distribution and arterial oxygenation

63
Q

what are the goals of PSV

A

increase VT
decrease RR
decrease WOB associated with artificial airway

64
Q

what muscle is an indicator of adequate PSV

A

sternocleidomastoid muscle

65
Q

what should you set PSV with lung dx

A

8-14

66
Q

what should you set psv without lung dx

A

about 5

RTH 132 (11 decks)

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