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MVI > NPPV Comp > Flashcards

NPPV Comp Flashcards

1
Q

what is standard criteria for instituting mechanical ventilation

A
  1. apnea or absence of breathing
  2. acute ventilatory failure
  3. impending ventilatory failure
  4. refractory hypoxemic respiratory failure with increased WOB or innefective breathing pattern
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2
Q

what are indications for NPPV in adults

A
  1. respiratory rate >25 breaths per minute
  2. moderate to severe acidosis: pH 7.25 - 7.30; PaCO2 45 mmHg - 60 mmHg
  3. moderate to severe dyspnea with use of accessory muscles and paradoxical breathing pattern
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3
Q

what are absolute contraindications of NPPV in adults

A
  1. respiratory arrest
  2. cardiac arrest
  3. cardiovascular instability
  4. nonrespiratory organ failure
  5. patent tracheoesophageal fistula
  6. inability to protect the airway or high risk for aspiration
  7. uncooperative patient
  8. facial or head surgery or trauma
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4
Q

what are relative contraindications of NPPV in adults

A
  1. copious or viscous secretions
  2. fixed nasopharyngeal abnormalities
  3. extreme obesity
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5
Q

what are circumstances in which NPPV should change to invasive ventilation

A
  1. respiratory arrest
  2. respiratory rate > 35 breaths/minute
  3. severe dyspnea with use of accessory muscles and possibly paradoxical breathing
  4. life threatening PaO2 < 40 mmHg or PaO2/FiO2 < 200
  5. severe acidosis (pH < 7.25) and hypercapnia (PaCO2 > 60 mmHg)
  6. hypersomnolence, impaired mental status
  7. cardiovascular complications (hypotension, shock, heart failure)
  8. failure of NPPV
  9. other circumstances (metabolic abnormalities, sepsis, pneumonia, pulmonary embolism, barotrauma, massive pleural effusion)
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6
Q

what is the rule for low pressure alarms

A

minus 5-10 below PIP

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7
Q

what is the rule for high pressure alarms

A

plus 10 above PIP

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8
Q

what is the rule for high rate alarms

A

plus 10 above spontaneous rate

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9
Q

what is the rule for low rate alarms

A

between low rate and spontaneous rate

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10
Q

what is the rule for high tidal volume alarms

A

plus 20% above spontaneous tidal volume

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11
Q

what is the rule for low tidal volume alarms

A

minus 20% below spontaneous tidal volume

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12
Q

what is the rule for low minute ventilation alarms

A

minus 20% of spontaneous minute ventilation

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13
Q

rise is used on what type patient

A

acute or chronic patient for comfort

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14
Q

ramp is used for what type patient

A

chronic but stable patients

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15
Q

if a patient complains of nausea while wearing NPPV what is the short term fix

A

take the mask off and allow patient to expel gas while assessing for gastric inflation

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16
Q

if a patient complains of nausea what are long term fixes

A
  1. lower pressures to lowest tolerated
  2. try a different interface
  3. ask nurse to place NG tube to help expel air
17
Q

what do you do if a patient is apneic on NPPV

A
  1. do ABC assessment
  2. if no pulse start CPR
  3. long term look to intubate
18
Q

what are the ways to tell if a patient is apneic on NPPV

A
  1. timed breaths indicated by machine
  2. orange color waveform graphic
  3. patient trigger percent is low
  4. Ti/TOT is low
19
Q

what do you do if there is mask discomfort

A

check mask for correct size and fit

20
Q

what do you do if there is excessive leaks around mask

A

minimize headgear tension by undoing and readjusting with equal offloading pressure

21
Q

what do you do if there are pressure sores

A
  1. use spacers or switch mask styles

2. use wound-care dressing over nasal bridge

22
Q

what do you do if there is nasal/oral dryness or nasal congestion

A
  1. add or increase humidification
  2. irrigate nasal passages with saline
  3. apply topical decongestants
  4. use chin-strap to keep the mouth closed
  5. change to full-face mask
23
Q

what do you do if there is mouthpiece/lip seal leakage

A
  1. use nose clips

2. use custom-made oral appliances

24
Q

what do you do if there is aerophagia, gastric distention

A
  1. use lowest effective pressures for adequate tidal volume

2. use simethicone agents

25
Q

what do you do if there is aspiration

A

adhere to proper selection of patients who can protect their own airway

26
Q

what do you do if there is mucus plugging

A
  1. ensure adequate patient hydration
  2. ensure adequate humidification
  3. avoid excessive oxygen flow rates (> 20 L/min)
  4. allow short breaks for NIV to permit directed coughing techniques
27
Q

what do you do if there is hypotension

A

avoid excessively high peak pressures (

28
Q

what are exclusion criteria for NIV

A
  1. respiratory arrest or the need for immediate intubation
  2. hemodynamic instability
  3. inability to protect the airway (impaired cough or swallowing)
  4. excessive secretions
  5. agitated or confused patients
  6. facial deformities or conditions that prevent mask from fitting
  7. uncooperative or unmotivated patient
  8. brain injury with unstable respiratory drive
29
Q

what are indications for NIV in acute respiratory failure in adults

A
  1. acute exacerbation of COPD
  2. acute asthma
  3. hypoxemic respiratory failure
  4. community-acquired pneumonia
  5. cardiogenic pulmonary edema
  6. immunocompromised patients
  7. postoperative patients
  8. postextubation (weaning)
  9. do not intubate
30
Q

what are indications for NIV in chronic disorders

A
  1. restrictive thoracic disorder
  2. muscular dystrophy
  3. multiple sclerosis
  4. amyotrophic lateral sclerosis
  5. kyphoscoliosis
  6. postpolio syndrome
  7. stable spinal cord injury
  8. severe stable COPD
  9. nocturnal hypoventilation
  10. obstructive sleep apnea
  11. obesity hypoventilation
  12. idiopathic hypoventilation
31
Q

if a patient has respiratory acidosis what do you do to fix it

(hypercapnic = decreased pH and increased PaCO2)

A

increase PS to increase VT to blow off CO2

32
Q

if a patient has respiratory alkalosis what do you do to fix it

(hypoxemic = increased pH and decreased PaCO2)

A

decrease PS to decrease VT to allow body to not blow off as much CO2

give O2 if needed if hypoxemic and increase EPAP

33
Q

pressure support affects what

A

TIDAL VOLUME

MVI (6 decks)

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