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S2 MAP II > Oxygen and Ventilator Management > Flashcards

Oxygen and Ventilator Management Flashcards

1
Q

principles of rehab w/ oxygen and ventilator management

A

early mobilization of the patient
mobilization can occur with ventilator weaning
a patient who gains overall strength will be more likely to wean off the ventilator and be less likely to develop side effects of bed rest
progress is guided by vital signs, not by the volume (size) of the apparatus
“if there’s nothing wrong with their legs, have them walk”

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2
Q

some of the challenges of mobilization with vent

A 
trachs
A lines
IVs
telemetry
ventilators
pulse oximetry
BP monitors
Dobhoff/G tubes
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3
Q

causes of respiratory failure

A 
drugs - narcotics
metabolism - hyponatremia, hypercapnia
neoplasm
infections - meningitis, WNV, polio
trama - flail chest, contusion of lung
other - ALS, MS, OSA, GB, obesity, COPD, CF, ILD, atelectasis, PE
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4
Q

measuring respiratory function

-normal blood gases

A 
PaO2
-80-100 mmHg
PaCO2
-35-45 mmHg
pH
-7.35-7.45
HCO3
-22-26 (base)
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5
Q

measuring respiratory function

  • pulse ox tells you…
  • what to observe of the patient
  • patients may not have
A

pulse oximetry gives a measure of the % O2 in the blood. it does not tell you the pCO2 level
observe the patient. are they more combative or confused (could be a sign of climbing pCO2). have they turned pale, labored breathing
patients may not have labored breathing with respiratory failure - look for other signs

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6
Q

types of lines and tubes for respiratory support

A 
nasal cannula
non-rebreather mask
face mask
Bipap/Cpap: noninvasive ventilation
heated hi-flow
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7
Q

nasal cannula

-flow range

A

1 to 6 L/min

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8
Q

if more than 6 L/min is needed, what oxygen delivery systems can you use

A 
pendant oxymizer
high flow tubing
-has its own color
simple mask
non-rebreather mask
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9
Q

Bipap

-stands for

A

bilevel positive airway pressure

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10
Q

Bipap

  • when would you use it
  • can be used as a temporary way to…
A

patient has to be able to breathe independently
positive airway pressure during inspiration and exhalation
can be used as a temporary way to “blow out” residual CO2 to reduce confusion and improve oxygenation

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11
Q

how does a Bipap work?

A

“the inspiratory positive airway pressure is higher and supports a breath as it is taken in
conversely, the expiratory positive airway pressure is a lower pressure that allows you to breathe out.
these pressures are preset and alternate just like your breathing pattern

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12
Q

BiPAP/CPAP

  • what type of ventilation
  • used for…
  • what does CPAP stand for?
A 
non-invasive ventilation (NIV)
used for sleep apnea
temporary artificual ventilation
CPAP
-continuous positive airway pressure
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13
Q

CPAP

  • non-invasive form of…
  • can be provided thorugh…
  • provides…
  • used with what condition
A

non-invasive form of Positive End Expiratory Pressure (PEEP)
can be provided through a ventilator or via an independent machine
provides constant end-expiratory pressure that keeps the airway open
used with OSA (obstructive sleep apnea)

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14
Q

characteristics of volume control ventilators

  • what is set
  • what varies
A 
set tidal volume
set rate
set PEEP
set FiO2 (fraction of inspired O2)
peak inspiratory pressure varies
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15
Q

characteristics of pressure control

  • what is set
  • what varies
A 
set inspiratory pressure
set rate
set PEEP
set FiO2
tidal volume varies
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16
Q

modes of ventilation

A

full support
intermittent ventilation
continuous positive airway pressure

17
Q

full support ventilator

  • what does it do
  • disadvantage
A

set number of breaths
gives additional full breath once patient initiates breath
disadvantage
-barotrauma: you’re pushing too much air into the lungs and the muscles become weak (like putting a brace on someone)

18
Q

intermittent ventilation

-what type of patient would you use it with

A

use with a patient who can spontaneously breathe in between breaths given by machine

19
Q

continuous positive airway pressure

-3 descriptors

A

ventilator mode
nasal mask
also used for sleep apnea as a unit separate form a ventilator

20
Q

common abbreviations

  • CMV
  • SIMV
  • CPAP
A 
CMV
-controlled mandatory ventilation
SIMV
-synchronized intermittent mandatory ventilation
CPAP
-continuous positive airway pressure
21
Q

common abbreviations

  • PS
  • PEEP
  • ETT
A 
PS
-pressure support
PEEP
-positive end expiratory pressure
ETT
-endotracheal tube
22
Q

principles behind weaning

A

resting settings alternate with weaning settings/time off the ventilator
time off the ventilator increases by 2-4 hours per day
tidal volume, RR, HR, O2 sat and blood gases indicate tolerance for vent weaning

23
Q

reasons for a tracheostomy

A

need for artificial/mechanical ventilation greater than 2 weeks
inability to swallow
blockage of the airway (such as laryngectomy)
obstructive sleep apnea
frequent suctioning needed due to ineffective cough

24
Q

inability to swallow often due to…

A

stroke or other neuromuscular disease

25
Q

types of tracheostomies

A

cuffed
uncuffed
fenestrated

26
Q

cuffed tracheostomy

-what does it do?

A

holds the trach in place and prevents air flow to nose and mouth

27
Q

uncuffed trach

-what does it do

A

allows air flow over vocal cords - patient can talk

28
Q

fenestrated trach

-what does it do

A

allows patient to talk

29
Q

trach brands

A

bivona
shiley
jackson

30
Q

trach position

  • does not interfere with…
  • below…
  • cuff holds…
  • cuff prevents…
A

does not interfere with the passage of food
below the vocal cords
holds the trach in place
prevents air passing up through the vocal cords

31
Q 
aerosol collar (trach collar)
-what do they do?
A

deliver humidified O2

32
Q

portable circuits

  • wide end connects to…
  • narrow end connects to…
A

wide end connects to the T collar

narrow end connects to the portable tank

33
Q

oxygen settings

-add about _____ of O2 for each extra liter of O2 up to _____ L/min

A

3% up to 6 L/min

34
Q

6 L/min O2 is considered a FiO2 of ____ or ____

A

0.4 or 40%

35
Q

can patients with trachs shower?

-if so, what are precautions?

A

yes

avoid water entering the trach with a light dressing to cover

36
Q

4 myths of oxygen and ventilation

A

you can never work with a patient with SaO2 lower than 90%
ventilated patients need sedation
ventilated patients can’t walk
ventilated patients can’t eat

37
Q

Passy Muir valves for speaking

  • joint decision between…
  • trach must be…
  • patient must be…
A

joint decision bewteen MD, SLP, and RT
trach must be cuffless or the cuff must be deflated
patient must be able to swallow

38
Q

eating and talking with a trach

  • coordinate with…
  • most patients…
A

speech therapy

most patients want to eat and talk

S2 MAP II (17 decks)

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