Perme Lecture 5+6

Question 1

With higher flow rate devices, you need increased ______

Answer 1

Humidification

If flow rate is more than 3L/m -> needs humidification

Question 2

Nasal canula can give up to 6L/m what can happen if it is increased more than this?

Answer 2

Potentially damages nose

Question 3

What kind of mask can deliver the HIGHEST concentration of oxygen

Note: very serious if patient has this!

Answer 3

Nonrebreather mask

Question 4

What is the advantage of a venturi mask?

Answer 4

Can choose the oxygen percentage delivered based on colored valve

Question 5

For nonrebreather masks, the flow rate needs to be….

Answer 5

High enough to keep the back 1/3 to 1/2 full

Question 6

A __________ mask is typically the last step after intubating OR the first step after a patient got off intubation

Answer 6

nonrebreather mask

Question 7

A patient will have a tracheostomy mask (T-collar) if they need….

Answer 7

Prolonged mechanical ventilation

Question 8

What is paradoxiccal breathing

Answer 8

More accessory muscles working/ diaphragm is tired

These patients must be mechanically ventilated

Question 9

What are 4 mechanical ventilation indications

Answer 9

1. Acute respiratory failure
2. protection of airway and lung parenchyma
3. Relief of upper airway obstructions
4. Improvement of pulmonary toilet (basically improved ability to clear secretions)

Question 10

Before you work with an intubated patient what should you do?

Answer 10

Have nurse or doctor certify that the intubation is in the right location

Question 11

What are the 5 most important things to look at on a ventilator display

Answer 11

Mode of ventilation

FiO2

PEEP

Minute Ventilation

Respiratory Rate

EACH PARAMETER TELLS YOU ABOUT YOUR PATIENTS LAST BREATH

Question 12

What is PEEP

Answer 12

Positive end expiratory pressure

pressure applied by ventilator at the end of each breahte

prevents airway from collapsing

Question 13

Excessive PEEP may cause….

Answer 13

Reduced cardiac output

Impair oxygen delivery system

Question 14

_____ helps expand collapsed alveoli

Answer 14

PEEP

Question 15

What is considered normal PEEP? Moderate PEEP? high PEEP?

Answer 15

3-5 is normal physiological PEEP

Moderate 5-15

High > 15

Note: High PEEP is used only for severe lung injury

Question 16

Assist Control ventilator

Answer 16

Every breathe is the same. Rate and tidal volume is pre-set. Patient can trigger the breathes

Note: not for weaning off ventilator

Question 17

Synchronized Intermittent Mandatory Ventilation

Answer 17

Pressure support is preset and tidal volume

Patient gets spontaneous breathes by triggering ventilator, these spontaneous breathes do not have a preset tidal volume

Rate of how many times the ventilator will help per minute is pre-set just like Assist-Control

Note: this mode is for weaning

Question 18

Pressure support ventilation

Answer 18

Additional pressure to assist with oxygen delivery

The patient controls respiratory rate and inspiratory time

Note: this mode is for weaning off ventilator

Question 19

What is the only method of ventilation where the rate is not preset

Answer 19

Positive Support/ CPAP

Question 20

Non-invasive ventilation is only used when….

Answer 20

Short term ventilation is needed

-prevent intubation

-failed intubaiton

Question 21

If patient does not tolerate being removed from Non Invasive Positive Pressure Ventilation then….

Answer 21

They may not tolerate any kind of physical activity

Question 22

What kind of ventilators can allow patients to take an extra breathe?

Answer 22

A/C and SIMV

PS has no preset rate so no breathes are “extra”

Question 23

What type of ventilator essentially breathes for the patient

Answer 23

A/C

Question 24

Difference between Critical Illness myopathy vs clinical illness polyneuropathy?

Sorry this is a lot!

Answer 24

Critical Illness Myopathy (CIM):

CIM primarily affects the muscles.
It is characterized by weakness and dysfunction of the skeletal muscles.
CIM is often associated with muscle wasting and difficulty in weaning patients from mechanical ventilation.
CIM is thought to be caused by a combination of factors including prolonged immobilization, systemic inflammation, and use of** certain medications such as corticosteroids**

CIP primarily affects the peripheral nerves.
It is characterized by weakness, sensory deficits, and loss of reflexes in a symmetric pattern affecting multiple limbs.
CIP often presents as difficulty in weaning patients from mechanical ventilation and may also involve dysfunction of other organ systems such as the gastrointestinal tract.
CIP is believed to be caused by systemic inflammation, microvascular dysfunction, and metabolic disturbances.

Question 25

True or false: NO specific treatment has been shown to reduce the incidence of critical illness myopathy and critical illness polyneuropathy

Answer 25

TRUE

Question 26

major feature of CIM is

Answer 26

diffuse flaccid weakness in all limbs

Question 28

Phase 1 of early mobility and walking program:

Answer 28

acutely critical, restricted to bedrest

Question 29

Phase 2 of early mobility and walking program:

Answer 29

able to stand but not ambulate

Question 30

Phase 3 of early mobility and walking program:

Answer 30

able to ambulate -focus on orthostatic tolerance and endurance

Question 31

Phase 4 of early mobility and walking program:

Answer 31

higher levels of physical activity, preparing for discharge

Question 32

Out of the 4 phases of the early mobility and walking program, which phase is it most important for PT to see the patient in?

Answer 32

Phase 2 when they can stand but not walk

Question 33

What does Perme score measure

Answer 33

mobility status of patients in ICU takes into account ICU support, mental status, gait, endurance, functinal strength, bedmobility....

Question 34

IMPORANT: ______ is the main contributor to presistent disability whereas ______ can be associated with a full recovery

Answer 34

Critical illness polyneuropathy Critical illness myopathy

Question 35

Out of critical illness myopathy and critical illness polyneuropathy, which is associated with severe septic shock, and organ failrue

Answer 35

critical illness polyneuropathy

Question 36

When a ventilator alarm goes off what do you want to do?

Answer 36

-Rest patient -Check vent connection? "disconnected on patient's side" Reconnect. Can't figure it out? -Call RT or RN to assist ASAP

Question 37

What is continous positive airway pressure usually used for?

Answer 37

Sleep apnea

Question 38

Consequences of bed rest include ____ total blood volume, hemoglobin concentration, VO2max and ventilation, and _____ resting HR

Answer 38

decreased increased

Question 39

an example of immobility is a pt who is

Answer 39

sedated, fixed, immovable, casting

Question 40

muscle strength may decline at a faster rate for someone is on bed rest or who is immobile?

Answer 40

immobile (think casting)