RCP 105 (VENTS) midterm Flashcards

Question

Explain how to calculate the I:E ratio for a time-cycled, pressure-limited ventilator.

Answer 1

Minute volume x sum of I:E ratio (add) ex: Given= 12 L/min, 1:3 12 L/min x (1+3) 12 L/min x 4 = 48 L/min

Answer 2

volume of gas contained in the equipment and supplies that does not take part in gas exchange (going to vary depending on machine and patient)

Answer 3

volume occupying the conducting airways that does not take part in gas exchange (150mL adults)

Answer 4

= inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It's characterized by daily cough and mucus (sputum) production General Appearance: barrel chest, clubbing and cyanosis Respiratory Pattern: dyspnea, accessory muscle use, pursed-lip breathing Breath Sounds: diminished aeration with bilateral expiratory wheeze Diagnostic Chest Percussion: tympanic or hyperresonant Cough: congested, productive thick sputum Chest- Xray: hyperlucency, hyperinflation, increased A-P diameter, flattened diaphragm ABG: compensated respiratory acidosis with hypoxemia and hypercapnia

Answer 5

= An infectious inflammatory process that primarily affects the gas exchange area of the lungs causing capillary fluid to pour into the alveoli. This process leads to inflammation of the alveoli, alveolar consolidation and atelectasis. viruses account for 50% pneumonia General appearance: Diaphoretic, cyanotic Respiratory Pattern: Tachypnea BS: Crackles, bronchial, whispered pectoriloquy Diagnostic Chest Percussion: Flat or dull note over consolidation Cough Productive: yellow/green sputum, may also be rust color Vitals: Fever, (bacteria >100° F and viral < 101° F) increased HR, RR and BP Chest X-ray- Increased density in area of consolidation and atelectasis, air bronchograms possible pleural effusion ABG-Acute alveolar hyperventilation with hypoxemia CBC: Increased WBC with bacterial infection, decreased with viral Culture and Sensitivity to determine cause

Answer 6

= the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gasses and particulate matter Anatomic alterations: Permanent enlargement and destruction of the air spaces distal to the terminal bronchioles Destruction of alveolar-capillary membrane Weakening of the distal airways, primarily the respiratory bronchioles Air trapping and hyperinflation Chest- Xray: hyperlucency, hyperinflation, increased A-P diameter, flattened diaphragm ABG: compensated respiratory acidosis with hypoxemia and hypercapnia

Answer 7

= A chronic, inflammatory, obstructive, non-contagious airway disease with varying levels of severity, characterized by exacerbations of wheezing and coughing Patient Assessment-History and Physical exam SOB-pursed-lip breathing, chest tightness Appearance of the chest –increased A-P diameter during an attack Respiratory Pattern- Accessory muscle usage, retractions (more so in kids) Diagnostic Chest Percussion – hyperresonant/tympanic note BS - Diffuse wheezing, bilateral wheezing, diminished breath sounds, prolonged expiration Physical Appearance – diaphoresis Vitals – tachycardia, tachypnea Decreased blood pressure during inspiration Increased blood pressure during expiration Chest X-ray –During an attack increased A-P diameter, translucent lung fields, depressed or flattened diaphragm ABG – Initially acute respiratory alkalosis with hypoxemia then acute respiratory acidosis

Answer 8

= left-sided heart failure Occurs when the left ventricle is unable to pump out a sufficient amount of blood during each ventricular contraction Determined by means of the left ventricular ejection fraction (LVEF) Vital signs: Increased respiratory rate (Tachypnea), heart rate (pulse), blood pressure Cheyne-Stokes respirations Paroxysmal nocturnal dyspnea and orthopnea Cyanosis Cough and sputum—frothy and pink in appearance

Answer 9

= A blood clot that becomes dislodged and travels to another part of the body Clinical manifestations result from the pathophysiologic mechanisms caused (or activated) by: Atelectasis Bronchospasm Vitals: Increased Respiratory rate (Tachypnea) Stimulation of peripheral chemoreceptors Reflexes from the aortic and carotid sinus baroreceptors Increased heart rate (pulse) Systemic hypotension (DECREASED blood pressure) Cyanosis Cough and hemoptysis Peripheral edema and venous distention Distended neck veins Swollen and tender liver Chest pain/decreased chest expansion Syncope, light-headedness, and confusion Abnormal heart sounds Increased second heart sound (S2) Increased splitting of the second heart sound (S2) Third heart sound (or ventricular gallop) Right ventricular heave or lift Chest assessment findings: Crackles Wheezes Pleural friction rub ABG: Acute alveolar hyperventilation with hypoxemia (acute respiratory alkalosis) pH= INCREASED PaCO2= DECREASED HCO3-= DECREASED PaO2= DECREASED SaO2= DECREASED Chest radiograph: Increased density (in infarcted areas) Hyperradiolucency distal to the embolus Dilation of the pulmonary arteries Pulmonary edema Right ventricular cardiomegaly (cor pulmonale) Pleural effusion (usually small)

Answer 10

= abnormal condition of the lungs characterized by the partial or total collapse of previously expanded alveoli Diagnosis: Physical Exam Chest X-ray: Provides pictures of the chest to help identify areas of collapsed lung tissue (GOLD Standard) Computed tomography (CT) scan: Creates detailed images of the lungs and chest cavity to help determine the cause of atelectasis Bronchoscopy: A thin, flexible tube with a camera is inserted into the windpipe to detect and remove blockages Vital signs: Increased Respiratory rate (tachypnea), Heart rate (pulse), Blood pressure Cyanosis Chest assessment findings: Increased tactile and vocal fremitus Dull percussion note Bronchial breath sounds Diminished breath sounds When atelectasis is caused by mucous plugs: Crackles Whispered pectoriloquy

Answer 11

= When gas (sometimes called free air) accumulates in the pleural space The pleural space, the visceral and parietal pleura separate, enhances the natural tendency of the lung to recoil, or collapse, the alveoli are compressed and atelectasis ensues A restrictive lung disorder Closed pneumothorax= Gas in the pleural space is not in direct contact with the atmosphere Open pneumothorax= The pleural space is in direct contact with the atmosphere such that gas can move freely in and out Tension pneumothorax= The intrapleural pressure exceeds the intra-alveolar (or atmospheric) pressure BS: diminished/absent on affected side CXR: all black, not able to see outlines Vitals: Increased respiratory rate (tachypnea) Decreased lung compliance/increased ventilatory rate relationship Activation of the deflation receptors Activation of the irritant receptors Stimulation of the J receptors Pain/anxiety Increased Heart rate (pulse)/Blood pressure Cyanosis Chest assessment findings: Hyperresonant percussion note over the pneumothorax Diminished breath sounds over the pneumothorax Tracheal shift (away from the affected side in a tension pneumothorax) Displaced heart sounds Increased thoracic volume on the affected side (particularly in tension pneumothorax) Bubbling from chest occurs due to air coming out ABG for small pneumothorax= Acute alveolar hyperventilation with hypoxemia (acute respiratory alkalosis) pH= INCREASED PaCO2= DECREASED HCO3-= DECREASED but normal PaO2= DECREASED SaO2= DECREASED ABG for large pneumothorax= Acute ventilatory failure with hypoxemia (acute respiratory acidosis) pH= DECREASED PaCO2= INCREASED HCO3-=INCREASED PaO2= DECREASED SaO2= DECREASED

Answer 12

= The result of double fractures of at least three or more adjacent ribs Causes the thoracic cage to become unstable The affected ribs paradoxically cave in (flail) during inspiration as a result of the generated subatmospheric intrapleural pressure Compresses and restricts the underlying lung Sharp rib fragments may also damage underlying tissue and large blood vessels Causes a restrictive lung disorder Anatomic alterations: Double fracture of numerous adjacent ribs Rib instability Lung volume restriction Atelectasis Lung collapse (pneumothorax) Lung contusions Secondary pneumonia Vital signs: Increased respiratory rate (tachypnea), Heart rate (pulse), Blood pressure Paradoxical movement of chest wall\ Pain/anxiety Cyanosis Diminished breath sounds: on both the affected and the unaffected sides ABG= Acute alveolar hyperventilation with hypoxemia (acute respiratory alkalosis) pH= INCREASED PaCO2= DECREASED HCO3-= DECREASED but normal PaO2= DECREASED SaO2= DECREASED

Answer 13

= Chronic dilation and distortion of one or more bronchi as a results of excessive inflammation and destruction of bronchial walls, blood vessels, elastic tissue and smooth muscle. This results in impaired mucociliary clearance causing accumulation of copious amounts of bronchial secretions Chest X-ray: hyperlucent lung fields, depressed or flattened flattened diaphragm, enlarged or elongated heart. ABG: Mild to moderate cases :acute alveolar hyperventilation with hypoxemia Severe cases: chronic ventilatory Failure with hypoxemia Bronchogram or CT: dilated bronchi, increased bronchial wall opacity Patient Assessment History of pulmonary infections General appearance: cyanosis, barrel chest, clubbing\ Respiratory Pattern: tachypnea, dyspnea, accessory muscle use, pursed-lip breathing. BS: wheezing, diminished breath sounds Diagnostic percussion: hyperresonat or tympanic notes Cough: productive of purulent, foul-smelling secretions, hemoptysis, sputum will separate into 3-layers Increased hematocrit and hemoglobin Elevated white blood count if acutely elevated Sputum examination: Streptococcus pneumoniae Haemophilus influenzae Pseudomonas aeruginosa Anaerobic organisms

Answer 14

= A contagious chronic bacterial infection that primarily affects the lungs TB pathogen, Mycobacterium tuberculosis—a rod-shaped bacterium with a waxy capsule It may involve almost any part of the body Anatomic: Alveolar consolidation Alveolar-capillary destruction Caseous tubercles or granulomas Cavity formation Fibrosis and secondary calcification of the lung parenchyma Distortion and dilation of the bronchi Increased bronchial airway secretions Diagnosis: Mantoux tuberculin skin test Acid-fast bacilli (AFB) sputum cultures The QuantiFERON-TB Gold (QFT-G) test The rapid Xpert MTB/RI assay

Answer 15

= The accumulation of fluid in the pleural space Restrictive lung pathophysiology Vital signs: Increased Respiratory rate (tachypnea), Heart rate (pulse), Blood pressure Chest pain/decreased chest expansion BLUNTED diaphragm Cyanosis Cough (dry, nonproductive) Chest assessment findings: Tracheal shift Decreased tactile and vocal fremitus Dull percussion note Diminished breath sounds Displaced heart sounds Pleural friction rub (occasionally)

Answer 16

= Refers to a broad group of inflammatory lung disorders More than 180 diseases Characterized by acute, subacute, or chronic inflammatory infiltration of alveolar walls by cells, fluid, and connective tissue If left untreated, the inflammatory process can progress to irreversible pulmonary fibrosis destruction of the alveoli and adjacent pulmonary capillaries fibrotic thickening of the bronchioles, alveolar ducts, and alveoli CXR: Granulomas honeycombing and cavity forming fibrocalcific pleural plaques bronchospasms excessive bronchial secretions pleural effusion Physical: cyanosis digital clubbing peripheral edema venous distension distended neck veins pitting edema enlarged and tender liver Nonproductive cough Chest assessment findings: Increased tactile and vocal fremitus Dull percussion note Bronchial breath sounds Crackles Pleural friction rub Whispered pectoriloquy Increased hematocrit and hemoglobin (polycythemia) ABG: Acute alveolar hyperventilation with hypoxemia (acute respiratory alkalosis) pH= INCREASED CO2= DECREASED HCO3= DECREASED PaO2= DECREASED SaO2= DECREASED

Answer 17

OSA= common sleep disorder that often requires lifelong care (blocked airflow) Presence of: Snoring Sleep fragmentation Periods of apnea during sleep Nonrefreshing sleep Persistent daytime sleepiness Central sleep apnea= disorder characterized by the repetitive stopping or reduction of both air flow and ventilatory effort during sleep. Brain fails to transmit signals for muscles to breaths Examples associated with it is Cheyne-Stokes breathing (CHF), medical conditions, brain stem infarction, spinal surgery, hypothyroidism, high altitude periodic breathing Diaphragm doesn't move AFIB Patients diagnosed with CSA are evaluated carefully for: The presence of cardiac disease Lesions involving the cerebral cortex and the brainstem AHI =# of apneas and hypopneas —-—------------------------ TST (hr) Physical: Apnea or hypopnea Cyanosis ABG: Acute alveolar hyperventilation superimposed on chronic ventilatory failure Possible impending acute ventilatory failure Acute ventilatory failure (acute hypoventilation) superimposed on chronic ventilatory failure CXR: Often normal Right-or left-sided heart failure

Answer 18

In response to injury: Pulmonary capillaries become engorged Permeability of the alveolar-capillary membrane increases Interstitial and intra-alveolar edema and hemorrhage Scattered areas of hemorrhagic alveolar consolidation Result in a decrease in alveolar surfactant and in alveolar collapse, or atelectasis *Create a restrictive lung disorder Physical: Increased Respiratory rate (tachypnea)/Heart rate (pulse)/Blood pressure Substernal or intercostal retractions Cyanosis Chest assessment findings: Dull percussion note Bronchial breath sounds Crackles CXR: Increased opacity, diffusely throughout lungs Ground-glass appearance ABG: Acute alveolar hyperventilation with hypoxemia (acute respiratory alkalosis) pH= INCREASED CO2= DECREASED HCO3= DECREASED PaO2= DECREASED SaO2= DECREASED

Answer 19

SIMV/VC SIMV/PC PS/CPAP BiPAP

Answer 20

PS commonly applied in the SIMV mode when the patient takes a spontaneous breath since PS is not active during mandatory breaths. Typically used to facilitate weaning in a difficult-to-wean patient Pressure support: increases the patient's spontaneous tidal volume decreases the patient's spontaneous frequency decreases the work of breathing

Answer 21

Spontaneous breathing trial is the diagnostic test to determine if the patient can be successfully extubated and weaned from mechanical ventilation for 20 to 30 mins. Starts PSC at 5-10cm and decrease 3-6cm until PSV reaches 6cm H2O.

Answer 22

= Absence of ventilatory support for at least 48 hours following extubation RSBI less than 100 breaths/min PaO2/Fio2 greater than 150mmHg Shunt less than 20% Vital capacity greater than 10mL/kg Maximal inspiratory pressure greater than -20 cmH2O (-30 is better) Static compliance greater than 30mL Deadspace want it less than 60% while intubated PEEP less than 8cm H2O pH greater than 7.25 PS less than 8cm Greater than 3 mins of spontaneous breathing

Answer 23

= failure of SPT (1) increase of airflow resistance, (2) decrease of compliance, (3) respiratory muscle fatigue Occurs within the first 20 to 30 min Clinical signs and symptoms include Agitation Anxiety Diminished mental status Diaphoresis Cyanosis Increased work of breathing

Answer 24

heart rate greater than 100 bpm (normal P-QRS-T pattern)

Answer 25

heart rate less than 60 bpm (normal P-QRS-T pattern)

Answer 26

= not preceded by a P wave and QRS complex is wide, bizarre, and not normal

Answer 27

P wave is generally not noticeable and QRS is wide, bizarre, and T wave may not be separated from QRS complex

Answer 28

chaotic electrical activity and cardiac activity, ventricles quiver out of control and no perfusion beat-producing rhythm no cardiac output, blood pressure, PT can die in minutes without treatment

Answer 29

= complete absence of electrical and mechanical activity cardiac activity and blood pressure fall to 0

Answer 30

First-degree AV block involves the consistent prolongation of the PR interval due to delayed conduction via the atrioventricular node

Answer 31

what is their level of consciouness

Answer 32

= reflects the elastic properties of the lung and chest wall (resistance) Corrected Tidal volume፥(plateau pressure-PEEP)

Answer 33

= reflects the airway resistance and elastic properties of the lung and chest wall Corrected tidal volume፥(PIP-PEEP)

Answer 34

(0.5-2.5 cmH2O)= airflow obstruction in the airways radius of the airway decreases and airway resistance increases hypoventilation may result if patient is unable to overcome airway resistance by increasing work of breathing

Answer 35

acute airflow obstruction deadspace ventilation congenital heart disease cardiovascular decompensation shock increased metabolic rate drugs decreased compliance

Answer 36

used for hypnotic effect Intravenous use GABA-activated chloride ion channel Adverse effects: Apnea Bradycardia Laryngospasm and bronchospasm Coughing Dyspnea Hypotension Burning or pain at infusion site Discoloration of urine to green or brown Increased calories because of the oil-in-water formulation

Answer 37

used to control delirium in mechanically ventilated patients Reversible causes of delirium should be ruled out before using haloperidol (see next slide) Haloperidol blocks dopamine receptors in the CNS (limbic, basal ganglia, and brainstem) producing a calming effect Haloperidol also has antiemetic effect Adverse effects: Blockade of dopamine receptors in the CNS may interfere with normal motor function

Answer 38

for patients undergoing uncomfortable procedures (e.g., mechanical ventilation, cardiac or vascular surgeries, colonoscopy) provides sedation, anxiolysis, and analgesia without respiratory depression An alpha-2 adrenoreceptor agonist Provides sedation and anxiolysis via receptors within the locus coeruleus (group of neurons in the pons) Provides analgesia via receptors in the spinal cord Adverse effects: Hypotension, bradycardia, and sinus arrest are potential adverse effects because dexmedetomidine reduces sympathetic activity Transient hypertension may occur Transient neurological abnormalities may occur in children upon discontinuance

Answer 39

- FDA approved for only newborns Persistent pulmonary hypertension and hypoxemic respiratory failure of the newborn Respiratory distress syndrome and hypoxemic respiratory failure of older infants and children Acute respiratory distress syndrome Inadequate cardiopulmonary hemodynamics in infants due to lack of pulmonary blood flow and oxygenation local vasodilation of vascular smooth muscle Adverse effects: When combined with oxygen, NO is converted to NO2 (nitrogen dioxide) At a level of >10 ppm, NO2 can cause cell damage, hemorrhage, pulmonary edema, and death NO and NO2 may be converted to nitric acid (HNO3) and nitrous acid (HNO2) HNO3 and HNO2 may cause lung inflammation (interstitial pneumonia) NO is inactivated by combining with hemoglobin to form methemoglobin (methemoglobinemia) NO causes inhibition of platelet aggregation and negative inotropic effect

Answer 40

= variation of the spontaneous mode of ventilation that augments a patient's spontaneous effort with positive pressure patient spontaneously breathing facilitate weaning in a difficult-to-wean patient

Answer 41

= PEEP applied to the airway of a patient who is breathing spontaneously intrapulmonary shunting refractory hypoxemia decreased FRC lung compliance auto-PEEP not responding to adjustments of ventilatory settings can sustain lung functions

Answer 42

= applies independent positive pressure pressures (PAP) to both inspiration and expiration preventing intubation of the end-stage COPD patient supporting patient with chronic ventilatory failure restrictive chest wall disease neuromuscular disease nocturnal hypoventilation

Answer 43

= ventilator delivers the preset tidal volume at a set time interval (time-triggered frequency) (controls patients tidal volume, respiratory, minute ventilation) if patient ¨fights¨ the ventilator in the initial stages of mechanical ventilatory support tetanus or other seizure activity complete rest for the patient for 24 hour period patient with a crush chest injury

Answer 44

= patient spontaneously breathes while giving mandatory breathes when needed ventilatory support patient provides part of minute ventilation

Answer 45

= patient spontaneously breathing while time triggered by present frequency severe ARDS (need high PIP)

Answer 46

= mandatory mechanical breaths may be patient-triggered by the patient's spontaneous inspiratory efforts (assist) or time-triggered by a present frequency (control) provide full ventilatory support stable respiratory drive

Answer 47

= mandatory pressure-controlled breathes are time-triggered by a preset frequency (pressure plateau created) severe ARDS (need high PIP)

Answer 48

= provides volume-controlled breaths with the lowest pressure possible by altering the flow and inspiratory time achieve volume support while keeping the PIP at a lowest level possible

Answer 49

= causes an increase of mandatory frequency when the patients spontaneously breathing level becomes inadequate (safe minute ventilation) prevent hypercapnia preventing hypoventilation preventing respiratory acidosis

Answer 50

Its positive pressure that is applied to a patient that is spontaneously breathing. when PEEP is applied to spontaneous breathing patient, airway pressure is called CPAP

Answer 51

= airway pressure strategy, and ventilation that increases the end, expiratory or baseline airway pressure to value greater than atmospheric pressure

Answer 52

= airway pressure that is above 0cm H2O during the expiratory phase of a respiratory cycle Physiology: if the force of elastic recoil is increased due to decrease in compliance, the alveolar volume will decrease if lung compliance continues to deteriorate → elastic recoil forces become great enough to overcome normal alveolar distending pressure → alveolar collapse and intrapulmonary shunting

Answer 53

= work of breathing increases by a factor of 16-fold when the radius of the airway is reduced by half its original size driving pressure=airflow/radius 4

Answer 54

procedure explained to patient patient in Fowles (semi-sitting) positon hyperinflation and oxygenation provided with manual resuscitator via ET tube ET tube suction cuff deflated ET tube removed encourage patient to breathe deeply and cough suction secretions vital signs, ABG, signs of tissue value assessed

Answer 55

= by a central venous catheter placed through either the subclavian or internal jugular veins, measured in the vena cava or right atrium how much blood is getting pumped to right side of the heart

Answer 56

= should be set at 100mL lower than expired mechanical tidal volume alarm triggered if patient does not exhale an adequate tidal volume

Answer 57

= should be set at 10-15cmH2O below the observed PIP alarm triggered if PIP is less than alarm setting

Answer 58

= should be set 10-15cmH2O above observed PIP alarm triggered when PIP is equal or higher than the high pressure limit

Answer 59

= should be set 15-20 seconds time delay triggered in circuit disconnection, ET suctioning

Answer 60

= should be set at 10/min over the observed frequency triggering is a sign of respiratory distress

Answer 61

= should be set 5-10% over and under analyzed FIO2

Answer 62

Benefits: reinflates collapsed alveoli and supports maintains alveolar inflation during exhalation Complications: decreased venous return decrease cardiac output barotrauma increased intracranial pressure alterations of renal functions alterations in water metabolism

Answer 63

provides an even, peak flow during the entire inspiratory phase

Answer 64

may improve distribution of ventilation in patients with partial airway obstruction

Answer 65

produces a high initial inspiratory pressure and the decrease in flow may help improve distribution of tidal volume and gas exchange COPD → may reduce PIP, MAP, physiological deadspace, and PaCO2

Answer 66

improve distribution of ventilation and therefore improve gas exchange (similar to spontaneous breathing flow)

Answer 67

wash hands and glove gather all suction supplies explain procedure to patient adjust vacuum to 100mmHg preoxygenate patient put sterile water in container test vacuum with suction insert catheter and advance until resistance (cough) pull catheter back (10-15 seconds) Complications: suction induced hypoxemia impeding airflow dislodging of bacteria into lower airway

Answer 68

= failure of the respiratory system to remove CO2 from the body, resulting in an abnormally high PaCO2. Occurs when the patient's minute ventilation cannot keep up with the CO2 production

Answer 69

= reduced oxygen in the blood ABG used to evaluate patient's oxygenation status

Answer 70

area clean, dry adjustment of tube every vent check proper oral care

Answer 71

heated humidification, heated wire circuit, a heat-moisture exchanger (HME)

Answer 72

Alpha 1= peripheral blood vessels Alpha 2= presynaptic sympathetic neurons, CNS Beta 1= heart Beta 2= smooth muscle (bronchial), cardiac muscle Beta 3= lipocytes

Answer 73

mode frequency tidal volume FIO2 I:E ratio inspiratory flow pattern alarm limits

Answer 74

= in the management of airflow obstruction in sleep apnea and in the reduction of respiratory workload in gross obesity

Answer 75

Drug overdose (central hypoventilation/acute respiratory insufficiency) Acute spinal cord injury (respiratory paralysis) Head trauma (abnormal respiratory pattern) Neurologic dysfunction (coma/stroke) sleep disorders (CSA/OSA) metabolic alkalosis acute airflow obstruction (COPD) Dead space ventilation (pulmonary embolism/decreased in CO) Congestive heart diseases Cardiovascular decompensation (decreased CO/VQ mismatch) Shock (blood loss/CHF) Increased metabolic rate (fever/increased WOB) Decreased compliance (ARDS/atelectasis) drugs (acute pulmonary edema/bronchospasms) chest trauma (flail/pneumothorax) premature births (idiopathic respiratory distress syndrome) electrolyte imbalance (hyperkalemia) Geratric patients (fatigue)

Answer 76

The more we break the circuit, the more we introduce to the circuit (infection control)

Answer 77

= a mask that covers only the nose Benefits: comfort patient compliance Risk: gas leaks nasal dryness drainage

Answer 78

= covers the nose and mouth Benefits: good seal more effective ventilation Risk: claustrophobia patient noncompliance regurgitation/aspiration asphyxiation in power or gas outage alarm/monitor necessary

Answer 79

= smaller nasal mask nasal congestion gas leaks nose bleed dry/sore mouth

Answer 80

= covers entire patients face

Answer 81

= the system that governs or controls the ventilator drive mechanism or output control value/ responsible for characteristics output waveforms

Answer 82

=desired output is selected and ventilatory achieves the desired output

Answer 83

=desired output is selected and ventilatory achieves the desired output

Answer 84

= a thin, flexible tube inserted into an artery to provide continuous access to arterial blood and blood pressure

Answer 85

= done in emergency situations

Answer 86

= time consuming and suitable in elective intubation

Answer 87

SV= CO/HR Normal range → 40-80 mL

Answer 88

Normal → 80-100mmHg Mild → 60-79mmHg Moderate → 40-59 Severe → less than 40

Answer 89

mode in which the ventilator drives either assisted breaths to patient at the beginning of a spontaneous breath or time-triggered mandatory breaths time triggered or patient triggered

Answer 90

each control breath provides the patient with a present, ventilator-delivered tidal volume Assisted- patient triggered Control- time triggered does not allow spontaneous breathing

Answer 91

Acetylcholine is released when the parasympathetic system is stimulated

Answer 92

pressure readings and waveforms are monitored to determine the catheter’s position as it moves through the right atrium (RA), right ventricle (RV), pulmonary artery (PA), and into a pulmonary capillary wedge pressure (PCWP) position after the PCWP reading, the balloon is deflated to allow blood to flow past the tip of the catheter

Answer 93

trauma to teeth and soft tissues esophageal intubation vomiting/aspiration hypoxia arrhythmias bradycardia obstruction pneumonia kinking mucosal injuries laryngeal damage improper tube position pressure sore inadvertent extubation sinusitis

Answer 94

= protein continuing iron that facilitates the transports oxygen in RBC PaO2 measures the amount of oxygen dissolved in the plasma whereas vast majority of oxygen in the blood is combined with or carried by hemoglobins PaO2 may be inadequate if patients hemoglobin levels are below normal (anemia)

Answer 95

= describes an urgent need to gain control of a patient's airway Steps: preparations pre-RSI medications cricoid pressure intubation post RSI stabilization

Answer 96

Etomidate (Amidate)= sedation and induction = decreases cerebral metabolic rate, cerebral blood flow, and intracranial pressure Etomidate binds at a distinct binding site associated with a Cl- ionopore at the GABAA receptor, increasing the duration of time for which the Cl- ionopore is open Succinylcholine= paralytic agent = depolarizing skeletal muscle relaxant used adjunctly to anesthesia and for skeletal muscle relaxation during intubation, mechanical ventilation, and surgical procedures It binds to the post-synaptic cholinergic receptors found on motor endplates, thereby inducing first transient fasciculations followed by skeletal muscle paralysis

Answer 97

= infection of the lung parenchyma that is related to any or multiple events that the patient undergoes during mechanical ventilation that happens after 48 hours Prevent: proper handwashing techniques closed suction systems continuous feed humidification systems change of ventilator circuit only when visibly soiled elevated head of 30-45 degrees

Answer 98

= filters dissolved particles from blood and selectively reabsorbs the substances that are needed to maintain normal composition of body fluid

Answer 99

= A gradual increase of PaCo2 caused by deteriorating lung functions with increased work of breathing/minute ventilation to compensate PaCo2 increases and pH falls → initiated mechanical ventilation

Answer 100

identifies whether bacteria are gram positive or gram negative takes 1 hour

Answer 101

performed to determine acid fast bacilli (Mycobacterium tuberculosis)

Answer 102

can be used as a diagnostic tool for bacterial and fungal infections such as infections caused by Pseudomonas app, Treponema palladium, Helicobacter pylori, Legionella, Leptospira, Bartonella, Pneumocystis, Candida, Histoplasma, Cryptococcus

Answer 103

identifies the bacteria present and takes 48 to 72 hours

Answer 104

identifies what antibiotics will kill the bacteria takes 48 to 72 hours

Answer 105

Hypokalemia (below 3): Decreased muscle functions Flattened T wave and depressed ST segment on ECG Arrhythmias Decreased bowel activity, diminished or absent bowel sounds

Answer 106

Hyperkalemia (above 5): Increased neuromuscular conduction Elevated T wave and depressed ST segment on ECG (mild) Cardiac arrest Increased bowel activity

Answer 107

= the volume of gas delivered over time, usually measured in liters per minute Unit of volume፥unit of time

Answer 108

I time= time for each breath x [I ratio/sum of I:E ratio] ex: Given= f=16/min → 60፥16 = 3.75 seconds Desired I:E ratio 1:4 = 3.75 sec x [1/(1+4)] 3.75 x (⅕) 3.75 sec ፥5 = 0.75 sec

Answer 109

= Increasing respiratory rate may manage this increase in minute ventilation, but if this is not feasible, increasing the tidal volume can increase plateau pressures and create barotrauma.

Answer 110

= minute ventilation required needs to be increased → increase ventilatory frequency 1. Decrease or remove deadspace 2. Increase Tidal Volume 3. Increase Respiratory Rate

Answer 111

1. FIRST- decrease FIO2 to less than .60 2. THEN - decrease PEEP

Answer 112

1. Increase Deadspace 2. Decrease the Respiratory Rate 3. Decrease the Tidal Volume

Answer 113

1. FIRST - increase Fio2 by 5-10% (up to 60%) 2. THEN - Increase PEEP levels by 5cmH20 until: - acceptable oxygenation is achieved - unacceptable side-effects occur (decrease in compliance, decrease in cardiac function, barotrauma)

Answer 114

Mode: control or AC Frequency: 10-12/min Tv: 10-12 mL/kg FIO2: 40%, 100% if CO2 toxicity or full cardiac arrest PEEP: 5cm H2O I:E ratio: 1:2 normal or 1:4 COPD/asthma

Answer 115

To measure elastic pressure, how well the lungs are reacting to treatment, if lungs are getting better or worse, and compliance. How much pressure were putting on the vessels