Rehab for the Patient with Respiratory Failure

Question 1

3 principles of rehab?

Answer 1

1. Early mobilization of the patient
2. Mobilization can precede ventilator weaning
3. Increased strength = better vent weaning

Question 2

Causes of respiratory failure (7)

Answer 2

a. restrictive airway disease
b. neuromuscular disorders
c. metabolic issues such as kidney failure decreasing blood pH
d. decreased perfusion (PE)
e. reactive airway disease
f. obstructive airway disease
g. ventilatory failure

Question 3

Severe hypoxemia

Answer 3

PaO2

Question 4

Hypercapnia

Answer 4

PaO2 > 40 mmHg

Question 5

Normal PaO2

Answer 5

80-100 mmHg

Question 6

Normal PaCO2

Answer 6

35-45 mmHg

Question 7

Normal pH

Answer 7

7.35-7.45

Question 8

Respiratory acidosis

Answer 8

higher CO2 with lower pH

Question 9

Pulse oximetry gives you what information?

Answer 9

% of O2 in the blood

Question 10

Signs of rising CO2

Answer 10

patient is combative and confused

Question 11

O2 delivery systems (3)

Answer 11

1. Nasal cannula: 1-6 L/min
2. Pendant Oxymizer: 6-15 L/min
3. Bipap/CPAP: Continuous Positive Airway Pressure (non-invasive and used for sleep apnea

Question 12

4 modes of ventilation

Answer 12

1. Full support
2. Assisted ventilation
3. Intermittent ventilation
4. Continuous Positive Airway Pressure (CPAP)

Question 13

Full support ventilation

Answer 13

gives full breath once patient initiates breath

Question 14

Assisted ventilation

Answer 14

allows patient to control breathing rate & depth in between ventilator breaths

Question 15

Intermittent ventilation

Answer 15

patient can spontaneously breathe in between breaths given by machine

Question 16

CPAP

Answer 16

patient initiates every breath & gives pressure to help

Question 17

Metabolic encephalopathy

Answer 17

delirium from electrolyte imbalances

Question 18

Reasons for tracheostomies

Answer 18

a. need for ventilation > 2 weeks
b. inability to swallow
c. blockage of airway
d. obstructive sleep apnea
e. frequent suctioning needed due to ineffective cough

Question 19

3 types of tracheostemies

Answer 19

1. cuffed
2. uncuffed
3. fenestrated

Question 20

Cuffed tracheostemy

Answer 20

• • holds the trach in place & prevents air flow to nose & mouth
• • if the outer bag is inflated, the cuff is inflated

Question 21

Uncuffed tracheostemy

Answer 21

– allows air flow over vocal cords - patient can talk

Question 22

Fenestrated tracheostemy

Answer 22

• • allows patient to talk

- - often promote increased scar tissue

Question 23

Positioning of trach

Answer 23

1. the trach does NOT interfere with the passage of food
2. the trach is below the vocal cords
3. the cuff holds the trach in place
4. the cuff prevents air passing up thru vocal cords

Question 24

Passy-Muir Valves

Answer 24

cuffless or deflated cuff w/ valve allows expired air to flow over vocal folds; but inspired air comes thru trach