Respiratory

Question 1

What is the timed cycle ventilator

Answer 1

Pushes air into the lungs until a preset time has elapsed

Peds or neonate unit

Question 2

What is the volume cycled ventilator

Answer 2

Pushes air into the lungs until a preset volume is delivered

Constant tidal volume is delivered regardless of the changing compliance of the lungs and chest wall or airway resistance in the client or ventilator

Question 3

What is the microprocessor ventilator

Answer 3

Computer or microprocessor is built into the ventilator to allow continuous monitoring of ventilatory functions alarms and client parameters
Type of ventilator is more responsive to clients who have severe lung disease or require prolonged weaning

Question 4

Noninvasive positive pressure ventilation or bilevel positive airway pressure (bipap) - what is it and in what situations

Answer 4

Support given without using invasive airway (trach)
Orofacial masks and nasal masks are used

Situations of COPD distress, heart failure, asthma, pulmonary edema, hypercapnic respiratory failure

Question 5

Controlled ventilation what is it

Answer 5

Receives a set tidal volume at a set rate

Clients- who cannot initiate respiratory effort

Least used - client initiates a breath the ventilator locks out the clients inspiratory effort

Question 6

Assist control ventilation what is it

Answer 6

Most common
Tidal volume and ventilatory rate are preset
Takes over the work of breathing for the client
Programmed to respond to the clients inspiratory effort if they do initiate a breath

Question 7

What happens when a client initiates a breath on assist control

Answer 7

Ventilator delivers the preset tidal volume while allowing the client to control their rate of breathing

However if the clients spontaneous ventilatory rate increases - wants to deliver a preset tidal volume with each breath - may cause hyperventilation and respiratory alkalosis

Question 8

What is synchronized intermittent mandatory ventilation

Answer 8

Similar to assist control
Tidal volume and ventilator rate are preset
Can breath spontaneously at own rate and tidal volume between the ventilator breaths

Can be used on primary mode or weaning

Question 9

Complications of mechanical ventilation

Answer 9

Hypotension caused by the application of positive pressure which increases intrathoracic pressure and inhibits blood return to the heart

Respiratory complication - pneumothorax or emphysema as a result of the positive pressure

GI alterations such as stress ulcers
Malnutrition if nutrition is not maintained
Infectious
Muscular deconditioning
Ventilator dependence or inability to wean

Question 10

What are the three ways to wean off of mechanical ventilation

Answer 10

SIMV
T PIECE
PRESSURE SUPPORT

Question 11

How to wean with SIMV

Answer 11

client breaths between the preset breaths per minute rate of the ventilator

The SIMV rate is decreased gradually until the client is breathing on his or her own without the use of the ventilator

Question 12

How to wean with the t piece

Answer 12

Client is taken off of the ventilator and the ventilator is replaced with a t piece of continuous positive airway pressure - which delivers humidified oxygen

Client is taken off of the ventilator for short periods initially and is allowed to breathe spontaneously

Need to tolerate longer periods off of the ventilator

Question 13

How to wean with positive pressure

Answer 13

Pressure support is predetermined pressure set on the ventilator to assist the client in respiratory effort
As weaning continues the amt of pressure is decreased gradually

Pressure may be maintained while the preset breaths per minute of the ventilator gradually are decreased

Question 14

Define tidal volume

Answer 14

The volume of air that the client receives with each breath

Question 15

Define rate

Answer 15

The number of ventilator breaths delivered per minute

Question 16

Define fraction of inspired oxygen

Answer 16

The oxygen concentration delivered to the client

Determined by the clients condition and ABG levels

Question 17

Define peak airway inspiratory pressure

Answer 17

The pressure needed by the ventilator to deliver a set tidal volume at a given compliance

Monitoring peak airway inspiratory pressure reflects changes in compliance of the lungs and resistance in the ventilator or client

Question 18

What is continuous positive airway pressure Pi

Answer 18

Positive airway pressure through the entire respiratory cycle for spontaneously breathing clients
Keeps alveoli open - prevents alveolar collapse
No ventilator breaths are delivered but the ventilator delivers oxygen and provides monitoring alarm system - pattern is determined by the clients efforts

Question 19

What is PEEP

Answer 19

Exerted during the expiratory phase of ventilation which improves oxygenation by enhancing gas exchange and preventing atelectasis

Means that there is severe gas exchange disturbance in the client to need Peep
Higher levels of PEEP increase the chances of complications such as barotrauma and tension pneumothorax

Question 20

What is pressure support option on the machine

Answer 20

Application of positive pressure on inspiration that eases the workload of breathing
May be used in combo with PEEP to wean for breathing

As the weaning process continues the amt of pressure applied to inspiration is gradually decreased

Question 21

What is acute respiratory distress syndrome

Answer 21

As a complication of some other condition

Diffuse lung injury and leads to extra vascular lung fluid

Question 22

In ARDS where is the major site of injury

Answer 22

Alveolar capillary membrane

Question 23

What does the interstitial edema cause in ARDS

Answer 23

Compression and obliteration of terminal airways and leads to reduced lung volume and compliance

Question 24

InARDS what do the ABGs say

Answer 24

Identify respiratory acidosis and hypoxemia that do not respond to increased oxygen

Question 25

What does the CXR show in ARDS

Answer 25

Bilateral interstitial and alveolar infiltrates

Interstitial Edema may not be noted until 30% increase in fluid content

Question 26

Assessment of ARDS

Answer 26

Tachypena 
Dyspnea 
Decreased breath sounds
Deteriorating ABG levels 
Hypoxemia despite high concentrations of delivered oxygen 
Decrease pulmonary compliance 
Pulmonary infiltrates

Question 27

Assessment of tonsillitis

Answer 27

Persistent or recurrent sore throat
Enlarged bright red tonsils that may be covered with white exudate
Difficulty in swallowing
Mouth breathing and an unpleasant mouth odour
Fever
Cough
Enlarged adenoids may cause nasal quality of speech mouth breathing hearing difficulty snoring or obstructive sleep apnea

Question 28

Things to check preop before a tonsillectomy

Answer 28

Assess bleeding and clotting studies because the throat is vascular
Assess for loose teeth as aspiration might be likely
Prepare for sore throat post op and they will need to drink liquids

Question 29

Post op instructions for tonsillectomy

Answer 29

Position child prone or side lying to promote drainage
Only suction if there is a airway obstruction
Monitor for signs of bleeding - frequent sign is swallowing - turn to side

Provide an ice collar
Avoid red purple or brown foods incase the child vomits as it appears as blood

Question 30

What foods should PTS avoid post op tonsillectomy

Answer 30

Milk ice cream and pudding as they coat the throat and encourage the client to cough which will increase bleeding

Soft food will be prescribed 1 to 2 days post op

Question 31

Normal signs post op from a tonsillectomy

Answer 31

Mouth odour
Slight ear pain
Low grade fever

Question 32

Notify the physician - tonsillectomy

Answer 32

Bleeding
Persistent earache
Fever occurs

May take 1-2 weeks of recovery

Question 33

What is the pressured cycled ventilator

Answer 33

Ventilator pushes air into the lungs until a specific airway pressure is reached

Used for short periods -PACU