Respiratory Equipment Flashcards
1
Q
wall flow meter -
A
adjusts the flow of O2
2
Q
Nasal canula delivers between _ and _ L per minute
what % of oxygen
A
1-6L
24-44% O2
3
Q
Normal air is what percent oxygen
A
21.4%
4
Q
1 L is how much oxygen
A
24%
5
Q
High flow nasal canula delivers between _ and _ L per minute
A
6-15 L
43-72%
6
Q
What is something special about high flow nasal canula
A
Need a humidifier to keep air moist
7
Q
Face mask delivers _ and _ liters per minute
A
5-10:
35-55%
8
Q
Cool Aerosol mask (CAM) delivers between _ and _ liters per minut
A
10-12 liters per minute
need higher flow but can’t tolerate nasal
9
Q
Non-rebreather - minimum flow is
A
10-15 liters per minute
60-80% O2 with no humidity
10
Q
Non-rebreather - bag deflation
A
bag should not deflate more than 1/3 with inspiration
11
Q
When will someone be on a non-rebreather
A
often when deciding to put them on vent or not - also when come off of vent
12
Q
Non-rebreather - are they breathing in their own air
A
NO!
13
Q
Misty Ox - High flow CAM - what percent O2
A
60-96%
with humidifier
14
Q
When is misty-ox high flow CAm used
A
when come off vent and are trying to get them stronger so they dont go back on vent
15
Q
Can you take a patient out of the room with misty-ox high flow CAM
A
NO! you can walk them in the room, but you cannot take them off of this system
16
Q
Venturi mask flow is how many liters per minute
A
3-6 or 4-10?
24-50% O2
Precise FiO2
17
Q
Why would you ask for a venturi mask
A
you can use it to take them around without having to drain an oxygen tank
Dont need to order - just ask RT
18
Q
Who would you not use a venturi mask with
A
misty ox or non re-breather
19
Q
Venturi mask - where is the air coming from
A
mixing the air from the outside with the air coming from the wall or tank
20
Q
Trach collar - delivers how much O2
A
24-50%
21
Q
Describe the trach collar
A
Pt has an artificial airway - you can connect this to venturi so not using oxygen tank up
22
Q
Gas injection nebulizer (GIN)
A
Extremely high flow
100% O2
GREEN TOP
23
Q
Ambu bag - how do you use it
A
push down halfway when they breath in and let it go when they exhale
24
Q
Common mistake of oxygen delivery with someone who has a trach
A
applying oxygen over their mouth! NOO! Give it through the trach!
25
Should you have someone with a stuffy nose on a nasal canula
NO!
26
NC for mouth breather?
NO
27
What can lead to poor oxygen flow
valve turned off
tube is pinched
tank is empty
28
Patients may be cyanotic if pulse ox is lower than what
90%
29
Symptoms of hypoxemia
```
Tachycardic
Dyspnea
Cyanosis
Perspiring (diaphoresis)
HA
Mental distrubance
Maybe hyperventilat
Inc RR
```
30
Treat hypoxemia by
dec work of breathing with oxygen
| reduce myocardial work
31
How is oxygen found in the blood with pulse ox
bound to hemoglobin
32
SaO2 measures what
oxyhemoglobin
| oxygen taken from blood draw!!! (ABGs)
33
SpO2 is measured how
pulse oximetry
34
Types of pulse oximetry
bedside or portable in hand
| probe can be finger, ear, nose
35
Know what can alter pulse oximtry reading
polish, rapid HR, cold hand, excessive mvmnt...
36
What O2 sat is good enough for us to work with
90%
37
What does the textbook say is normal
More than 92
38
SpO2 in patients with COPD
want it to be 90-92 but if their norm is 88 you can work with them at 88
39
Pediatric SpO2 norm
65-85%
40
What is considered significant desaturation
3%
| Rate it by how fast they return to baseline and how it impacts their performance
41
Suctioning - types
oropharyngeal
nasotracheal
endotracheal
42
Oropharyngeal suctioning - what is used
Yankauer suction tip
Only one that PT can do and pt could do it too
Getting suction from oral pharyngeal cavitiy
43
Nasotracheal and Endotracheal -
Internal and more for those on ventilator
| Suctioning out of the lungs
44
Inadequate humidification leads to
retention of secretions
Infection
crusting of secretions
airway obstruction
45
Intubation refers to the process of
placing an endotracheal tube (ETT) in a patients airway
46
Orotracheal intubation involves placing the ETT into
the mouth or oral cavity
47
Nasotracheal intubation involves placing the ETT into
the nasal cavity
48
Ett is necessary for who
unconsious patients - to maintain an open airway and ensure ventilation
49
Disadvanatges to intubation include
HTN, Inc HR, tracheal wall necrosis, vasovagal, fistula, inability to eat/drink/talk
50
Tracheotomy is what
an artificial airway created surgically in the trache
51
When is a tracheotomy necessary
```
Complete upper airway obstruction
Long term intubation
Facial trauma
Sleep apnea - long term
Dec work of breathing and will remove secretions
They can eat drink and talk
```
52
Complications of tracheotomyh
hemorrhage, thyroid injury, nerve injury, air leak, fistula, cardiac arrest
53
What is a stoma
the opening in the ant neck after removing the trach
| THey do not suture it shut
54
Types of trach tubes - cuffed
has balloon at distal end to prevent air/secretions from going anywhere but the tube
cuff can be inflated or deflated
55
Why would a cuffed trach tube be deflated
if they want to talk - the cuff needs to be deflated but you need to get them PMV
56
Types of trach tube - high volume
low pressure requires high volume of air to inflate but will apply less pressure on the tracheal wall
57
Types of trach tube - high pressure
low volume require a low volume of air to seal the trachea
58
Can we inflate or deflate patient trach tube cuff
NO! talk to nursing or RT to ensure the appropriate cuff presssure first
59
Types of trach tubes - cuffless
no cuff at distal end - sleep apnea or long term
60
Type of cuffless trach tube
Metal (Jackson)
| common for chronic trach patients
61
Foam filled - type of trach tube (Binova)
Cuff passively inflates from atm pressure
| No air is injected into the foam cuff
62
What is good about the foam filled
it is gentle on the tracheal wall
| More for a fragile trachea that is long term use
63
Fenestrated - type of trach tube
TALKING!
| window in the tube that allows air to pass from lower to upper airway for speech
64
Bad thing about fenestrated trach tube
doesnt work well with thick secrettions so if you notice they are short of breath might be clogged
65
Trach tubes are selected based on
individual patient needs
66
Primary reason people on vents feel anxiety, fear, panic
inability to communicate
67
How to communicate with patients who have a trach
nonverbal handwritting, gestures, lip reading, communication boards, augmentative communication
68
Verbal methods for talking with those who have a trach
Passy muir valve - placed in the trach that allows air to be inhaled but then closes to allow air to exit PMV for speech
69
What to be cautious of with PMV
cuff has to be deflated
| they may be more tired when you are working with them
70
Effects of trach on swallowing
Dec laryngeal elevation
Dec sensation
Dec subglottic pressure
Can cause aspiration (debated)
71
Indications for mechanical ventialtion
```
Resp failure
CNS dysfunction
drug overdose
Obesity
Sleep apnea
Stroke
B or SC injury
MS
Metabolic imbalance
Infection
```
72
Resp failure
lack of adequate gas exchange within the lungs
73
Endotracheal tube
used initially
| securred to mouth with tape
74
optimal position for endotracheal tube
1-2 cm above carina
75
Nasoendotracheal tube used when
if endotracheal causes more damage
76
Tracheostomy tube
surgically inserted around 2nd or 3rd tracheal ring
77
Two types of ventilators
Neg pressure
| Pos pressure
78
Problems with neg pressure ventilators
not easy access to patient
79
Neg pressure ventilator - how it works
pull the air out and cause someone to breath
| but messes with their CO
80
Pos pressure ventilator
pushing air into their lungs and then they exhale
81
Classification of ventilators
pressure ventilators
| Volume ventilators
82
Tidal volume - norm
5-10 ml/kg of body weight
83
Tidal volume is what
volume of air in a normal breath
84
what is the tidal volume for ventilator dependent patients
10-15 ml/kg
85
Ventilator - rate
number of ventilatory breaths delivered per minute
86
Norm - rate
10-12 breaths per minute but will vary with idal volume
87
FiO2 what does it stand for
fraction of inspired air
88
FiO2 is what
Oxygen concentration of the gas delivered by the ventilator
Has a humidifier on it
Usually 30-100%
89
FiO2 that we wont work with
80-100%
90
Peak inspiratory pressure is what
pressure exerted on the lung when the required volume is delivered
91
Peak inspiratory pressure alarm goes off when
pressure limit is reached before the preset volume is delivered
or if something is obstructing it
92
PEEP stand for what
positive end expiratory presure
93
PEEP is what
an expiratory maneuver in which the airway and intrathoracic pressure are not allowed to return to atmospheric
94
What is PEEP used in conjunction with
positive pressure ventilation
95
Classic criterion for using PEEP
inability to maintain PaO2 above 60mmHg with and inspired O2 conc of 50% or higher
96
What is normal PEEP
5
97
Ventilator can give what PEEP
0-15
98
What PEEP do you consider as precaution for whether to work with them or not
10-15 range
99
Inspiratory Hold
Maneuver that either presets the pressure or a predetermined volume is reached and held for a period of time before the exhalation is initiated
This is a setting on the vent - trying to mimic normal breathing
100
Expiratory retard
resistance applied to exhalation whereby the circuit pressure is permitted to drop slowly to atm.
Also hleps mimin normal breathing
101
Modes of ventilator - Control mode is also called
Constant minute ventilation
| Controlled mandatory ventilation
102
Modes of ventilator - control mode does what
```
# of breaths you have is preset
typically after surgical procedures
Vent is doing pretty much everything for them - usually used when undergoind a durgical procedure and they are sedated
```
103
Modes of ventilator - assist control
set minimum # of breaths and tidal volume
| Can be pressure or volume controlled
104
Modes of ventilator - assist control - sensitivity is set so that if patient does breath above the preset number of breaths what happens
the ventilator will adjust
They can be breathing on their own and if they dont reach set volume or pressure then the machine will supplement what is needed to match the specific setting
105
SIMV stands for
synchronized intermittent mandatory ventilation
106
SIMV does what
sets the min number of assisted breaths and tidal volume
107
SIMV - pt might breath on their own with this but what is differenct with this and assist control
this one they can take a breath on their own but if they do not reach the set setting it wont help them get to it... but it does have a min number of assisted breaths
108
MMV stands for
Mandatory minute ventilation
109
MMV does what
gives mandatory breaths when needed
| Consered with rate
110
PSV/CPAP stands for
Continuous positive airway pressure
111
PSV/CPAP does what
technique to apply PEEP to a spontaneously breathing pt
Maintains pos pressure through resp cycle
used to wean off ventilator
112
what is CPAP with smartcare
ventilator makes changes on its own depending on pt needs
113
Caution with CPAP and smartcare
turn it off when working with pt
| it will reset them and then the settings might be too high when you are done working with them
114
NIPPV stands for
non invasive pos pressure vent
115
NIPPV does what
connected to vent via tight mask
| for those that dont want to be intubated but need to be ventilated
116
Vent alarms
```
1 high pressure from anything clogging it
2 low pressure if something disconnected
3 Low PEEP/CPAP - break in line
4 low exhaled volume - something leaking
5 apnea alarm - pt not taking breath
6 inc volumes - shallow breathing
7 inc frequency - pt breathing faster
```
117
What to do first for someone on vent
talk with nursing and check medical record
