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N202 > respiratory/vent exam > Flashcards

respiratory/vent exam Flashcards

1
Q

movement of air in and out of lungs, passive exhalation, can give 21% (RA) to 100% oxygen

A

mechanical ventilation

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2
Q

what are some indications for mechanical ventilation

A

acute resp. failure, apnea, hypoxemia, hypercapneia, sepsis, severe COPD

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3
Q

negative pressure ventilation

A

Iron lung, no airway protection,

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4
Q

positive pressure ventilation modes are

A

assist control, synchronized intermittent mandatory ventilationpressure support ventilation

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5
Q

the most common, the ventilatior controls the amount of volume the patient will revieve, this option requires a rate, Vt, inspiratory time, and PEEP be set for the pt, when the pt initiates a spontaneous breath, a full volume breath is delievered, decreases the work of lungs

A

assist control

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6
Q

this mode requires that rate, Vt, inspiratory time, sensitivity, and PEEP are set, in between mandatory breaths, pts can spontaneously breathe at their own rates and Vt. the vent synchronizes the mandatory breaths with the pts own inspitations, this cannot be used on critically ill, or fatiqued

A

synchronized intermittent mandatory ventilation (SIMV)

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7
Q

what is a normal tidal volume

A

500 ml

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8
Q

how is pressure support written as an order

A

PS 15/8

  • 15 is inhalation
  • 8 is exhalation
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9
Q

this mode provides an augmented inspiration to a spontaneously breathing pt, no machine breaths, when the pt initiates a breath, a high flow of gas is delivered to the preselected pressure level, used to wean pts off vent, helps with inhalation, it decreases pts work of breathing, the vent addds a pressure boost to help with inspitations so it decreases work of breathing caused by endotracheal tube and vent tube

A

pressure support ventilation (PSV)

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10
Q

this vent option creates a positive pressure at the end of exhalation. it restores FRC.

A

PEEP

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11
Q

this vent option restores FRC, the pt recieving PSV or SIMV with PEEP, recieves this when breathing spontaneously, the pressure is continuous during spontaneous breathing,

A

CPAP

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12
Q

FRC

A

functional resistance capacity, helps to increase gas exchange in between breaths, keeps alveoli open

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13
Q

2 levels f positive pressure support provided with O2, high inspiratory and lower expiratory pressures via tight fitting mask; noninvasive, mask goes over mouth and nose, for inhalation and exhalation

A

BiPAP

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14
Q

what is the highest pressure measured in the lungs upon inspiration

A

peak airway pressure/peak inspiratory pressure

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15
Q

what do you want your peak airway pressure/peak inspiratory pressure to be?

A

less than 30 cm, normally 20 cm H2O, with a cough 55-60 cm H20
-it is set to end inspiratory phase to prevent trauma

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16
Q

plateau pressure (end inspiratory static pressure)

A

want it to be less than 30 cm H20, greater than 30 cm of H2O stretches lung and injuries tissue, in order to get this measurement you must pause vent

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17
Q

FIO2

A

fraction of inspired O2, 21-100% (usually 40-60%), usually adjusted to maintain PaO2 greater 60 mmHg or SpO2 level of greater 90%

  • goal is to give the least amount of O2 possible
    (ex. 0.5 = 50%)
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18
Q

Vt

A

volume of gas delivered to pt during each vent breath, goal Ve 5-10 L, 5-8 ml/kg is normal
Ve = minute ventilation (RR x Vt)

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19
Q

Rate (respiratory rate)

A

set between 12-16/minute, 3 of breaths/min

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20
Q

I:E ratio

A

inspiratory to expiratory ratio, normal is 1:2

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21
Q

high pressure limit

A

regulates maximal pressure the vent can generate to deliver a breath (Vt), when pressure limit is reached the vent terminates the breath, usual setting is 10-20 cm of H2O above the peak inspiratory pressure

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22
Q

what will higher levels of PEEP do to FiO2

A

decrease FiO2 bc it opens up alveoli

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23
Q

PEEP

A

maintains pts airway pressure above the baseline, helps open alveoli, helps decrease risk of O2 toxicity, can have risk for pneumothorax, dont want to go above 8 cm of H2O

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24
Q

sensitivity

A

helps sincrinize the pts intrinsic (their own) with mechanical support and helps prevent the vent from hyperventilating the pt

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25
Q

what is the minute ventilation goal (Ve)

A

5-10 liters

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26
Q

etCO2

A

end tidal CO2, est amount of CO2 present at the end of each exhaled breath

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27
Q

normal etCO2

A

30-43 mmHg

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28
Q

what are some assessments that need to be done when you have a vent pt

A

breath sounds, ABGs, CXR, skin, accessory muscle use, secretions, anxiety, location of ET tube, ability to speak or whisper around tube

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29
Q

what is the approx. location of an ET tube for men and women

A

21 cm at the lip for women

23 cm at the lip for men

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30
Q

lactic acid greater then 2

A

not good, sepsis

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31
Q

what should your suctino be no higher than

A

120 mmHg pressure

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32
Q

anion gap

A

greater 17 is acidosis

less than 10 is alkalosis

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33
Q

what complications can happen with ventilators

A

VAP (prevent with chlorexidine, HOB elevated)
mechanical over ventilation
pnumothorax, sub Q emphasyma

34
Q

what does the pt need to show in order to start weaning from the vent

A

breath on their own with a Vt of 350 on pressure support, RR 12/24, oxygen at 40% or less, 20-40 of baseline for BP, 10-20 of baseline for HR, PEEP of 5 (10/5), normal pH, no cardiac issues occuring

35
Q

how will you know that the pt is not tolerating weaning

A

acidodic, diaphoresis, anxiety, SpO2 less 90%, SBP less 90, SBP greater 180, RR greater then 35, accessory muscle use

36
Q

what will a increase RR cause

A

increase of RR = hyperventilation = decrease of CO2 = resp. alkalosis

37
Q

action of propofol

A

rapidly acting hypnotic, produces amnesia, inhibits sympathetic vasoconstricter nerve activity

38
Q

contriindications of propofol

A

allergy to glycerol, soybean oil, egg products, pregnancy, or pts who are lactating

39
Q

onset of propofol

A

40 seconds

40
Q

dosage of propofol

A

5-50 mcg.kg.min (for no longer than 72 hours)

41
Q

what can effect the amount of propofol that needs to be given

A

illicit drugs & alcohol abuse

42
Q

what adverse effects can propofol have on pts

A

decrease BP/HR/CO, dysrhythmias, HA, seizures, acidosis, infection, fever, flushing, green urine

43
Q

how often do the propofol bottles and tubing need to be changed

A

Q12 hours

44
Q

ramsay sedation scale

A

1-5 scale, 1 is awake, anxious & agitated, restless or both
4 is asleep, brisk reponse to light tactile stimuli or loud auditory stimulus
6 is no response to anything

45
Q

Nimbex action

A

non depolarizing neuromuscular blocking agent, must be given sedation and pain medications with this

46
Q

what contraindications does Nimbex have

A

history of neuromuscluar disease ( have an increase of sensitivity), cant be used for rapid sequence intubation, pts with burns may show resistance

47
Q

onset of Nimbex

A

intermediate (half life of 22-29 minutes)

48
Q

dosage of Nimbex

A

2-6 mcg/kg/min, max dose is 10 mcg/kg/min

49
Q

adverse effects of Nimbex

A

decrease BP, increase HR

cant use longer than 6 days

50
Q

assessments that need to be done with Nimbex

A

TOF (train of four), recommended blockagde is 1 or 2

0-4, o is unresponsive to anything, 4 is less than 75% blockage

51
Q

what is the reversal agent of nimbex

A

neostigmine

52
Q

why is nimbex used

A

prevents t from working against vent, eliminates coughing, gagging, less O2 consumption by muscles

53
Q

what are indications of artificial airways

A

prevention or relieve upper airway obstruction, decrease aspiration, facilitate secretion removal, provide closed system for positive pressure mechanical ventilation, respiratory distress

54
Q

oral insertion of tube passed trough mouth, vocal cords, put in trachea with aid of laryngoscope or bronchoscope

A

ET tube

55
Q

what are advantages of ET tube

A

larger diameter tube, easier to suction, can do fiberoptic bronchoscopy, reduce airway resistance & work of breathing

56
Q

why would a nasal intubation be done

A

used during oral trauma

57
Q

how long should an ET attempt be limited to

A

no more than 30 seconds

58
Q

when a CXR is taken where should the tube be

A

tip should be 3-5 cm above carina

59
Q

how long after placement of ET tube should ABGs be done

A

wait 20-30 minutes

60
Q

what does the cuff of the ET tube need to be at

A

maintain 20-25 mm Hg or less

over 25 can compress capillaries which can cause cell death

61
Q

MOV

A

minimal occluding volume, place stethoscope over trachea & inflate cuff to MOV by adding air until no leak at peak inspiratory pressure (end of vent inspiration) if no vent inflate until no sound after deep breath

62
Q

MLT

A

minimal leak technique, similar to MOV except remove a small amount of air from cuff until a slight leak is auscultated at peak inspiration (not use on vented pts)

63
Q

what needs to be done prior to placing an ET tube

A

pre oxygenate for at least 2 minutes

64
Q

what is used to check the cuff pressure of a ET tube

A

manometer

65
Q

what can be done to prevent aspiratoin with ET tube

A

HOB 30-45 degrees, OG tube

66
Q

when do you suction an ET tube

A

on the way out, oxygenate prior to and after suctioning

67
Q

post extubation assessment

A

observe for laryngospasm, stridor, diff. breathing

assess: breath sounds, neck for stridor, accessory muscle use, SpO2, LOC, RR, HR, BP

68
Q

following extubation what complications can occur

A

acute laryngeal edema, hoarseness, aspiration, stenosis of trachea

69
Q

surgical incision in trachea for breathing, sits below 2nd tracheal ring

A

tracheotomy

70
Q

opening in the neck, flange, faceplate, which rests on neck between clavicles, outer and inner cannula & obturator

A

stoma

71
Q

why would a pt get a trach

A

upper airway damage, increase comfort, suction easier, decrease work of breathing by decreasing dead space ventilation, long term vent (14 days), bypass upper airway obstruction

72
Q

when does the complete sealing of incision of a trach happen after extubation

A

72 hours

73
Q

nursing care with trachs

A

keep oburator at bedside, hemostat, suction equipment, mouth care,

74
Q

what complications can happen bc of trachs

A

mediastinal emphysema, hemorrhage, pneumothorax, cardiac arrest, pressure sore, obstruction

75
Q

what are indications for suctioning

A

visible secretions, sudden resp. distress, aspiration, increase of peak airway pressures, auscultation of adventious breath sounds, increase RR, coughing, sudden or gradual decrease in PaO2/SpO2
*suction to need not routine

76
Q

when would you have to use a bullet?

A

only when have an occlusion, rarely used bc brings bacteria to airway

77
Q

how long should you suction for

A

no more than 15 seconds

78
Q

what are signs that suctioning is not being tolerated

A

decrease in SpO2, increase in BP, sustained cough, dysrhythmias

79
Q

results from inadequate gas exchange, either insufficient O2 transferred to the blood (hypoxemia) or inadequate CO2 removal (hypercapnia)

A

acute respiratory failure

  • can be one or both
  • it is a condition not a disease
80
Q

hypoxemic respiratory failure

A

PaO2 of 60 mm Hg or less

inspired O2 concentration of 60% or greater

81
Q

hypercapnic respiratory failure

A

PaCO2 above normal (greater than 45 mmHg), acidemia (pH less than 7.35)

82
Q

what are the causes of hypoxemic respiratory failure

A

ventilation-perfusion mismatch, shunt, diffusion limitation, alveolar hypoventilation

N202 (8 decks)

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