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RET2874 Final Flashcards

1
Q

Alveolar Oxygen Equation

A

PaO2 = (Pb - 47)FiO2 - (PaCO2 x 1.25)

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2
Q

Defibrillation (biphasic) initial, second, and third shock intensities

A

120 J, 150 J, 200 J

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3
Q

Indications for unsynchronized counter shock (defibrillation)

A

V-fib, v-tach, pulseless v-tach

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4
Q

Cardioversion is also known as…

A

Synchronized electric shock

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5
Q

Indications for cardioversions

A

V-tach, SVT, A-fib, A-flutter

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6
Q

Initial and subsequent voltage for cardioversions

A

50 J, 100 J, 200 J, 300 J, 360 J

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7
Q

Pressure which, if exceeded during positive pressure ventilation, can cause esophagus to open and gastric distension

A

20-25 cmH2O

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8
Q

Patients with ______________ can not tolerate BHT procedures even if a secretion clearance problem exists.

A

Acute exacerbations of COPD

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9
Q

Copious sputum production is defined as

A

25-30 mL/day

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10
Q

Supine position with the patient inclined at an angle of 45 degrees so the pelvis is higher than the head.

A

Trendelenberg

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11
Q

Trendelenberg contraindications

A

Gross hemoptysis, icp > 20mmHg, uncontrolled hypertension, distended abdomen, post neurosurgery, uncontrolled airway at risk for aspiration, esophageal surgery

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12
Q

Percussion should be performed for _______.

A

3-5 min

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13
Q

Vibration should be performed _____ percussion.

A

After

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14
Q

MI:E indications

A

Chronic neuromuscular patients

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15
Q

Involves active expiration against variable flow resistance at pressures of 10-20 cmH2O

A

PEP

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16
Q

BHT for infants

A

PDPV

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17
Q

BHT for children

A

Exercise, PEP, PDPV, ACB, HFO

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18
Q

BHT for children > 12 years

A

Exercise, ACB, PEP, PDPV, HFO

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19
Q

BHT for neuro patients

A

PDPV, suction, MI:E

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20
Q

BHT for patients with musculoskeletal weakness

A

PEP, MI:E

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21
Q

Medications for BHT

A

N-acetylcysteine, dornase alfa, hypertonic saline

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22
Q

Incentive spirometry criteria

A

VC > 15 ml/kg or IC > 33%; no difficulty with secretions

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23
Q

In IPPB the __________ and ___________ determine the tidal volume.

A

Set pressure, flow rate

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24
Q

IPPB indications

A

The need to improve lung expansion AND other therapies are unsuccessful, patient cannot cooperate, inability to clear secretions

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25
Q

Absolute contraindication for IPPB

A

Tension pneumothorax

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26
Q

Initial pressure setting for IPPB

A

10-20 cmH2O

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27
Q

Initial sensitivity setting for IPPB

A

1-2 cmH2O

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28
Q

The goal of IPPB is _____ ml/kg of IBW or at least ___ of the patient’s predicted inspiratory capacity.

A

10-15, 30%

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29
Q

Inspiration occurs at ambient pressure and expiration generates an increased pressure that gradually decreases as expiratory flow decelerates.

A

PEP

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30
Q

Inspiration occurs as ambient pressure and maintains positive pressure throughout expiration.

A

EPAP

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31
Q

Maintains positive airway pressure throughout both inspiration and expiration.

A

CPAP

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32
Q

PEP preset pressures

A

10-20 cmH2O

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33
Q

EPAP preset pressures

A

10-20 cmH2O

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34
Q

CPAP preset pressures

A

5-20 cmH2O

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35
Q

CPAP indications

A

Unresponsive atelectasis with hypoxemia, cardiogenic pulmonary edema

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36
Q

IPPB is ________ cycled.

A

Pressure

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37
Q

The sensitivity setting is __________ on a Bird IPPB.

A

Pressure

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38
Q

With IPPB, PIP should initially be set at ____________, with _____________ flow.

A

10-15 cmH2O, moderate

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39
Q

For an alert patient at high risk for atelectasis or has atelectasis and VC > 15 ml/kg or IC > 33% predicted use…

A

IS along with deep breathing, frequent repositioning, and early ambulation

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40
Q

For patients with minimal risk of post op atelectasis use…

A

Deep breathing exercises, frequent repositioning, and early ambulation

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41
Q

For patients who are high risk for post op atelectasis or has atelectasis AND secretion retention and a VC > 15 ml/kg or IC > 33% predicted use…

A

PEP or EPAP with bronchodilators, deep breathing exercises, frequent repositioning, early ambulation, and directed cough

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42
Q

High risk of post op atelectasis AND unable to use IS, PEP or EPAP with VC

A

IPPB

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43
Q

Acute hypercapnic respiratory failure critical values

A

PaCO2 > 55 mmhg and rising, pH 0.6

44
Q

Acute hypoxic respiratory failure critical values

A

PaO2 450 on O2, PaO2/PAO2

45
Q

Additional critical values for ventilatory support

A

MIP -20 to 0 cmH2O, VC 35,

46
Q

How to manage sudden distress in a ventilator-supported patient

A

Remove patient from ventilator, initiate manual resuscitation, perform rapid physical assessment, check potency of airway; if death is imminent treat for airway obstruction or pneumothorax

47
Q

Application and maintenance of pressure above atmospheric level at the airway throughout the expiratory phase of positive pressure mechanical ventilation.

48
Q

The goal of PEEP is to…

A

Improve oxygenation

49
Q

Method of ventilatory support where the patient breathes spontaneously without mechanical assistance against threshold resistance with pressure maintained above atmospheric throughout the breathing cycle.

50
Q

CPAP is the appropriate therapy for patients in CHF along with _____________________ and ____________.

A

Positive inotropic agents, diuretics

51
Q

Noninvasive mode of ventilatory support that allows separate regulation of inspiratory and expiratory pressures.

52
Q

IPAP controls…

A

Removal of CO2

53
Q

EPAP controls…

A

Oxygenation and increases FRC

54
Q

If maxed out FIO2, increase the ________ but compensate for increased EPAP or PS will decrease, thus decreasing _____________.

A

Baseline, ventilation

55
Q

Increasing the pressure support…

A

Decreases the CO2

56
Q

Indications for BiPAP

A

CHF/COPD exacerbation, hypercapnic respiratory failure, central sleep apnea, increased WOB, OSA, hypoventilation due to neuromuscular disorder, palliative care

57
Q

Exclusion criteria for BiPAP

A

Cardiac/respiratory arrest, need for immediate intubation, hemodynamics instability, uncooperative patient, and inability to protect the airway

58
Q

Spontaneous mode on BiPAP

A

Patient triggers all breaths

59
Q

Spontaneous/timed mode on BiPAP

A

Backup in case inspiration is not triggered

60
Q

Timed mode on BiPAP

A

No possibility of patient triggered inspiration.

61
Q

Initial settings on BiPAP

A

IPAP 10-15 cmH2O, EPAP 4-8 cmH2O

62
Q

Additional settings on BiPAP

A

Rate, backup rate, %IPAP (basically I time), rise time

63
Q

Alarms on BiPAP

A

High and low pressure, low minute ventilation, high and low rate

64
Q

Total leak on BiPAP should be…

A

7-25 L/min

65
Q

In TCPL ventilation, the breath ends after the set ______ has been reached and _________ regulates flow during breath.

A

I-time, pressure

66
Q

Pressure support modes are ____ cycled.

67
Q

What determines the VT in TCPL ventilation?

A

PIP, I-time

68
Q

The most powerful influence on oxygenation is…

69
Q

What contributes to the MAP?

A

I-time, PIP, PEEP, rate

70
Q

____ is the greatest contributed to the MAP.

71
Q

Initial vent settings for neonate

A

PIP 15-20 cmH2O, PEEP 3-5 cmH2O, rate 20-40 bpm, flow 6-8 l/sec, I-time .3-.5 (lbw) or .5-.8 (larger infants)

72
Q

Indications for neonatal CPAP

A

Spontaneously breathing babies with respiratory distress at birth (following surfactant)

73
Q

When to intubate a neonate

A

PaO2 50-60 mmHg, provide/protect an airway, cardiorespiratory instability, me onion, surfactant therapy

74
Q

Placement of ETT under 2 years old

A

Depth at lip = size of tube x 3

75
Q

Placement of ETT over 2 years old

A

Depth at lip = (age/2) + 12

76
Q

Determining ETT size neonates

A

1/10 GA rounded down to nearest size

77
Q

Determining ETT size 1 year old or greater

A

(Age/4) + 4

78
Q

Pediatric hypoxemia

79
Q

Neonatal hypoxemia

80
Q

Cstat formula

A

Returned Vt/(Pplat - PEEP)

81
Q

Raw formula

A

(PIP - Pplat)/flow

82
Q

Tc formula

A

Cstat x Raw

83
Q

TCT

84
Q

In volume control ventilation, the _______ and _____ remain constant while the ______ varies with lung characteristics.

A

Volume delivery, inspiratory flow, PIP

85
Q

In pressure control ventilation the ______ is constant and the _____________ and ___________ varies.

A

PIP, volume delivery, inspiratory flow

86
Q

Modes of ventilation

A

Assist/control (CMV), SIMV, Spontaneous

87
Q

Mode of ventilation which can provide full support and is either volume or pressure controlled; patient controls the rate.

A

Assist/Control (CMV)

88
Q

Mode of ventilation in which synchronized breaths improve patient comfort; can be volume or pressure controlled.

89
Q

Mode of ventilation which requires active, spontaneous respiratory drive; includes pressure support or CPAP.

A

Spontaneous

90
Q

Application of set positive pressure to a spontaneous inspiratory effort; flow is decelerating.

A

Pressure support

91
Q

Volume control mandatory breath

A

Volume limited, volume cycled

92
Q

Pressure control mandatory breath

A

Pressure limited, time cycled

93
Q

Spontaneous breath

A

Flow triggered, flow limited

94
Q

Oxygen Content Formula

A

CaO2 = (Hb x SaO2 x 1.34) + (PaO2 x 0.003)

95
Q

Volume control assisted breath

A

Volume limited, volume cycled

96
Q

Pressure control assisted breath

A

Pressure limited, time cycled

97
Q

Volume control ventilation is used in ______ and ______ modes.

98
Q

In volume control ventilation, the Vt should be set at ________ for normal lungs.

99
Q

In volume control ventilation, the Vt should be set at_______ for patients with COPD.

100
Q

In volume control ventilation, the Vt should be set at _________ for patients with ARDS.

101
Q

Pressure control ventilation is used in _____ and _____ modes.

102
Q

Normal airway resistance is _____________.

A

1 cmH2O/L/sec

103
Q

Normal compliance is ___________.

A

0.1 L/cmH2O

104
Q

Normal Tc is _______.

105
Q

Ti

A

Incomplete delivery of Vt

106
Q

Te

A

Incomplete emptying of the lungs

Respiratory Care (1 decks)

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