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RCP 210 > Test 2 Study Guide > Flashcards

Test 2 Study Guide Flashcards

1
Q

In HFOV, 1 Hz = ____ breaths/min

A

60 breaths/min = 1 Hz

(usually between 3-15 Hz)

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2
Q

Pressure Volume Curve: Areas in green show ?

A

The oscillatory breaths and the region occupied within a pressure-volume curve.

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3
Q

Pressure Volume Curve: Areas in orange show?

A

Injury

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4
Q

Pressure Volume Curve: What can appear in the lower left region?

A

Atelectrauma (low compliance)

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5
Q

Pressure Volume Curve: What can appear in the upper right region?

A

Volutrauma (low compliance)

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6
Q

How does HFOV oxygenate?

A

FIO2 and mean airway pressure oxygenate

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7
Q

How does HFOV ventilate?

A

Frequency (Hz), amplitude, and I-time ventilate.

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8
Q

the gas exchange between the lung units with different time constant

A

Pendelluft

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9
Q

during normal bulk gas flow causes gas in the center of the airway to move more rapidly than gas near the airway walls due to frictional effects

A

Gas streaming

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10
Q

simply enhanced diffusion of gas caused by the rapidly oscillating gas stream reaching the small airways

A

Taylor-type dispersion

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11
Q

Method of triggering a ventilator breath which uses natural electrical discharge from the diaphragm during inspiration (EAdia)

A

Neurally Adjusted Ventilatory Assist (NAVA)

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12
Q

The _____ is the primary difference between (NAVA) and other modes of mechanical ventilation

A

inspiratory signal trigger

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13
Q

the inspiratory signal is detected using _____

A

diaphragmatic electromyography (EMGdia)

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14
Q

In NAVA, The ventilator can be set to cycle to expiration when diaphragmatic signal reaches ___% to ___ % of its maximum signal strength.

A

40% to 70%

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15
Q

The ventilator can be set to cycle to ___ when diaphragmatic signal reaches (40% to 70%) of its maximum signal strength.

A

expiration

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16
Q

The idea in NAVA is to cycle to expiration based on a _____

A

diminished inspiratory (EAdia)

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17
Q

Why is NAVA cycled to expiration?

A

to prevent continued inflation by ventilator when patient’s central respiratory control centers have switched to the expiratory phase

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18
Q

Disadvantages of NAVA

A

Esophageal catheter cost, catheter discomfort, catheter displacement, and apnea

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19
Q

Advantage of NAVA

A

Improve patient–ventilator synchrony.

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20
Q

In case of apnea (or absence of an EMGdia signal), NAVA ventilator will return to a ___ mode as a safety feature

A

pressure-controlled mode

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21
Q

As (NAVA) levels are increased, ___ and ___ will increase

A

peak pressure and tidal volume

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22
Q

Optimal (NAVA) support allows patient to choose a ___ and ___ to maintain an appropriate (PaCO2) while sufficiently unloading the respiratory muscles

A

respiratory rate and (VT)

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23
Q

NAVA graphics: What does the yellow line mean?

A

Actual Pressure delivery

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24
Q

NAVA graphics: What does the gray line mean?

A

estimated pressure delivery

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25
Q

Optimal Placement of the NAVA Catheter

A

second and third leads are highlighted in pink and (Edi) signal is present

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26
Q

NAVA: The ____ waveform is very useful in identifying the mode of ventilation, as well as (PIP), (Pplateau), and baseline pressure (PEEP or CPAP)

A

The “pressure-time waveform,” also known as the “pressure-time scalar,

(Can also provide a visual representation of the inspiratory time, expiratory time, and (I:E ratio))

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27
Q

NAVA: The ____ provide visual confirmation of the patient’s actual inspired and expired tidal volumes.

A

Volume-time curves

28
Q

NAVA: The ____ provides a graphic display of the inspiratory and expiratory gas flow versus time

A

The “flow-time curve” or “flow-time scalar

29
Q

Maneuver which briefly holds the inspired breath prior to exhalation to obtain an inspiratory plateau pressure (Pplateau).

A

Inspiratory Pause

30
Q

represents the force required to distend the lung within the thorax at a point of no gas flow.

A

Plateau pressure

(Hold for (0.5 to 2 seconds)

31
Q

Formula for calculating RAW

A

RAW = (PIP – Pplateau) ÷ inspiratory flow rate

32
Q

Normal RAW in intubated patients

A

(5 to 10 cm H2O/L/sec)

33
Q

(RAW) is the difference between ___ and ___

A

(PIP) and (Pplateau).

34
Q

What increases RAW?

A

Bronchospasm, increased secretions, mucosal edema, mucus plugging, (ETT) occlusion

35
Q

Calculate the RAW given the following:

FIO2: .60
Peak Pressure: 38
Vt: 600
Flow: 40 LPM
Rate: 12
Pplat: 29
PEEP: 5

A

First convert flow:

40 LPM/60 = .67 L/sec

PIP-Pplat/Flow: 38-29/.67 = 13.43

36
Q

Formula for static compliance

A

(CST) = VT ÷ (Pplateau – PEEP).

37
Q

Normal static compliance for nonintubated patients

A

60 to 100 mL/cm H2O.

38
Q

Normal static compliance for intubated patients

A

40 to 60 mL/cm H2O.

39
Q

____ is determined by the patients lung compliance and thoracic or chest wall compliance.

A

Static compliance

40
Q

What will decrease lung compliance

A

Atelectasis, pneumonia, pulmonary edema, (ARDS), and pulmonary fibrosis

41
Q

Will cause decreased thoracic compliance

A

Thoracic cage deformities, ascites, obesity, and pregnancy

42
Q

During volume ventilation, how is the (PIP) affected by a decrease in compliance

A

the peak inspiratory pressure (PIP) will increase

43
Q

During volume ventilation, how is the (PIP affected by an increase in airway resistance?

A

an increase in airway resistance will directly cause the Peak Inspiratory Pressure (PIP) to increase

44
Q

With an increase in (RAW), how is the (PIP- Pplateau) difference affected?

A

An increase in airway resistance (Raw) will result in a higher than expected difference between the peak inspiratory pressure (PIP) and plateau pressure (Pplateau)

45
Q

How is the (Pplateau) affected by a decrease in compliance?

A

When compliance decreases, the plateau pressure will increase

46
Q

Simplified alveolar air equation

A

PAO2 = PIO2 – (PaCO2/0.80)

47
Q

What is the (PAO2) of a patient breathing (60% oxygen), with a (PaCO2) of (45 mm Hg) at a (PB) of (760 mm Hg)?

A

PAO2 = .60 (713) - (45/.80)
PAO2 = 427.8 - 56
PAO2 = 371.8

(Normal value is 100)

48
Q

Formula for oxygen delivery

A

DO2 = (CaO2 x 10) × ̇QT

(Normal oxygen delivery is 1000)

49
Q

Things that will include PAO2

A

Increase (FiO2)
Increased (PB)
Decreased (PaCO2)

50
Q

Alarm settings for low TV

A

(100 mL) below set tidal volume

51
Q

Alarm settings for low MV

A

(20%) above and below average minute ventilation (2 L/min)

52
Q

Alarm settings for PEEP

A

2 to 5 cm H2O below set (PEEP)

53
Q

Alarm settings for Peak Inspiratory Pressure

A

(5 to 10 cm H2O) above observed (PIP)

54
Q

Apnea Alarm setting

A

(20 seconds)

55
Q

Alarm settings for Respiratory Rate

A

(10 breaths/min) above total rate.

56
Q

Level ___ alarms require immediate attention, cannot be silenced, and are life threatening

A

Level 1

(patient should be immediately disconnected from mechanical ventilation and ventilated manually via resuscitation bag with (100% FiO2) until the problem can be identified and corrected.

Replacing the ventilator with another unit should be immediately considered if the problem cannot be readily identified)

57
Q

Level ____ alarms may be life threatening, if left unattended

A

Level 2

58
Q

Level ___ alarms are generally associated with patient ventilatory parameter fluctuations including volume loss or lung mechanics alteration

A

Level 3

59
Q

Examples of Level 1 alarms

A

Power failure
Control circuit failure
High or low primary line pressure
Exhalation valve failure

60
Q

Examples of Level 2 alarms

A

Humidification failure
High/Low PEEP
FIO2 blender control failure
Circuit leak
Circuit occlusion

61
Q

Examples of Level 3 alarms

A

AutoPEEP
High or low Ve
High or low Vt
High or low peak pressures

62
Q

Effects of mechanical ventilation on the pulmonary system

A

Support tissue oxygenation and removal of carbon dioxide without causing additional trauma

◦Ventilating chronic (CO2) retainers to achieve a normal (CO2) may result in unwanted alkalosis.

◦(FiO2) to (0.70) within two days, (0.50) or less within five days

Limit use of (100%) oxygen to less than (24h) to avoid oxygen toxicity, absorption atelectasis, ventilation depression in chronic (CO2) retainers, and retinopathy of prematurity in neonates.

63
Q

Effects of mechanical ventilation on the immune system

A

triggers activation of the inflammatory cascade.

Patients who receive large tidal volume ventilation and low (PEEP) have higher concentrations of inflammatory mediators

Ventilator-associated pneumonia (VAP) is a form of hospital acquired pneumonia which develops (48 hours) or more after the initiation of mechanical ventilation.

Clinical findings often include a new or progressive lung infiltrate on imaging, fever, purulent sputum, leukocytosis, and deteriorating oxygenation status

64
Q

Signs of ventilator-associated pneumonia

A

new or progressive lung infiltrate on imaging, fever, purulent sputum, leukocytosis, and deteriorating oxygenation status

65
Q

Effects of mechanical ventilation on the cardiac system

A

RCP 210 (6 decks)

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