Test 3 Study Guide

Question 1

Methods to reduce Ventilator Induced Lung Injury (VILI)

Answer 1

Use of positive end expiratory pressure (PEEP)◦
Lung recruitment strategies◦
Permissive hypercapnia
◦Pressure limited modes
◦Noninvasive ventilation (NIV).

Tidal volume range of 4-8 mL

Question 2

Most airway complications are associated with _______

Answer 2

Endotracheal tube

Question 3

Purposes of ET cuff (2)

Answer 3

To seal the airway for optimal delivery of mechanical ventilation.

2.To prevent aspiration and reduce incidence of VAP.

Question 4

Recommended cuff pressure

Answer 4

20-30

Question 5

a _____ with a (PEEP) valve should be available at the bedside for unforeseen events.

Answer 5

bag-valve-mask

Question 6

the primary driver of (VILI)

Answer 6

Alveolar overdistention

Question 7

difference between plateau pressure and pleural pressure, determines the degree of alveolar distention.

Answer 7

transpulmonary pressure

Question 8

As plateau pressure rises, so does the transpulmonary pressure, which can result in ____ or lung injury related to high lung volumes

Answer 8

Volutrauma

Question 9

refers to injuries caused by high ventilation pressure, resulting in alveolar rupture and release of gas

Answer 9

Barotrauma

Question 10

Gas embolism occurs in the ____

Answer 10

Pulmonary veins

Question 11

Pneumothorax occurs in the ____

Answer 11

Pleural Cavity

Question 12

Mediastinal emphysema and subcutaneous emphysema occur in the _____

Answer 12

Mediastinum

Question 13

Ventilation at low tidal volumes can induce _____ the repeated collapse and opening of the alveoli with each breath

Answer 13

atelectrauma

(use of optimal PEEP)

Question 14

Optimal PEEP range

Answer 14

6-8

Question 15

Pneumonia that develops after (48 hours) of being placed on mechanical ventilation

Answer 15

Ventilator induced pneumonia

Question 16

The ventilator ____ itself provides an environment for bacterial growth and biofilm production.

Answer 16

circuit

Question 17

Formation of _____ implementing these strategies has been associated with a significant reduction in development of (VAP).

Answer 17

(VAP) bundle protocols

Question 18

Prevention strategies for VAP

Answer 18

Avoiding invasive mechanical ventilation when possible.

◦Minimizing time on mechanical ventilation by minimizing sedation and implementing weaning protocols early.

◦Elevating the head of bed to (30 to 45 degrees).

◦Removal of subglottic secretions.

Question 19

Airway lining and alveoli are most exposed to ____ and are at the highest risk for cellular injury.

Answer 19

inspired oxygen

Question 20

Clinical consequences of oxygen toxicity

Answer 20

Absorption atelectasis
◦Worsening hypercapnia
◦Airway and parenchymal damage

Question 21

High levels of inspired oxygen result in ______ and ultimately alveolar closure, or atelectasis

Answer 21

alveolar nitrogen washout

Question 22

_____ results from the Haldane effect and increased dead space ventilation

Answer 22

Hyperoxic hypercarbia

Question 23

Certain drugs, such as _____ may increase the sensitivity of the lungs to oxygen.

Answer 23

bleomycin (Blenoxane)

Question 24

FiO2 should be ___ whenever possible

Answer 24

<60%

Question 25

____ is most significant condition associated with prolonged mechanical ventilation, increased sedation, and even death in the (ICU)

Answer 25

Patient-ventilator asynchrony

Question 26

ny single variable displayed against time on the ventilator is known as

Answer 26

Scaler

Question 27

Types of scalers

Answer 27

Flow-time (F-T), volume-time (V-T), and pressure-time (P-T)

Question 28

formed by plotting inspiratory and expiratory curves of two of the three following variables; pressure, flow, volume

Answer 28

Loops (Pressure-volume loop Flow - volume loop)

Question 29

Pressure-volume loop = _____

Answer 29

Compliance

Question 30

Constant flow pattern is used with _____ targeted ventilation.

Answer 30

volume

Question 31

Peak flow rate maintained at set value. I-time varies with changes in compliance and resistance. Expiration is generally passive

Answer 31

Volume targeted ventilation

Question 32

Descending flow pattern is used with ____ targeted ventilation.

Answer 32

Pressure

Question 33

Flow rate decays during inspiration

Answer 33

Pressure-targeted ventilation

Question 34

Inspiratory flow is above the isoflow line. Inspiratory flow resembles a sine wave.

Answer 34

Spontaneous breath

Question 35

the time it takes for airway pressure to reach a preset maximum value

Answer 35

Rise time

Question 36

Allows instantaneous delivery of flow at the start of the breath. Immediate rise in pressure to the preset level. When rise is set to fast, turbulence can result in a higher than preset airway pressure (PIP).

Answer 36

Rapid rise time

Question 37

Delays initial flow delivery. Delays the rise in pressure to the preset level.

Answer 37

Slow rise time

Question 38

Causes of airway obstruction

Answer 38

Bronchospasm Inflammation Secretions

Question 39

Characteristics of airway obstruction

Answer 39

Decreased peak expiratory flow. Prolonged expiratory time

Question 40

Airway obstructions response to bronchodilators

Answer 40

Increased peak expiratory flow. Shorter expiratory time

Question 41

Causes of air trapping

Answer 41

The presence of air trapping can result from inadequate alveolar emptying as a result of increased airway obstruction .May result from short expiratory time. High respiratory rates. Excessively long I-time.

Question 42

Inspiratory tidal volume is the _____ Expiratory tidal volume is the _____

Answer 42

Inspiratory tidal volume the upstroke Expiratory tidal volume is downstroke

Question 42

The ____ waveform is useful in detecting air leaks as a result of volume loss through the circuit, a chest tube, bronchopulmonary fistula, or around the cuff of the endotracheal tube (ETT).

Answer 42

V-T waveform

Question 43

The volume of the leak can be easily estimated by measuring the distance from the ____ to the end of the expiratory tracing.

Answer 43

plateau

Question 44

In any situation in which the ventilator does not appear to be functioning correctly, immediately _____

Answer 44

Disconnect the patient

Question 45

Tidal Volume range to prevent VILI

Answer 45

4 to 8 mL

Question 46

Most common airway complications

Answer 46

Laryngeal and tracheal injuries, including laryngeal edema, vocal cord injury, and tracheal stenosis,

Question 47

Normal adult urine output

Answer 47

60 mL/hr 1500 mL/day

Question 48

Amount for polyuria

Answer 48

>3L/25 hours Diabetes mellitus ◦Diabetes insipidus ◦Excessive fluid intake ◦Diuretics

Question 49

Amount for oliguria

Answer 49

<500 mL/24 hours Acute nephritis ◦Hypotension ◦Hypovolemia ◦Renal failure

Question 50

Xray shot from back to front. Clearer than AP xrays

Answer 50

Posteroanterior (PA)

Question 51

Xray used in ICU. Shot from front to back. Can see scapula. Heart appears larger

Answer 51

Anterior posterior (AP)

Question 52

Know xrays: Atelectasis v. Pneumothorax and tubes

Question 53

Normal range for BUN

Answer 53

3-20 mg/day

Question 54

Normal range for Creatinine

Answer 54

(0.5 to 1.2 mg/dL) males (0.4 to 1.1 mg/dL) females.

Question 55

Normal range for Glomerular filtration rate (GFR)

Answer 55

(90 to 120 mL/min)

Question 56

Normal range for BNP

Answer 56

<100 pg/mL) Increased in heart failure

Question 57

Normal Troponin

Answer 57

<0.01% Draw and trend serial numbers

Question 58

Complications of PEEP

Answer 58

Barotrauma by overdistention Compromises cardiac output and blood pressure. May reduce cerebral venous outflow

Question 59

Absolute contraindication of PEEP

Answer 59

Tension pneumothorax

Question 60

May be beneficial for patients with severe ARDS, refractory hypoxemia.

Answer 60

Prone positioning Should be initiated within the first 36 hours 18-20 hours consecutively

Question 61

CPAP mode for recruitment maneuvers

Answer 61

"30 for 30" or "40 for 40" 30 of PEEP for 30 seconds

Question 62

Bronchial hygiene techniques to improve oxygenation

Answer 62

Suctioning Airway care Humidification Bronchodilators Inhaled corticosteroids

Question 63

Formula for dead space to tidal volume ratio

Answer 63

VD/VT = (PaCO2 - PCO2) ÷ PaCO2 Normal is 0.30 but range is 0.20 - 0.40

Question 64

Certain patients with dangerously elevated (ICP) may be briefly _____ to achieve a (PaCO2) between (26- and 30-mm Hg) for (6 to 12 hours).

Answer 64

hyperventilated

Question 65

ventilatory strategy which decreases tidal volume and associated delivery pressures to reduce alveolar pressures and minimize alveolar over distention.

Answer 65

Permissive hypercapnia (PaCO2) rises and (pH) falls resulting in a respiratory acidosis

Question 66

Ventilator adjustments that will decrease (PaCO2) include

Answer 66

Increased tidal volume Increased frequency Decreased mechanical dead space (if present)

Question 67

Ventilator adjustments that will increase (PaCO2) include

Answer 67

Decreased tidal volume Decreased frequency Addition of mechanical dead space