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RCP 210 > Test 3 Study Guide > Flashcards

Test 3 Study Guide Flashcards

1
Q

Methods to reduce Ventilator Induced Lung Injury (VILI)

A

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

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2
Q

Most airway complications are associated with _______

A

Endotracheal tube

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3
Q

Purposes of ET cuff (2)

A

To seal the airway for optimal delivery of mechanical ventilation.

2.To prevent aspiration and reduce incidence of VAP.

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4
Q

Recommended cuff pressure

A

20-30

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5
Q

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

A

bag-valve-mask

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6
Q

the primary driver of (VILI)

A

Alveolar overdistention

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7
Q

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

A

transpulmonary pressure

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8
Q

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

A

Volutrauma

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9
Q

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

A

Barotrauma

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10
Q

Gas embolism occurs in the ____

A

Pulmonary veins

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11
Q

Pneumothorax occurs in the ____

A

Pleural Cavity

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12
Q

Mediastinal emphysema and subcutaneous emphysema occur in the _____

A

Mediastinum

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13
Q

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

A

atelectrauma

(use of optimal PEEP)

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14
Q

Optimal PEEP range

A

6-8

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15
Q

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

A

Ventilator induced pneumonia

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16
Q

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

A

circuit

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17
Q

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

A

(VAP) bundle protocols

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18
Q

Prevention strategies for VAP

A

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.

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19
Q

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

A

inspired oxygen

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20
Q

Clinical consequences of oxygen toxicity

A

Absorption atelectasis
◦Worsening hypercapnia
◦Airway and parenchymal damage

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21
Q

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

A

alveolar nitrogen washout

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22
Q

_____ results from the Haldane effect and increased dead space ventilation

A

Hyperoxic hypercarbia

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23
Q

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

A

bleomycin (Blenoxane)

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24
Q

FiO2 should be ___ whenever possible

A

<60%

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25
Q

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

A

Patient-ventilator asynchrony

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26
Q

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

A

Scaler

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27
Q

Types of scalers

A

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

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28
Q

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

A

Loops

(Pressure-volume loop
Flow - volume loop)

29
Q

Pressure-volume loop = _____

A

Compliance

30
Q

Constant flow pattern is used with _____ targeted ventilation.

A

volume

31
Q

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

A

Volume targeted ventilation

32
Q

Descending flow pattern is used with ____ targeted ventilation.

A

Pressure

33
Q

Flow rate decays during inspiration

A

Pressure-targeted ventilation

34
Q

Inspiratory flow is above the isoflow line.

Inspiratory flow resembles a sine wave.

A

Spontaneous breath

35
Q

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

A

Rise time

36
Q

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).

A

Rapid rise time

37
Q

Delays initial flow delivery.

Delays the rise in pressure to the preset level.

A

Slow rise time

38
Q

Causes of airway obstruction

A

Bronchospasm
Inflammation
Secretions

39
Q

Characteristics of airway obstruction

A

Decreased peak expiratory flow.
Prolonged expiratory time

40
Q

Airway obstructions response to bronchodilators

A

Increased peak expiratory flow.
Shorter expiratory time

41
Q

Causes of air trapping

A

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.

42
Q

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

A

Inspiratory tidal volume the upstroke
Expiratory tidal volume is downstroke

42
Q

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).

A

V-T waveform

43
Q

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

A

plateau

44
Q

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

A

Disconnect the patient

45
Q

Tidal Volume range to prevent VILI

A

4 to 8 mL

46
Q

Most common airway complications

A

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

47
Q

Normal adult urine output

A

60 mL/hr
1500 mL/day

48
Q

Amount for polyuria

A

> 3L/25 hours

Diabetes mellitus
◦Diabetes insipidus
◦Excessive fluid intake
◦Diuretics

49
Q

Amount for oliguria

A

<500 mL/24 hours

Acute nephritis
◦Hypotension
◦Hypovolemia
◦Renal failure

50
Q

Xray shot from back to front. Clearer than AP xrays

A

Posteroanterior (PA)

51
Q

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

A

Anterior posterior (AP)

52
Q

Know xrays: Atelectasis v. Pneumothorax and tubes

A
53
Q

Normal range for BUN

A

3-20 mg/day

54
Q

Normal range for Creatinine

A

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

55
Q

Normal range for Glomerular filtration rate (GFR)

A

(90 to 120 mL/min)

56
Q

Normal range for BNP

A

<100 pg/mL)

Increased in heart failure

57
Q

Normal Troponin

A

<0.01%

Draw and trend serial numbers

58
Q

Complications of PEEP

A

Barotrauma by overdistention

Compromises cardiac output and blood pressure.

May reduce cerebral venous outflow

59
Q

Absolute contraindication of PEEP

A

Tension pneumothorax

60
Q

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

A

Prone positioning

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

61
Q

CPAP mode for recruitment maneuvers

A

“30 for 30” or “40 for 40”

30 of PEEP for 30 seconds

62
Q

Bronchial hygiene techniques to improve oxygenation

A

Suctioning
Airway care
Humidification
Bronchodilators
Inhaled corticosteroids

63
Q

Formula for dead space to tidal volume ratio

A

VD/VT = (PaCO2 - PCO2) ÷ PaCO2

Normal is 0.30 but range is 0.20 - 0.40

64
Q

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

A

hyperventilated

65
Q

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

A

Permissive hypercapnia

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

66
Q

Ventilator adjustments that will decrease (PaCO2) include

A

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

67
Q

Ventilator adjustments that will increase (PaCO2) include

A

Decreased tidal volume
Decreased frequency
Addition of mechanical dead space

RCP 210 (6 decks)

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