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CPPT II > Unit 2: CPAP, BiPAP & Mechanical Vents > Flashcards

Unit 2: CPAP, BiPAP & Mechanical Vents Flashcards

1
Q

CPAP and BiPAP are what kind of Pressure ?

what do they DO?

A
  • PUSH air
  • (+) Pressure—prevent collapse of bronchioles and alveoli
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2
Q

CPAP

the “C” stands for….

A

CONTINUOUS

*Inspiration ONLY

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3
Q

BiPAP

“Bi” stands for….

A

Biphasic

  • 2x–> INSP and EXP pressure
  • NOTE: APPLE shaped== abdomen weight==more likely CPAP
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4
Q

CPAP and BiPAP are _______pressure

A

Non-Invasive

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5
Q

CPAP and BiPAP

Goals:

A
  • PREVENTS bronchial collaps
  • Improves Gas exchange
  • DECd work of breathing
  • IMPROVES ventilation in V/Q matching
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6
Q

CPAP and BiPAP improves gas exchange

3 ways:

A
  1. INC FiO2 in residual volume
  2. Maintaining open alveoli
  3. Optimizing V/Q
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7
Q

How is CPAP delivered?

2 Ways

A
  1. Mask
  2. Tracheostomy Tube
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8
Q

CPAP

  1. Mask

explain

A
  • Face mask CPAP machine
  • For:
    • ​sleep apnea
    • weak diaphragm
    • *optimizing V/Q
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9
Q

CPAP

  1. Tracheostomy Tube

Explain…

A
  • Tracheostomy CPAP setting on Ventilator
  • For:
    • ​weaning FROM MV
  • **> 2 hr CPAP wean w/ stable vitals (RR <30bpm) is a GOOD INDICATOR for weaning potential
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10
Q

CPAP

*Continuous Positive Airway Pressure

Fun Facts

A
  • ONLY 1 PRESSURE SETTING
  • Continuous POSITIVE PRESSURE t/o breathing cycle
  • SETTING: 5-25 CmH2O
  • *DOES NOT have mandatory RR
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11
Q

BiPAP

Bilevel Positive Airway Pressure

2 Settings:

A
  1. INSP phase (iPAP)
  2. EXP phase (ePAP)
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12
Q

BiPAP

iPAP phase vs. ePAP phase

A
  • iPAP is provided on ea. pt triggered breath FOLLOWED BY an ePAP
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13
Q

BiPAP Settings

iPAP vs. ePAP

A
  • iPAP
    • ​== 4 to 30 cmH2O
  • ePAP
    • ​== 2 to 20 cmH2O

*carry to mech. vent–> we want AS LOW AS POSS.–> less assist ==BETTER!!!

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14
Q

BiPAP has additional setting for RR:

what does this do?

A
  • Machine forces breath if pre-set time passes w/ apnea
    • ​Setting avg is 10-12 breaths per minute
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15
Q

Mechanical Ventilator is _______pressur support

A

INVASIVE

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16
Q

WHY does a pt. need Mechanical Ventilation?

4 reasons:

A
  1. Airway obstruction
  2. Pt unable to control oral secretions==Freq. aspirations
  3. NON-effective/NON-productive cough
    1. ​Inability to clear bronchial secretions
  4. Need for positive-pressure system
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17
Q

HOW is Mech. Vent delivered?

3 Ways:

A
  1. Nasal Pharyngeal Tube
    1. SHORT-TERM
  2. Oral ET Tube
  3. Tracheostomy Tube (can have Cuffed adult trach. tubes)
    1. Sx incision INTO trachea
      1. ​LONG-TERM 2-3d
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18
Q

Nasal Pharyngeal Tube

Mech. Vent.

A

see pics

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19
Q

Oral ET Tube

A

see pics

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20
Q

Tracheostomy Tube

Sx incision

LONG TERM

A

see pics

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21
Q

PTs SHOULD DO Prio/During PT session AND document these components of Mech. Vent.

7:

A
    1. Mode of Ventilation
    1. FiO2==20.98 or ~21%
    1. PEEP (Positive End-Exp Pressure)
      * ​HOW MUCH CPAP provided– mmH2O
    1. RR –bpm
    1. Tidal Volume (VT) – mL
    1. Alarm settings
    1. Minute Ventilation (VE) –mL/min
      * ​VE==RR*TV
22
Q

MODE of Mech. Vent

A

see pics

23
Q

Mech. Ventilation MODES

Modes via Pressure-Control vs. Volume-Control

Talk about Volume-Controlled Mode:

A

Volume-Controlled Mode:

  • ​​Assist-Control (A/C or CMV)
    • ​SET volume for ea. breath
  • Synchronized Intermittent Mandatory Ventilation or SIMV
24
Q

Mech. Ventilation MODES

Modes via Pressure-Control vs. Volume-Control

Talk about Pressure-Controlled Mode

A

Pressure-Controlled Mode:

  • Continuous Positive Airway Pressure or CPAP
  • Pressure Support Ventilation or PSV
    • ​COMMON
    • works on PRESSURE
      • ​INSP (+) pressure
25
Q

MODES of Mech. Vent

Modes via Controlled vs. Spontaneous

Talk about Controlled Modes

A

Controlled Modes:

  • Assist-Control (A/C or CMV)
26
Q

MODES of Mech. Vent

Modes via Controlled vs. Spontaneous

Talk about Spontaneous Modes

A

Spontaneous Modes:

  • Synchronized Intermittent Mandatory Ventilation or SIMV —> VOLUME CONTROLLED
  • Continous Positive Airway Pressure or CPAP—> PRESSURE CONTROLLED
  • Pressure Support Ventilation or PSV —> PRESSURE CONTROLLED
27
Q

2 VOLUME CONTROLLED Modes:

A
  1. Assist-Control (A/C or CMV)
  2. Synchronized Intermittent Mandatory Ventilation or SIMV–> Trauma Units
28
Q

Volume Controlled mech. vents

Assist-Control (A/C or CMV)

A
  • All breaths are Identical whether triggered by patient OR machine
  • Pt. can only trigger breath when it falls @ a HIGHER RR than pre-set
29
Q

Volume Controlled Mech. Vent

Synchronized Intermittent Mandatory Ventilation (SIMV)

A
  • Machine pre-set lower RR w/ pre-set VT but when pt triggers a breath the pt controls EVERYTHING
  • partially spontaneous
    • ​This is your intermittent—synchronized to get a forced breath

* Pt controls some and machine controls some

30
Q

Pressure Controlled mech. vents

2 types:

A
  1. Continous Positive Airway Pressure CPAP
  2. Pressure Support Ventilation PSV
31
Q

Pressure Control Mech Vents

Continous Positive Airway Pressure CPAP

A
  • ONLY CPAP pressure is set
  • TOTALLY SPONTANEOUS
  • CPAP pressure is the same as PEEP used during other MV modes
32
Q

Pressure controlled MV

Pressure Support Ventilation

PSV

A
  • Provides Positive Pressure during INSP (iPAP) AND EXP (PEEP)
  • *Can be used in conjuction w/ SIMV
33
Q

Settings: Pre-set vs. Actual

FiO2:

60% or LESS ====

A

GREEN LIGHT for ALL THERAPY

34
Q

Settings: Pre-set vs. Actual

FiO2:

>60% ===

A

YELLOW LIGHT for Basic ADL/Bed Ex’s

*CAUTION

  • Consult w/ MDs, RTs, and nursing to det pts O2 reserve and ability to participate in mobility w/out sig. O2 desat.
  • Consider RT and/or MD to be present during PT session
35
Q

Settings: Pre-set vs. Actual

FiO2

A
  • 60% or LESS==== GREEN LIGHT FOR ALL THERAPY
  • >60%===YELLOW LIGHT FOR BASIC ADL/BED EX’S—> CAUTION
36
Q

Settings: Pre-set vs. Actual

PEEP

<10 cmH2O ===

A

GREEN LIGHT FOR ALL THERAPY

37
Q

Settings: Pre-set vs. Acute

PEEP

>10 cmH20 ====

A

YELLOW LIGHT FOR IN BED EX’S AND OOB

38
Q

Settings: Pre-set vs. Actual

PEEP

A
  • <10cmH2O=== GREEN LIGHT ALL THERAPY
  • >10cmH2O=== YELLOW LIGHT for IN BED EX’S and OOB
39
Q

Settings: Pre-set vs. Actual

Respiratory Rate (Pt’s Actual)

<30 bpm====

A

GREEN LIGHT FOR ALL THERAPY

40
Q

Settings: Pre-set vs. Actual

Respiratory Rate (Pts Actual)

>30 bpm ===

A

YELLOW LIGHT FOR IN BED EX’S AND OOB

41
Q

Settings: Pre-set vs. Actual

Respiratory Rate (Pt’s Actual)

A
  • <30 bpm===GREEN LIGHT
  • >30 bpm===YELLOW LIGHT FOR IN BED EX’S AND OOB
42
Q

Settings: Pre-set vs. Actual

Tidal Volume (VT)

A
  • Be cognizant of pts Actual VT vs. Set VT
  • *IF pt unable to maintain VT’s AND desat’ing during PT—> HOLD further therapy and consult w/ MD’s and RT’s for possible changes in vent. settings
43
Q

Settings: Pre-set vs. Actual

Alarms

LOW Pressure vs. HIGH Pressure

Explain LOW PRESSURE

A
  • Pt disconnects, circuit leaks/airway leaks
44
Q

Settings: Pre-set vs. Actual

Alarms

Low Pressure vs. High Pressure

Explain HIGH PRESSURE

A
  • Pt coughs
  • Secretions in airways
  • Pt biting the tubing
  • DECd lung compliance
  • INC airway resistance
  • Bronchospasm
  • Pt fighting the vent
45
Q

Minute Ventilation (VE)==>

A

RR*VT

46
Q

Mech. Vent settings shown

A
  1. Mode
    1. A/C
  2. FiO2
  3. PEEP
  4. fTOT
  5. VT
  6. Alarm Settings
  7. VE (MIN. Vent==RR*VT)
47
Q

Mech. Vent Settings

shown

A
  1. Mode
    1. S/T
  2. FiO2
  3. PEEP
  4. RR
  5. VT
  6. Alarm Settings
  7. VE (Min. Vent==RR*VT)
48
Q

PT Considerations w/ pts on Mech. Vents or Tubes

4 things (see pic):

A
  1. Set clear communication and expectations and provide TLC
  2. Inspect airways and note pos’s of ET tube @ START and END of ea. session
  3. Try not to pull it out! (*ESP the ET tube)
  4. If you are unable to monitor pt, the vitals, AND MV readings……ask nurse to help you
49
Q

Pt enters hospital w/ severe medical condition OR worsening pulmonary status…..

A

Flowchart

50
Q

Passy-Muir Valve

A

Cap on the end of the Tracheostomy tube

*For TALKING!!!

CPPT II (6 decks)

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