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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

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
**MODES of Mech. Vent** **Modes via Controlled vs. Spontaneous** **Talk about** **_Controlled Modes_**
**Controlled Modes:** * Assist-Control (**A/C or CMV)**
26
MODES of Mech. Vent ## Footnote **Modes via Controlled vs. Spontaneous** **Talk about _Spontaneous Modes_**
**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
2 **VOLUME CONTROLLED Modes:**
1. Assist-Control (A/C or CMV) 2. Synchronized Intermittent Mandatory Ventilation or SIMV--\> **Trauma Units**
28
**Volume Controlled mech. vents** **Assist-Control (A/C or CMV)**
* 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
**Volume Controlled Mech. Vent** **Synchronized Intermittent _Mandatory_ Ventilation (SIMV)**
* 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
**Pressure Controlled mech. vents** **2 types:**
1. Continous Positive Airway Pressure **CPAP** 2. Pressure Support Ventilation **PSV**
31
**Pressure Control Mech Vents** **Continous Positive Airway Pressure CPAP**
* ONLY CPAP pressure is set * **TOTALLY SPONTANEOUS** * CPAP pressure is the **same as PEEP used during other MV modes**
32
**Pressure controlled MV** **Pressure Support Ventilation** **PSV**
* Provides **Positive Pressure during INSP (iPAP) AND EXP (PEEP)** * **\*Can be used** **_in conjuction w/_ SIMV**
33
Settings: Pre-set vs. Actual ## Footnote **FiO2:** **60% or LESS ====**
GREEN LIGHT for ALL THERAPY
34
Settings: Pre-set vs. Actual **FiO2:** **\>60% ===**
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
Settings: **Pre-set vs. Actual** **FiO2**
* **60% or LESS==== GREEN LIGHT FOR ALL THERAPY** * **\>60%===YELLOW LIGHT FOR BASIC ADL/BED EX'S---\> _CAUTION_**
36
Settings: Pre-set vs. Actual **PEEP** **\<10 cmH2O ===**
GREEN LIGHT FOR ALL THERAPY
37
Settings: Pre-set vs. Acute ## Footnote **PEEP** **\>10 cmH20 ====**
YELLOW LIGHT FOR IN BED EX'S AND OOB
38
Settings: Pre-set vs. Actual **PEEP**
* **\<10cmH2O=== GREEN LIGHT ALL THERAPY** * **\>10cmH2O=== YELLOW LIGHT for IN BED EX'S and OOB**
39
Settings: Pre-set vs. Actual ## Footnote **Respiratory Rate (Pt's Actual)** **\<30 bpm====**
GREEN LIGHT FOR ALL THERAPY
40
Settings: Pre-set vs. Actual **Respiratory Rate (Pts Actual)** **\>30 bpm ===**
YELLOW LIGHT FOR IN BED EX'S AND OOB
41
Settings: Pre-set vs. Actual ## Footnote **Respiratory Rate (Pt's Actual)**
* **\<30 bpm===GREEN LIGHT** * **\>30 bpm===YELLOW LIGHT FOR IN BED EX'S AND OOB**
42
Settings: Pre-set vs. Actual **Tidal Volume (VT)**
* Be cognizant of pts **A****ctual 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
Settings: Pre-set vs. Actual ## Footnote **Alarms** **LOW Pressure vs. HIGH Pressure** **Explain _LOW PRESSURE_**
* Pt disconnects, circuit leaks/airway leaks
44
Settings: Pre-set vs. Actual ## Footnote **Alarms** **Low Pressure vs. High Pressure** **Explain _HIGH PRESSURE_**
* Pt coughs * Secretions in airways * Pt biting the tubing * DECd lung compliance * INC airway resistance * Bronchospasm * Pt fighting the vent
45
Minute Ventilation (VE)==\>
RR\*VT
46
Mech. Vent settings shown
1. Mode 1. A/C 2. FiO2 3. PEEP 4. fTOT 5. VT 6. Alarm Settings 7. VE (MIN. Vent==RR\*VT)
47
Mech. Vent Settings shown
1. Mode 1. S/T 2. FiO2 3. PEEP 4. RR 5. VT 6. Alarm Settings 7. VE (Min. Vent==RR\*VT)
48
PT Considerations w/ pts on Mech. Vents or Tubes ## Footnote **4 things (see pic):**
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
Pt enters hospital w/ severe medical condition OR worsening pulmonary status.....
Flowchart
50
Passy-Muir Valve
Cap on the end of the Tracheostomy tube \***For TALKING!!!**

CPPT II (6 decks)

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