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Module 7 > ventilated patient > Flashcards

ventilated patient Flashcards

1
Q

what 2 ABG parameters indicate respiratory status

A

pH and PaCO2

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2
Q

what are indicators a pt can not ventilate or oxygenate

A 
hypercapnia (high CO2)
respiratory failure
low PO2
RR >35
nasal flaring
tri podding
use of accessory and intercostal muscles
paradoxical breathing
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3
Q

what are late signs of respiratory failure

A

confusion, stupor, cyanosis, bradypnea, bradycardia, hypotension, dysrhythmias

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4
Q

what is indicative of respiratory failure

A

CO2 greater than 50 and low pH

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5
Q

if a pt is retaining CO2 we want to ______ the ______ volume and ________ rate

A

increase; tidal; respiratory

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6
Q

If their O2 sats are within normal limits but showing respiratory acidosis it an oxygenation or ventilation problem

A

ventilation

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7
Q

where should the ET tube be placed

A

3-4cm right above the carina

*pt will be coughing if ETT is on the carina and if you go in with suction and hit it it will cause damage

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8
Q

what is the gold standard when ETT is placed

A

capnometer
*when intubated you will put this at the end of the tube and when pt exhales and it turns yellow its good (auscultate too)

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9
Q

after using the capnometer and its successful what is next

A

secure the ET tube

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10
Q

what should the ETT balloon measure and why does it have to be that certain measurement

A

25mmHg
if overinflated it will cause tissue necrosis
if under inflated pt could aspirate whatever was sitting on top of balloon

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11
Q

what is minimal leak technique?

A

when you hear noises coming from where the ETT balloon is you get a 3cc syringe and inflate slowly until you hear nothing

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12
Q

when suctioning how long can you take

A

no longer than 10

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13
Q

when a pt has an ETT in what should the HOB be at all times

A

up

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14
Q

static compliance is

A

how stiff your lungs are

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15
Q

how can lungs be stiff?

A

every time pt has bronchitis or pneumonia for example it scars the lung tissue therefore decreasing static compliance (from coughing and damaging tissue)

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16
Q

f/RR (normal is 12-22)

A

frequency/ respiratory rate

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17
Q

fraction of inspired oxygen necessary to meet oxygenation goals (RA 21%)

A

FIO2

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18
Q

what is the I:E ratio

A

inspiratory time to expiratory time. normal 1:2 indicating exhalation time is twice as long as inhalation time

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19
Q

positive end-expiratory pressure. generally added to mitigate end- expiratory alveolar collapse (keep alveoli open) can decrease venous return to the heart

A

PEEP

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20
Q

why do we increase peep

A

when pt has really bad atelectasis we want to open up the alveoli and if we increase peep and pt inhaled it expands and when they exhale they deflate a little but don’t collapse

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21
Q

how can PEEP decrease venous return

A

if its increased pressure in thoracic it presses against vessels therefore decreasing venous return

22
Q

peak inspiratory pressure shows the greatest airway pressure at the end of the inspiratory cycle on the ventilator

A

PIP

*normal is 15-20 cmH2O

23
Q

minute ventilation/volume is the amount of air delivered to the lungs in one minute

A

Ve
*Vt x f = Ve
normal is 6-8L/min

24
Q

tidal volume is the amount of air delivered with each breath.

A

Vt norm is 8-10 mL/kg

25
Q

what ventilator is a FULL support mod and controls all the work of breathing
*requires least amount of pt effort

A

Assist control AC/ACV

  • pt is guaranteed the preset Vt, RR, FIO2, and PEEP
  • pt can only spontaneously trigger the ventilator to initiate a breath. Vt will remain the same can’t draw in anymore only what its set at
26
Q

is a set airway pressure to assist the patient with spontaneous breaths
*it decreases work of breathing by giving the patient a little boost on the breaths they initiate on their own

A

pressure support PS/PSV
*decreases respiratory rate and increases spontaneous Vt

pressure support is decreased as the patient improves

27
Q

what other ventilator can PS/PSV be activated with

A

CPAP

28
Q

same as PS/PSV this one just means that a preset pressure is present in the circuit and lungs throughout both the inspiratory and expiratory phases of the breath
*patient does ALL the work

A

CPAP

  • serves to keep alveoli from collapsing resulting in better oxygenation and less work of breathing
  • blows continuous air
  • apnea parameters are always set
29
Q

for a pt on CPAP who starts breathing fast or shallow what can be added

A

PS/PSV to give them a boost to slow RR and increase their own Vt

30
Q

_____ can be used non invasively on a non intubated pt using a face mask

A

CPAP

31
Q

what is very commonly used to evaluate the pt’s readiness for extubation

A

CPAP

32
Q

same as PSV but has 2 pressures IPAP and EPAP

A

BIPAP
*IPAP= inspiratory positive airway pressure (top number)
EPAP= expiratory positive airway pressure (bottom number)

33
Q

how does IPAP work

A

PS> boost> slow RR> increase Vt

can be increased to blow off CO2

34
Q

how does EPAP work

A

PEEP

can be increased to improve PO2 if already on 100% FIO2

35
Q

what is BIPAP used for

A

pt with COPD conditions unable to exhale against higher airway pressures to help resolve CO2 problems

36
Q

high pressure alarms can be caused by

A 
kinked tube
pt biting tube
excessive secretions or mucus plug
coughing, anxiety, pain
pulmonary edema
pneumothorax
pt "bucking the vent"
37
Q

if a pt is “bucking the vent” what should be done

A

pt is fighting against the ventilator so give only enough sedation med to calm them down not to knock them out

38
Q

how can you determine the lung injury PaO2: FIO2 ratio

A

divide the PaO2 by the FIO2 (decimal of percent)

39
Q

what is the normal lung ratio

A

300-500

40
Q

what is the acute lung injury ratio

A

200-300

41
Q

what is the ARDS ratio

A

<200 is very significant

42
Q

if your PaO2 is 80 and FIO2 is 80% what is the lung injury

A

80/.8= 100

ARDS

43
Q

what 2 indicators are there for HYPOventilation

A

high PaCO2 and low pH

44
Q

how can HYPOventilation be corrected

A

increase respiratory rate and or tidal volume

45
Q

low pressure alarms caused by

A 
unintentional extubation
tube dislodged or disconnected 
oxygen depleted
cuff leak
circuit leak
46
Q

what is oxygen toxicity

A

FIO2 > 50% for more than 24-48 hrs

47
Q

what are S/S of oxygen toxicity

A

restlessness, dyspnea, chest discomfort, fatigue, atelectasis

48
Q

what does it mean if you have High V/q

A

ventilation is higher than perfusion

49
Q

what does it mean if you have Low v/Q

A

perfusion is higher than ventilation (will have a high A-a gradient)

50
Q

does mechanical ventilation affect both sides of the VQ?

A

YES

51
Q

how do you tell if pt is in pain or anxious

A

increase BP, respiratory rate

52
Q

what is the best way to feed ventilated pt

A

through the GUT, but if you can’t do that there is TPN

*if you don’t feed the gut it dies and then translocation happens (becomes septic)

Module 7 (8 decks)

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