Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Assessing and Managing the Deteriorating Patient > Week 3: Non Invasive Ventilation > Flashcards

Week 3: Non Invasive Ventilation Flashcards

1
Q

What are the types of ventilation failure?

A

Type 1 respiratory failure –oxygen failure

Type 2 hypercapnoeic respiratory failure -Effects on carbon dioxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is ventilation?

A

The process of allowing fresh air into the lungs and exhaling carbon dioxide (byproduct of metabolism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does inspiration occur?

A

Diaphragm flattens and ribs elevate → ↑ volume of the thoracic cavity
Increased intrathoracicvolume → ↓intrathoracic pressure
Intrathoracic volume falls below atmospheric pressure and because of this pressure difference, air flows into the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does expiration work?

A

Inspiratory muscles relax
Natural elastic recoil of the lungs reduces the volume of the thoracic cavity
↓volume of the thoracic cavity → ↑intrapulmonary pressure.
Air moves out of lungs because the pressure in the alveolus is greater than atmospheric pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is airway resistance?

A

Refers to the forces that oppose airflow within the respiratory passageways
Increased resistance increases work of breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are factors which increase work of breathing?

A

Bronchoconstriction/dilation
Patency of ETT
Size of ETT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is lung compliance?

A

Refers to the ease at which the lungs can be expanded e.g. a balloon that is easy to inflate is very compliant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are conditions which affect lung compliance?

A

Pulmonary oedema
Adult Respiratory Distress Syndrome (ARDS)
Pulmonary fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is tidal volume?

A

Volume of one breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is minute ventilation?

A

Total air inhaled and exhaled each minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you calculate minute ventilation?

A

MV = VT X RR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What factors could change RR?

A

Increase: pain, exertion/exercise, stress/anxiety, medications (activation of SNS)
Decrease: medication (morphine), decrease LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What factors could affect tidal volume?

A 
Injury: fractured rib
Pneumothorax
LOC
Positioning: position of diaphragm (abdomen may impede), sit patient up
Lung disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is functional residual capacity?

A

Amount of air in lungs at end of a normal expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is anatomical dead space?

A

Volume of air that takes no part in gas exchange nose, pharynx larynx, trachea, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is alveolar ventilation?

A

Volume of air that actually reaches alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you calculate alveolar ventilation?

A

Alveolar ventilation = TV - dead space ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is gas exchange explained by Dalton’s law and Henry’s law?

A

Dalton’s law: pressure gradient. Higher O2 partial pressure in alveoli than capillaries –> O2 moves into blood. Opposite for CO2 partial pressure

Henry’s law: CO2 dissolves well in water (more soluble than O2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is O2 transported in the blood?

A

97% carried on the Hb
3% dissolved in the plasma
Portion dissolved in plasma can be measured as partial pressure of arterial oxygen (PaO2) done by ABG analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Include more on gas exchange

A

blank

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Include pulmonary oedema

A

blank

22
Q

Include V/Q relationship

A

blank

23
Q

What are first line pH buffers?

A

H+in the plasma is buffered by bicarbonate in the plasma
H+ + HCO3H2CO3CO2+ H2O
Some H+enters the cells and is buffered by intracellular bicarbonate
Haemoglobin
Albumen and globulin

24
Q

What are second line pH buffers?

A

If the amount acid exceeds the capability of the first line buffers the increased H+is detected by the chemoreceptorsin the medulla and the rate and depth of breathing is increased
Occurs when the ph <7.35
Increased rate and depth of breathing increases carbon dioxide removal reducing carbonic acid and H+load

25
Q

What are third line pH buffers?

A

Renal mechanisms is powerful but slower
Peak in 72 hours
Retain and excrete both H+and bicarbonate to bring pH back to normal

26
Q

What are the 5 steps of an ABG analysis?

A 
Step one: Examine the pH
Step two: Compare the CO2 and the pH
Step 3: Consider the HCO3 and Base excess in conjunction with the pH
Step 4: Assess the oxygen levels
Step 5:Compare the PaO2 and SaO2
27
Q

What are the causes of respiratory acidosis?

A

Respiratory disease (pneumonia, COPD), over-sedation

28
Q

What are the causes of respiratory alkalosis?

A

Overventilation due to pain or emotional distress

29
Q

What are the causes of metabolic acidosis?

A

DKA

Shock

30
Q

What are the causes of metabolic alkalosis?

A

Chronic vomiting

Sodium bicarb overdose

31
Q

What are the indications of Continuous Positive Airway Pressure?

A 
Acute exacerbations of COPD
Asthma
Acute cardiogenic pulmonary oedema 
Hypoxemic respiratory failure
Post-op respiratory failure - atelectasis
Obstructive sleep apnoea
32
Q

How does Continuous Positive Airway Pressure work?

A

Gas delivered at constant preset pressure during both inspiration and expiration
Ventilation (RR and TV) controlled by patient
Supports ventilation, doesn’t replace
Decreases work of breathing to increase TV upon inspiration
Inhibits paradoxical chest movements

Increases functional residual capacity:
Splints airway to keep open
Forcing open collasped alveoli, preventing collaspe at end expiration
Improved amount of O2 which crosses alveolar/capillary membrane

33
Q

What is FiO2?

A

blank

34
Q

Include PEEP

A

blank

35
Q

What is Bilevel Positive Airway Pressure?

A

Delivers positive pressure in two phases to a spontaneously breathing patient
Includes: inspiration positive airway pressure (IPAP) during inhalation, and expiratory positive airway pressure (EPAP) during exhalation

36
Q

What are the indications for Bilevel Positive Airway Pressure?

A 
Acute respiratory failure, type 2
Chronic airway limitation
Pneumonia
Congestive heart failure
Acute pulmonary oedema
Atelectasis
Neuromuscular disease
Sleep apnoea
Poor candidates for mechanical ventilation
37
Q

How does Bilevel Positive Airway Pressure work?

A

As patient breathes, a positive pressure gradient is established until the preset inspiratory pressure support is reached. Enhances TV
Detects reducing amount of airflow in, cuts out on expiration to allow natural elastic recoil to PEEP level
Promotes CO2 removal

38
Q

What is IPAP and what does it do?

A 
Inspiratory Positive Airway Pressure:
Supports breath
Improves TV
Maximises removal of CO2
Reduces work of breathing
Opens airways and alveoli
39
Q

What is EPAP and what does it do?

A

Expiratory Postiive Airway Pressure:
Exerts positive intrapulmonary pressure on expiration
Increases functional residual capacity
Recruits underinflated lung tissue

40
Q

What are the physiological effects of Bilevel Positive Airway Pressure?

A

Increased functional residual capacity
Reduced respiratory muscle work
Atelectatic alveoli opened –> improved compliance
Improved oxygenation
Assistance inhaling –> increased transpulmonary pressure –> inflation of lungs and augmentation of alveolar ventilation –> augmentation of TV
Improved cardiac performance: reduction in preload and afterload reducing myocardial oxygen consumption
Upper airway able to warm and humidify gas

41
Q

What are the contraindications of Bilevel Positive Airway Pressure?

A 
Respiratory arrest
Facial trauma/surgery
Excessive secretions/inability to clear
Risk of aspiration
Low GSC/agitation
Severe hypoxia
Haemodynamically unstable
Upper GIT bleeding
Upper airway obstruction
42
Q

How does Continuous Positive Airway Pressure improve oxygenation?

A

Splints open airways
Forces alveoli open for gas exchange
Pushes fluid back into capillaries

43
Q

What is the assessment and management of a patient receiving Continuous Positive Airway Pressure?

A

Assess: tolerance, mucous membranes, pressure areas, vitals, hourly ABGs for CO2, O2 and pH, mask fit and seal
Management: reassure, educate, plan breaks, consider humidifier or dry mouth spray, dressings for pressure areas, positioning

44
Q

What is the usual range for Continuous Positive Airway Pressure?

A

5-15 cmH2O

45
Q

What variables need to be set on a Continuous Positive Airway Pressure device?

A

Oxygen %

PEEP level

46
Q

What paediatric medical conditions are treated with Continuous Positive Airway Pressure?

A

Altered control of breathing e.g. Congenital Central Hypoventilation Sydnrome
Neuromuscular weakness e.g. Duchenne muscular dystrophy, spinal muscular dystrophy
Upper spinal cord injury
Upper airway obstruction (non-acute) e.g tracheobronchomalacia, some craniofacial abnormalities
Chronic lung disease
Obstructive sleep apnoea

47
Q

What are the four variable in Bilevel Positive Airway Pressure?

A

Expiratory positive airway pressure
Inspiratory positive airway pressure
Frequency of cycling or breath rate at 4-30 cycles per minute
Proportion of each respiratory cycle spent in IPAP, 10-90%

48
Q

What are the four modes of Bilevel Positive Airway Pressure?

A

Spontaneous
Spontaneous/timed
Timed
Continuous Positive Airway Pressure

49
Q

What are the complications of non-invasive positive pressure ventilation?

A 
Decreased CO
Ill fitting mask and leaks
Decreased patient compliance
Skin irritation
Dry mucous membranes
Gastric distension
Aspiration
Barotrauma and pneumothorax
50
Q

What primary assessment needs to be performed on a patient with non-invasive positive pressure ventilation?

A 
A and B:
RR, depth, work of breathing
Patient-ventilator synchrony
Chest wall movement
Use of accessory muscles
Continuous pulse oximetry
ABG analysis

C:
BP, HR, JVP, rhythm

D:
AVPU or GSC

E

51
Q

What is the nursing management for a person with non-invasive positive pressure ventilation?

A

Oral care:
Mouth washes
Need to decide if it is appropriate to remove mask, ventilation takes priority

Pressure relief from mask:
Breaks
Padding

Nasal care:
Humidification devices

Comfort:
Positioning
Promote secretion removal
Analgesia
Psychological support

Decrease O2 consumption: temperature control

Nutritional support and adequate phosphate levels

52
Q

What are the indications that non-invasive positive pressure ventilation is not working?

A

Unstable cardiovascular system
Deteriorating mental state
Increasing RR
Hypoxia and increased CO2

Assessing and Managing the Deteriorating Patient (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions