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RTH 132 Hannah > Written Lab Final > Flashcards

Written Lab Final Flashcards

1
Q

How long do you do IPPB for?

A

15-20 minutes (short-term)

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2
Q

What are the clinical goals of IPPB?

A
  • improve lung expansion
  • short term vent support
  • deliver medications
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3
Q

What are the relative contraindications of IPPB?

A
  • hiccups
  • ICP>15mmHg
  • active hemoptysis
  • untreated active TB
  • uncooperative patient
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4
Q

What happens when you increase sensitivity for IPPB?

A

the magnet is further away so it is easier to trigger a breath

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5
Q

How is IPPB powered?

A

pneumatically

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6
Q

What will happen if the IPPB is set to be too sensitive?

A

it will auto-cycle too quickly

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7
Q

What are the indications for IPPB?

A
  • atelectasis
  • increased WOB
  • hypoventilation
  • increased RAW
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8
Q

What are the hazards of IPPB?

A
  • increased RAW
  • airtrapping
  • bronchospasm
  • pneumothorax
  • hyperventilation
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9
Q

How do you know if IPPB therapy is effective?

A
  • VT increased by more than 25%
  • breath sounds improved
  • more effective cough
  • ABG improved
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10
Q

How do you set the flow rate?

A

watching the pressure gauge and talking to the patient

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11
Q

What is the mean airway pressure?

A

the average of both pressures on exhalation and inhalation

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12
Q

What happens to the alveoli due to IPPB treatment?

A

increase in size

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13
Q

What do you set pressure at for IPPB

A

10-15ml/kg body weight and no more than 20 cmH20

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14
Q

How does IPPB start?

A

when sensitivity between -2 and -5 is triggered

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15
Q

How do you increase pressure with IPPB?

A

decrease the sensitivity by moving the magnet closer

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16
Q

How do you create volume with IPPB?

A

increase the pressure

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17
Q

What is an absolute contraindication of IPPB?

A

untreated tension pneumothorax

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18
Q

How can you tell if a patient is trying to breathe with the IPPB machine?

A

the manometer will have pressure jumps

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19
Q

What is the physiology of IPPB?

A
  • increase MAP
  • increase VT
  • decrease WOB
  • secretion control
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20
Q

How does IPPB affect inspiration pressure?

A

pressure becomes positive instead of negative

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21
Q

What will happen if the machine is set too difficult?

A

the patient won’t be able to trigger a breath and the manometer will swing negative, but nothing will happen

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22
Q

What does IPPB stand for?

A

intermittent positive pressure breathing

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23
Q

When is a breath terminated with IPPB?

A

when the predetermined inhalation pressure is reached

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24
Q

How does a pharyngeal airway relieve airway obstruction?

A

it keeps the base of the tongue away from the posterior wall of the pharynx to prevent the tongue from occluding the airway

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25
Q

What are the steps of proper oral airway insertion?

A
  • remove foreign substances from mouth
  • hyperextend the neck and open the patient’s mouth
  • insert the airway with the tip pointing toward the roof of the mouth
  • observe the passing of the uvula and rotate 180 degrees
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26
Q

How do you measure an endotracheal tube?

A

measure from the mouth to the jaw

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27
Q

What are the indications for oral pharyngeal airways?

A
  • unconscious patient
  • facilitate suctioning
  • enhance bag mask ventilation
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28
Q

In terms of endotracheal tube size, what size is better?

A

larger rather than smaller

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29
Q

What is a berman airway?

A

hard plastic with grooves down the sides

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30
Q

What are complications of oral airways if the tube is not the right size?

A

too large: blocks coughing reflex

too small: does not relieve obstruction

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31
Q

What does the bite block do?

A

keeps from biting the tongue

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32
Q

Why should an oral airway never be taped in place?

A

in case the patient becomes conscious, the airway should be easily removable

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33
Q

What is a guedel airway?

A

soft plastic with a lumen down the middle

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34
Q

What are complications of oral airways?

A
  • teeth or lip damage
  • gagging
  • aspiration
  • failure to remove quickly when reflexes return
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35
Q

What are the advantage of nasal airways over oral?

A
  • can be used in both semiconscious and conscious patients
  • can be inserted during seizures
  • jaw trauma
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36
Q

How do you visually assess placement of a nasal airway?

A
  • examine oropharynx
  • flashlight
  • tongue depressor
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37
Q

How often should you change the nasal pharyngeal airway?

A

every 24 hours

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38
Q

How do you measure a nasopharyngeal airway?

A

tip of the nose to the tragus of the ear

39
Q

Where should the bevel face during insertion?

A

midline

40
Q

What are the complications of nasal pharyngeal airways?

A
  • trauma to the mucosa
  • infection
  • bleeding
  • chemical inflammation
  • obstructed with secretions
41
Q

Why are nasopharyngeal airways helpful with semiconscious patients?

A

allows the patient to breath and aids frequent suctioning

42
Q

What do you use to lubricate the airway?

A

water soluble lubricant

43
Q

What are the hazards of nasopharyngeal airways?

A
  • intubation of the meninges
  • sinusitis
  • otitis media
  • bleeding
  • gastric inflation
44
Q

What should you use to secure a nasopharyngeal airway?

A

place a safety pin through the side of the flare

45
Q

How should you determine which side of the nasal passage is less obstructed?

A

temporarily occlude each side and see which side has better airflow

46
Q

What are the nasopharyngeal airway supplies?

A
  • 3 sizes of airways

- water soluble lubricant

47
Q

Why should you change the nasal pharyngeal airways so often?

A
  • reduce the risk of infection

- increased RAW

48
Q

How do nasopharyngeal airways facilitate suctioning?

A

protect the nasal cavity from suctioning and trauma

49
Q

What are the contraindications of nasal airways?

A
  • nasal trauma
  • basilar skull fractures
  • deformities of the nose
  • coagulation disorders
50
Q

What are the indications for suctioning?

A
  • retention of secretions

- sputum sample needed

51
Q

What should you keep suction pressure at?

A

80-120 mmHg

52
Q

How long should you suction for?

A

no more than 15 seconds

53
Q

What should you do before and after suctioning?

A

preoxygenate and postoxygenate

54
Q

What are the hazards of suctioning?

A
  • hypoxemia
  • tissue damage
  • bleeding
  • infection
55
Q

What mode of ventilation is time triggered, pressure controlled and time cycled?

A

pressure control

56
Q

What mode of ventilation is patient triggered, pressure controlled and flow cycled?

A

pressure support

57
Q

What mode of ventilation is a combination of mechanical and spontaneous breaths - the mechanical breaths are time/patient triggered, pressure limited and time cycled?

A

P-SIMV

58
Q

What mode of ventilation is a combination of periods of control mode and periods of spontaneous breathing?

A

IMV

59
Q

What mode of ventilation is patient triggered, flow controlled during inspiration and time cycled?

A

assist control

60
Q

What mode of ventilation is a specific (limited) number of assist control breathed interdispersed with spontaneous breathing?

A

SIMV

61
Q

How do you calculate static compliance?

A

VT / (plat-peep)

62
Q

How do you calculate dynamic compliance?

A

VT / (peak-peep)

63
Q

How do you calculate airway resistance?

A

(peak-plat) / flow

64
Q

When parts do you need to setup a ventilator?

A
  • exhalation valve
  • exhalation valve housing
  • circuit (inspiratory and expiratory lines)
  • flow sensor
  • bacteria filter
  • HME or humidifier
  • temperature probe
65
Q

What should you do if a person has a high amount of CO2?

A

increase the RR or VT

66
Q

What should you do if a person has a low PaO2?

A

increase the FiO2

67
Q

How do you calculate itime?

A

(VT / flow) x 60

68
Q

What are the indications for intubation?

A
  • respiratory failure or arrest
  • cardiac arrest
  • inability to protect airway
  • failure to breathe adequately
69
Q

What are the contraindications for intubation?

A
  • severe airway trauma or obstruction
  • cervical spine injury
  • mallampati classification of III or IV
70
Q

What are the hazards of intubation?

A
  • intubation of the esophagus
  • damage to teeth or lips
  • hypoxia
71
Q

What is the proper tube size for a male and female?

A

male: 8-8.5
female: 7-7.5

72
Q

What should the cass tube pressure be?

A

no more than 20 cmH2O

73
Q

What should you always check before intubation?

A

the cuff

74
Q

What supplies do you need for intubation?

A
  • laryngoscope handle
  • blades
  • ET tube
  • water soluble lubricant
  • syringe
  • securing device
  • bag valve mask
  • suction equipment
  • stethoscope
75
Q

What pressure should the cuff be kept at?

A

25-35 cmH2O or 20-30 mmHg

76
Q

What is the term for measured peak inspiratory pressure for every breath, including spontaneous?

A

Ppeak

77
Q

What is the term for an inspiratory hold maneuver with a freeze frame?

A

Pplateau

78
Q

What is the term for mean airway pressure over an eight breath average?

A

Pmean

79
Q

What is the term for positive end expiratory pressure?

A

PEEP (in cmH2O)

80
Q

What is the term for minimum pressure seen throughout ventilatory cycle?

A

Pmin (in cmH2O)

81
Q

What is the term for unintended positive end expiratory pressure?

A

autopeep (in cmH2O)

82
Q

What is the term for airway occlusion pressure?

A

PO.1 (in cmH2O)

83
Q

What is the term for a calculated parameter of the respiratory rate divided by VT in liters (rapid shallow breathing index)?

A

RSB; <105 is GOOD

84
Q

What is the term for measured exhaled tidal volume, including spontaneous measured at the flow sensor?

A

VTe (average 4-12L)

85
Q

What is the term for a measured eight breath average if leak in volume per breath?

A

Vleak

86
Q

What is the term for peak inspiratory flow measured per mandatory and spontaneous breaths?

A

Inspiratory flow (range: 40-80L/min)

87
Q

What is the term for peak expiratory flow measured in L/min?

A

Expiratory flow

88
Q

What is the term for resistance to inspiratory flow caused by endotracheal tube and the patient’s airways during inspiration?

A

Rinsp (normal 3-6 cmH2O/L/sec)

89
Q

What is the term for resistance to the expiratory flow caused by endotracheal tube and the patient’s major airways during exhalation?

A

Rexp

90
Q

What should you set for a high pressure limit?

A

10-15 above peak pressure

91
Q

What should you set for a high minute volume?

A

<3-5 above observable minute volume

92
Q

What should you set for a low minute volume?

A

2 below observable minute volume

93
Q

What should you set for a low tidal volume?

A

100-200 below maintained tidal volume

94
Q

What should you set for a high respiratory rate?

A

5-10 above observable rate

RTH 132 Hannah (12 decks)

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