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Winter Exam 1

Terms in this set (85)

Normal range for dynamic compliance?
30 - 40 mL/ cm H2O
Normal range for static compliance?
40 - 60 mL / cm H2O
Normal range for airway resistance?
0.6 - 2.4 cm H2O / L / sec
What parameters are set in the A/C mode, volume ventilation?
FiO2
RR
VT
PEEP
Sensitivity
I-time
What parameters are set in the A/C mode, pressure ventilation?
FiO2
RR
PEEP
Pressure Control (PC)
Sensitivity
I-time
What parameters are set in the SIMV mode, volume ventilation?
FiO2
RR
PEEP
VT
Sensitivity
I-time
Pressure Support (PS)

*pressure support is only set when the patient generates their own tidal volumes
What parameters are set in the SIMV mode, pressure ventilation?
FiO2
RR
PEEP
PC
I-time
Sensitivity
PS
What parameters are set in the CPAP mode?
FiO2
CPAP
PS
Explain the differences between pressure and volume ventilation.
GUARANTEED TEST QUESTION.
Volume ventilation: You set a specific tidal volume that is delivered to the patient with each breath. The pressure is variable based on airway compliance and resistance.

Pressure ventilation: Tidal volumes variable based on airway compliance and resistance, but the pressure delivered to the patient is always the same.
Can you add PS to the A/C mode?
No; pressure support is only added when the patient is generating their own tidal volumes. In A/C mode they are not.
When performing a ventilator check in the SIMV mode, when do you chart the peak airway pressure; assisted, controlled or spontaneous breath?
Assisted or controlled.
VT would be lower during a spontaneous breath.
Do you set a tidal volume in pressure control ventilation?
No; patient generates their own tidal volumes.
What is a trigger variable?
The trigger variable determines the start of inspiration.

*pressure, flow, or time
What's another name for a trigger variable?
Sensitivity
Difference between a pressure and flow trigger variable.
Pressure-triggered: The breath is initiated and delivered by the ventilator when the ventilator senses the patient's spontaneous (negative pressure) inspiratory effort.

Flow-triggered: When the patient's inspiratory flow reaches a specific value, a ventilator supported breath is delivered (a set tidal volume breath). In this mode, it's easier for the patient to trigger the vent.
What is a cycle variable?
Inspiration ends when a specific cycle variable is reached.
Give an example of a cycle variable.
Pressure
Flow
Volume
Time
Define the term minute ventilation.
Minute ventilation is the volume of gas inhaled or exhaled (exhaled minute volume) from a person's lungs per minute.
Define the term inspiratory time.
The duration of time the tidal volume is delivered (volume ventilation) or the pressure (pressure control) is maintained; depending on the mode.
Define the term rise time.
Determines the speed for the rise of flow (volume) or pressure (PCV, PRVC, VC+Modes).
Define the term Auto-PEEP.
Gas trapped in the alveoli at end expiration, due to inadequate time for exhalation, broncho-constriction or mucus plugging.
What's another name for Auto-PEEP?
Dynamic hyperinflation
Intrinsic PEEP
What's the normal Auto-PEEP value?
< 3 cm H2O
What are some ventilator changes you can make to decrease Auto-PEEP?
Expiration time needs to be lengthened
Reducing the RR, I-time or both
Decrease tidal volume
Increase PEEP levels
Administer a bronchodilator
Suction the patient
Make sure the patient is properly sedated.
Define the term mean airway pressure (MAP).
Average pressure within the airway during one complete respiratory cycle.

*cm H2O
Define the term plateau pressure.
The pressure needed to maintain lung inflation in the absence of airflow.
Define peak pressure.
The pressure used /needed to deliver the tidal volume by overcoming non-elastic (airways) and elastic (lung parenchyma) resistance
Ways to reduce the incidence of VAPS?
30 degrees at the head of the bed
Slight cuff leak during inspiration
Oral care
Suctioning
What button is depressed to obtain an Auto-PEEP reading?
Expiratory Hold
What button is depressed to obtain a Plateau Pressure reading?
Inspiratory Hold
How would you document an FiO2 of 60% and 100%?
0.6
1.0
How would you document an inspiratory time of one second?
1.0
If the patient's compliance decreased, the peak airway pressures would increase, decrease or stay the same while on volume ventilation?
Decreased compliance means stiffer lungs, so the peak airway pressures would increase on volume ventilation.
If the patient's compliance increased, the peak airway pressure would increase, decrease or stay the same while on volume ventilation?
The peak airway pressure would decrease with more compliance.
If the patient's compliance decreased, the peak airway pressure would increase, decrease, or stay the same while on pressure ventilation?
The peak airway pressure would remain the same because with pressure ventilation, you set the pressure and that amount is delivered every time.
If the patient's compliance increased, the peak airway pressure would increase, decrease, or stay the same while on pressure ventilation?
The peak airway pressure would remain the same because with pressure ventilation, you set the pressure and that amount is delivered every time.
What should the high pressure alarm be set at if the peak airway pressure is 30 cm H20?
40 cm H2O
If the patient had a set tidal volume of 450 mL, what should the high and low tidal volume alarms be set at?
High: 500 mL
Low: 400 mL
What should the low and high minute ventilation alarms be set at?
High: 10 above
Low: 2 below
The apnea alarm for an adult patient should be set at?
20 seconds
What are some clinical causes for an increase in airway resistance? How can you fix these problems?
Make sure the size of the tube does not have too much resistance (either width or length)

Suction the patient

Administer a bronchodilator

Drain any water in the circuit
What are some clinical causes for the high and low minute ventilation alarm?
Low: Disconnection or leak anywhere in the circuit/cuff, weaning with low spontaneous VT.

High: Water in the circuit, saturated HME, high RR or VT
What modes are used for weaning?
CPAP
SIMV
What ventilator setting is used to increase spontaneous tidal volumes?
Pressure Support

*provides support to overcome any resistance the patient has. It's like a little push for the patient. The goal of weaning is to decrease this PS.
What ventilator setting(s) is used to increase oxygenation?
FiO2
PEEP
MAP (increase I-time)
VT (increase)
What type of clinical conditions would require the level of pressure support be increased?
Normal = 5 - 10 cm H2O

COPD, asthmatics.
If your patient has the following ABG results: 7.33, 57, 80, 25 on VC/AC, 1.0, 450, 12/12, +5, what ventilator settings would you change?
Not really ventilating, and not really oxygenating given the FiO2 of 1.0...

Increase the PEEP to 7
Increase the RR to 14
Increase the VT to 500
If your patient has the following ABG results: 7.55, 28, 110, 22 on VC/AC, 1.0, 650, 18/18, +8, what ventilator settings would you change?
Overventilating and hyperoxygenating...

Drop VT to 600
Drop RR to 14
Keep PEEP at 8, drop FiO2 to 0.8
Define acute ventilatory failure.
A sudden increase in PaCO2 without any compensation from HCO3-
Impending ventilator failure can be evaluated by trending the patient's....
ABG results
What is the normal range for the V/Q ratio?
0.6 - 2.2
What clinical condition causes the V/Q ratio to be high?
Pulmonary Embolism
What clinical condition causes the V/Q ratio to be low?
Atelectasis
Name clinical conditions that cause True Alveolar Deadspace.
Pulmonary Embolism
Decrease CO, BP, venous return
What is anatomical deadspace?
Gas in respiratory system that never reaches alveoli to participate in gas exchange.
What is the normal VD/VT?
Spontaneous: <40%
Ventilated: <60%
What is refractory hypoxemia?
When you turn up the FiO2 to a high amount, but the PaO2 of the patient does not improve.

PaO2/FiO2 index of less than 250 mmHg suggests refractory hypoxemia.
What ventilator changes could you make to treat refractory hypoxemia?
Increase PEEP
Name some clinical conditions that can create a diffusion defect.
Pulmonary Edema
Pulmonary Fibrosis
CHF
What is the definition of low lung compliance?
Patient's lungs are stiff.
What characteristics will the lungs have if low lung compliance is noted?
Tachypnea
Small tidal volumes

*ARDS
What is the definition of high lung compliance?
Lungs are too easily stretched.
What characteristics will the lungs have if high lung compliance is noted?
Lots of air trapping

*COPD
What units are associated with pressure?
cm H2O
What units are associated with flow?
LPM
What units are associated with volume?
mL
Normal value for Intrapulmonary Shunt?
< 10%
What is the patient's minute ventilation if the RR is 12 breaths/min and the tidal volume is 600 mL?
7.2 LPM
Calculations and units: IBW for male and female.
...
Calculations and units: Tidal volume ranges
...
Calculations and units: Corrected tidal volume
...
Calculations and units: Airway resistance
...
Calculations and units: Static compliance
...
Calculations and units: Dynamic compliance
...
Calculations and units: I:E ratio
...
Calculations and units: Auto-PEEP
...
Calculations and units: Mean Airway Pressure
...
Calculations and units: VD/VT
...
Calculations and units: Alveolar Minute Ventilation
...
Calculations and units: Shunt Equation
...
Calculations and units: Deadspace
...
Normal NIF?
-30 cmH2O or higher

Use manometer

*THIS ASSESSES MUSCLE STRENGTH
Normal VC?
65-75 ml/kg for normal people.

For an ETT, 10-15 mL/kg.

*THIS ASSESSES COUGH REFLEX
Normal VT?
5-10 mL/kg
Normal MV?
5-10 LPM
THIS SET IS OFTEN IN FOLDERS WITH...