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Pilbeam CHAPTER 6
Student Study Note Cards
| Question | Answer |
|---|---|
| Settings for Vt and f should reflect a Ve that is derived from the initial calculation based on _______ ,________ and _______.(ApQ)(TM) | Gender, BSA, pts pathology(TM)(ApQ) |
| The advantage of VS is?(RQ)(TM) | Spontaneously breathing pts can establish their own RR and Vt.(TM)(RQ) |
| A pt with ARDS who is 5'4" and weighs 195 lbs needs to be changed from a CPAP of 10 cmH2O to VC-CMV. What tidal volume and rate would you set and why?(AzQ)(TM) | 4-8ml/kg and RR 15-30bpm because these are appropriate for ARDS pts(AzQ)(TM) |
| Define Mechanical Tidal Volume. (RQ) | Set volume delivered to the patient; amount breathed in during 1 breath. (CG) |
| 5'2" pt. What is her VT range? (ApQ) | 418.2mL-627.3mL (CG) |
| 5'7" pt on pressure ventilation with PIP of 15 cmH2O, PEEP 5cmH2O, RR 14bpm. Actual Vt is 350ml. What setting should you modify to achieve appropriate Vt? (AzQ) | Increase PIP to give bigger breaths (CG) |
| What is the IBW for a 6'1" male in kg? And what would you expect his VT, RR, and VE(min) to be? (BSA = 2.08) (Az Q) | 83.6 kg, 585 ml - 836 ml, 12-18 bpm, 8.3 Lpm (ACE) |
| What is mechanical dead space? (RQ) | The volume of gas that is rebreathed during ventilation (ACE) |
| What's the equation for respiratory frequency? (AP Q) | f= VE(min)/VT (ACE) |
| What basic settings help improve ventilation? (RQ) | RR, Vt or PC level, PS (KMH) |
| 5'6"female patient--what is her Vt range? (ApQ) | 488-732ml (KMH) |
| What is a normal flow range? Do COPDers like a high flow or low flow and why? (AzQ) | 40-60lpm--high flow--they like their flows given to them fast with a short I time to increase E time (KMH) |
| What will improve a pts VE leading to a decrease in CO2 and improves ventilation? (RQ) | RR (MK) |
| A 5'8' pt has a RR of 15bpm. What is her TCT? (ApQ) | 60/15=4 seconds (MK) |
| A pt has a TCT of 7 seconds. They have an I Time % of 30%. What is their I Time, E time and I:E ratio? Is their I:E ratio normal? (AzQ) | I time=2.1 sec E time=4.9 sec I:E=1:2.3--yes (MK) |
| We will use Itime to manipulate what other value? KRM | Flow |
| Pt has the following: RR 15, Itime % of 35% and Flow 45 Lpm. Find the TCT, Itime, and Etime. KRM | TCT=4 seconds, Itime=1.4, Etime=2.6 second |
| What are 3 factors we look for to check the body's ability ot oxygenate the tissues? KRM | Hemoglobin, Circulation and adequate ventilation. |
| What would be the first setting you would change on a ventilator to improve ventilation? RQ | RR(JB) |
| Increasing PEEP has what kind of side effects? Apq | increase in intrathoracic pressure, decrease venous return, decreased bp, increase in ICP, (JB) |
| If you have a TCT of 7 and an itime of 20%, what would be your Itime set in seconds? AzQ | intime=TCTXItime%. 7X.20= 1.4s (JB) |
| A female 5'4" patient is on a ventilator. You check her values and her Vt is is 354 ml. What is her tidal volume range and is hers adequate right now?(AzQ) | 454 to 682 mL. NO. (AT) |
| What is the normal PS range? (RQ) | 5 to 15 cmH2O (AT) |
| Find the tidal volume if you have a flow of 30 lpm and an I-time of 0.8 (ApQ) | 400 mL (AT) |
| Pressure support only effects what type of Pts?RQ | Spontaneously breathing (MC) |
| What is the goal Vt for a Pt that is 6 foot 2inches? ApQ | 687-1032 mL (MC) |
| If you have a Pt who has CHF and you notice that their PEEP is at 10 cmH2O and their heart rate begins to rise and their BP begins to drop what should you do and why is this occurring?AZQ | The pt is having to much intrathorasic pressure causing restriction on the heart. Decrease PEEP and notify the MD. (MC) |
| Basic settings for 100: Respiratory rate falls under this categorize (RK) | What is Ventilation (RQ) |
| Basic settings for 250: This oxygenation setting holds the alveoli open. there normal values are..(RK) | What is PEEP, normal 5-15cmH2O good starting point around 10cmH2O (AqQ) |
| Basic settings for 500: These are all normal ranges for all basic settings to start mechanical ventilation. (RK) | What is RR:12-20bpm Vt:8-12ml/kg PC:15-20cmH2O FiO2:SpO2 >90% PEEP:5-15cmH2O Itime:.8-1.2sec (Azq) |
| What would be some settings to change on a vent to help improve oxygenation? (RQ) | FiO2, PEEP, Itime (KAH) |
| If your patient in ICU on a vent had a change in FiO2 of 15% over your 8 hour shift what would you do? (AzQ) | The physician should be contacted, this pt could be having a worsening disease process or a diffusion problem (KAH) |
| What is the "PEEP rule?" (RQ) | If FiO2 is at 60% or higher and there is little to no change in PaO2 then PEEP maybe be needed to fight refractory hypoxemia. |
| List the settings that affect ventilation, and then those that affect oxygenation. (ApQ) | -Ventilation: RR, Vt or PC, and PS -Oxygenation: FiO2, PEEP, Itime, Hgb, circulation, adequate ventilation (BH) |
| You are giving an aerosol to a ventilated patient and they look like they are having a hard time taking a breath when they want to. What is the problem and how would you fix it? (AzQ) | The patient's vent is on a flow trigger setting and the extra flow being added to the circuit by the aerosol causes it to be too much for the patient to trigger. While delivering the aerosol the vent should be changed to pressure triggering. (BH) |
| How does PEEP affect the lungs? (ApQ) | It applies pressure into the lungs, and holds the alveoli open to improve oxygenation. (KJ) |
| When you are in _____ ______, you can't have a ____ and a _____ set at the same time. This setting will do what for your patient, and will over come _____. (AZQ) | Pressure Support. Pressure Control, Tidal Volume. This setting will provide a boost to overcome AW resistance and compliance of the ET Tube. (KJ) |
| On Vt, the faster the Itime, the bigger the ____. When increasing the Vt, we want to be careful of what? | Surface Area, slower flow. Barotrauma, which can lead to damage of the lungs. It stretches the alveoli. (KJ) |
| Pressure control level is only set in which type of ventilation? (RQ) BL | Pressure ventilation |
| When setting the Itime for a COPD or asthma patients, where would you set it at? What does this do for them? (AzQ) BL | 0.8 cmH2O or the lower side because it gives them higher flows and gives them a longer Etime for their airtrapping. |
| what would the tidal volume range for a 5'9 male? What two ways can you calculate this? (ApQ) BL | 582-873mL or 728mL Find by IBW in kg multiplied by 8 and 12ml OR find IBW in kg and multiply by ten for quick reference. |
| What are three setting that would effect Oxygenation on a ventilated patient? (RQ) MB | FiO2, PEEP, Itime. MB |
| You have a 5'2" male what would be his Vt range? (RpQ) MB | 430-644 mL MB |
| Where would you most likely set the Itime for a COPD patient? (RpQ) MB | Most likely 0.8-1 sec MB |
| Which setting would you change first to adjust ventilation? (AH) | RR |
| When would you not want to set a Pressure Support? (AH) | When pt is not spontaneously breathing. |
| A patient'a mechanical ventilator settings are: RR 16 Vt 650ml, PEEP 15cmH20, Itime 1sec, FiO2 50%, PS 0. Pt's blood pressure is 75/43. What can be causing the low blood pressure? (AH) | PEEP of 15cmH2O. Peep causes increased ICP and decreased BP. |
| What is mechanical deadspace? (Marianne B.) | It is the volume of gas that is rebreathed during ventilation. (RQ) |
| Calculate CT with a volume change of 50 ml and a pressure change of 25 cm H2O. (Marianne B.) | It is 2 ml/cm H2O. (ApQ) |
| If a physician orders a Vt of 600 ml and 14 bpm for a 25 year old female with a BSA of 3.0. Is the ordered VE adequate? (Marianne B.) | No it is not. The ordered VE is 8.4 L and the estimated VE is 10.5 L. So the patient would have to take additional breaths. (AzQ) |
| What is your first choice in settings to change when you want to change ventilation? (ApQ)(CZ) | Respiratory rate |
| What is one setting we can change without a physician's order? (RQ)(CZ) | FiO2It is ordered most often in order to keep the patient's SpO2 over 90% Itime, Flow, and Trigger could also be changed without a MD order. |
| Your patient is set at 12 RR. Her I time is 1 sec and tidal volume is 450 ml. What is her TCT? Etime? flow? (AzQ) (CZ) | TCT is 5, Etime is 4 sec, flow is 27 lpm |
| 6'0" male, what is his Vt and IBW? ApQ (JM) | IBW is 178 lbs. 80.9 kg Vt on vent is 647 to 970 ml |
| Define respiratory distress.RQ (JM) | This has a sudden onset, pt appears alarmed, sweating, flushed, anxious, or panicked. Pt can talk in short broken sentences. HR will be increased and irregular. |
| What is this pts I:E ratio and why is that important to know? Itime=1.8 sec, TCT is 3.4 AzQ (JM) | This is an inverse I:E ratio and indicated a severe obstruction. Itime should be less than Etime. |
| Your pt is showing increased use of the sternocleidomastoid muscle during inspiration on a PSV mode. What does this indicate & how might you adjust your vent? (NMB) | May indicate that the level of pressure support is not high enough for the pt. Adjust by increasing your patients pressure support value. (ApQ) |
| What mode of ventilation provides closed-loop pressure breaths & targets the pressure to achieve the set volume? This mode is also a pressure-limited & time-cycled mode. (NMB) | PRVC (Pressure Regulated Volume Control) (RQ) |
| Your pt has set PS of 10cmH2O and a PEEP of 5cmH20. How much total pressure are you delivering to your pt? (NMB) | 10cmH2O + 5cmH20 = 15cmH20 (AzQ) |
| A ventilated patient has been transferred from an acute care facility to a long-term care patient. What pressures would you use? (RQ) rt | 1/3 of previous PIP or 15-20 cwp. rt |
| What two functions does setting the RR do? ApQ rt | 1) provide a trigger 2) provide cycling (rt) |
| A patient with pneumonia on volume control has a PIP of 32; ABGs show that the patient is growing hypercapnic. What can you do to improve ventilation? AzQ-rt | Decrease Vt and increase RR. (rt) |
| An unresponsive person was brought in by a family member. They are breathing shallow with periods of apnea. What Fio2 would you put them on? (Jenn B) | If a previous FiO2 is unknown then start the patient at 100% and wean them down. |
| What is the volume of gas that is rebreathed during mechanical ventilation? (Jenn B) | Mechanical dead space (Vdmech). |
| A patient is breathing 15 bpm with Vt 500ml and Flow of 35 lpm. What is their Itime? What is thier I:E? (Jenn B) | Itime=.86, I:E= 1:3.65 |
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