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Pilbeam CH 16-17
Student Study Note Cards
| Question | Answer |
|---|---|
| What usually helps to minimize the adverse effects of PPV on cardiovascular funtion? (AH) | SHorter Itime and longer Etime |
| Paw can be increased by adding what 2 things? (AH) | Adding PEEP and inspiratory pause |
| Define Auto-PEEP. (AH) | Unintentional PEEP that occurs during mechanical ventilation when a new inspiratory breath begins before expiratory flow has ended. |
| Explain the affects of O2 and CO2 in the brain during positive pressure ventilation, and when would we want to use more CO2? (AzQ) | When O2 is present in the vessels of the brain it acts as a vasoconstrictor, causing less blood flow into the brain. CO2 however acts as a vasodilator and promotes blood flow. A good time for increased CO2 is closed head injuries. (BH) |
| Explain what affect PPV has on blood flow to the kidneys. What three fuctions of the kidneys are changed and how? (ApQ) | PPV decreases blood flow the the kidneys. This causes: -decrease in drug and waste clearence -decreased filtration -decreased urine output (BH) |
| What does PPV do to CVP and what is it normally? (RQ) | PPV increases CVP which is normally 2-8 mmHg (BH) |
| What is it a sign of when your patient has puffing under the skin on their neck, face, chest, feet, or abdomen? (RQ) | This is a sign of subcutaneous emphysema. (CZ) |
| What is cardiac tamponade and what can it lead to? (ApQ) | Cardiac temponade is the compression of the heart by fluid or air in the pericardial sac; can also be caused by PPV in the lungs around the outside of the heart. If air isn't removed it can lead to cardiopulmonary arrest. (CZ)(ApQ) |
| What are some signs and symptoms of hypokalemia? (RQ) | Cool skin, decreased PaCO2, twitching, and tetany. (CG) |
| How does auto-PEEP affect ventilator function? (ApQ) | The presence of auto-PEEP will slow the beginning of gas flow during inspiration due to the pressure gradient created between the mouth and the ventilator. (CG) |
| Four days after being placed on MV, a post-op abdominal surgery pt has indications of low urine output, and a weight gain of 1 kg. What is the potential cause? (AzQ) | possible kidney failure, PPV, and fluid loading (CG) |
| What effect does malnutrition have on a patient's body? (AzQ) | It affects their ability to fight infection, heal wounds, and reduces the ability to maintain spontaneous ventilation because of their weak resp muscles. (CZ) |
| When adding positive pressure, does it increase or decrease blood flow in each system? (RQ) | decrease (MK) |
| If there is a too big drop in cardiac output, what would you do with the FiO2? (ApQ) | decrease (MK) |
| If positive pressure increases the ICP, it will do what to the cerebral blood flow? and is CO2 a dilator or constrictor in the brain? (AzQ) | decrease, constrictor (MK) |
| What does Positive Pressure Ventilation do to the metabolism of drugs? (RQ) | Decrease (KMH) |
| What type of people do we want to watch when on PPV since it decreases metabolism and why? (ApQ) | The elderly--they already have a slow metabolism (KMH) |
| What does CO2 do in the brain, O2 in the brain and how long can we want this to happen? (AzQ) | CO2 dilates, O2 constricts--1st 48 hours (KMH) |
| adding positive pressure what does that do to blood flow throughout the body (APQ) | decreases (RK) |
| how does the kidney function relate to positive pressure. (RQ) | decreases (RK) |
| what functions of the kidney will decrease in positive pressure. (AZQ) | dug/waste clearance, filtration, urine output. (RK) |
| During PPV, does the intrathoracic pressure increase, decrease, or stays the same? What does this do to other closed chambers in the body? (AzQ) BL | Increase. This causes pressure on other closed chambers. |
| What happens to the cardiac output when administering PPV? What else will change in the same direction as C.O.? Why? (ApQ) BL | Cardiac output decreases, and stroke volume will have the same change as C.O. This is because the pressure on the great vessels and heart so it can't pump as hard. |
| When weaning a COPD'er off the vent after 2-3weeks, what do we need to do to their caloric need? (RQ) BL | Increase so they have the energy to breathe on their own. |
| PEEP increases what?(RQ)(TM) | FRC and Paw, improves oxygenation(RQ)(TM) |
| PPV can decrease what? What does this cause?(AzQ)(TM) | Cardiac output and mean arterial blood pressure which causes an increase in ICP(AzQ)(TM) |
| A pt on PC-CMV has initial ABG of 7.30/60/101. What should an RT do?(ApQ)(TM) | Increase minute ventilation to the pt(ApQ)(TM) |
| When does sheer stress occur? | When an alveoli the is normal expands adjacent to one that is collapsed.(KRM) |
| What is atelectrauma? | Injury to the lungs that occur because of repeated opening and closing of alveoli at lower lung volumes. (KRM) |
| With PPV, does it increase or decrease the amount of anatomical dead space and alveolar dead space? | increases both. (KRM) |
| How can a decreased PaO2 in a patient with respiratory failure effect the renal function? (ApQ) (MB) | it can reduce renal function and decrease urine flow (MB) |
| What is the term that is described by the injures to the lungs that occur because of repeated opening and closing of the lung units at lower lung volumes? (RQ) (MB) | Atelectrauma (MB) |
| What are clinical signs and symptoms associated with Respiratory Alkalosis and Hypokalemia? (RpQ) (MB) | Cool skin, Twitching, and tetany (MB) |
| Name 4 potential complications from PPV? AC | reduced cardiac output reduced urine output decreased blood pressure increased ICP |
| Define auto-peep AC | An unintentional PEEP that occurs during mechanical ventilation when a new inspiratory breath begins before expiratory flow has ended. |
| What is one of the simplest ways to reduce WOB for our patient? AC | Use the largest possible ET tube that is appropriate for the patient. |
| What can positive-pressure ventilation (PPV) significantly alter? (AL) | positive-pressure ventilation (PPV) can significantly alter cardiovascular, pulmonary, neurologic, renal, and gastrointestinal |
| What is cardiac transmural pressure (PTM)? (AL) | The effective filling and emptying of the heart is determined, in part, by the pressure difference between the inside of the heart and the intrathoracic pressure. |
| What does shorter inspiratory times and the longer expiratory times usually help? (AL) | It will usually help to minimize the adverse effects of PPV on cardiovascular function. |
| What effect does the endocrine system have when using PPV? AzQ | It increases the release of ADH which results in less output of fluids compared to intake (I/O). A reduction in ANF due to low atrial filling pressure cause water and sodium retention. ACE |
| What patients are susceptible to barotrauma? | Patients with high levels of PEEP and high Vt, ALI/ARDS, high peak airway pressures and low end-expiratory pressures, aspirating gastric acids, necrotizing pneumonias, and bullous lung disease (TB or emphysema). ACE |
| Does a pt's thoracic pressure decrease or increase when they are placed on a mechanical ventilator? RQ MC | Increase MC |
| A pt has a closed head trauma and is placed on a mechanical ventilator, what type of ventilator should you place them on and what should you be aware of? ApQ MC | Volume ventilation but be cautious of the pt's ICP. MC |
| Why is it important to pay attention to a pt's I/O's and other metabolic assessments? AzQ MC | because the work of the kidneys and liver are decreased while on PPV and should be assessed to make sure they receive proper dietary needs to help the body heal. MC |
| If we have positive pressure ventilation what would be the effect on the O2 delivery? (AZQ) | You would have increased O2 delivery, providing increased FiO2, which also will increase the surface area (KAH) |
| What happens to the kidneys blood flow with positive pressure? Increase, decrease, or stay the same? (RQ) | The blood flow will decrease (KAH) |
| What are some organs we would want to watch in elderly patients and why? (Apq) | Keep an eye on the liver and kidneys because this will effect a patients metabolism (KAH) |
| Explain the effects of O2 & CO2 in the brain during PPV, and when would permissive hypercapnia be a good thing? (AzQ) | O2 is a vasoconstrictor, so less blood gets the the brain, and CO2 is a vasodilator, it causes blood to flow to the brain. Permissive hypercapnia is useful for closed head injuries. (Marianne B.) |
| Why is it important to watch for cardiac tamponade? (ApQ) | It is important to watch for this because the heart is being compressed by fluid or air. If untreated this could lead to death. (Marianne B.) |
| What does PEEP do to FRC? (RQ) | It increases it. (Marianne B.) |
| PPV does what to cardiac output??? (RQ) | it will reduce cardiac output(JB) |
| what are does PEEP increase when applied? (ApQ) | increases FRC but also increases Paw aka airway pressure (JB) |
| what does an inspiratory do? (AzQ) | improves oxygenation but also measures Pplat. (JB) |
| What will auto-PEEP do to the pt if present? (RQ) | will make it more difficult for spontaneously breathing pts to trigger a breath (JB) |
| Hyperventilation results from what? (ApQ) | Lower than normal PaCO2 and rise in pH. |
| Ventilator-associated lung injury can be caused by what?(AzQ) | shear stress, damage to pulmonary, alteration of surfactant (JB) |
| If renal arterial pressures decrease below 75mmHg what will happen to the pt's urinary output? (ApQ) | The pt's urinary output will decrease. (NB) |
| When pulmonary cells, are over stretched during mechanical ventilation chemical mediators/inflammatory cells are released causing a distinct lung appeareance on a CXR. What might that look like & what disease process might this resemble? (AzQ) | Ground Glass Appearance - ARDS (NB) |
| What are some causes of hyperventilation? | hypoxemia, pain, anxiety syndromes, circulatory failure, & a/w inflammation (NB) |
| When you have an I:E ratio, what are some of the benefits of this? And how do you calculate this? (AzQ) | I:E ratio tells us the shorter the inspiration time and the longer the expiratory time (Itime should always be shorter than Etime) the less harmful effects from PPV. Equation: Etime/Itime (KJ) |
| Injuries to the lungs that happen due to repeated opening & closing of the lung units is called _____? And what is an example of this type of issue? (ApQ) | Atelectrauma. ALI/ARDS is an example of this.(KJ) |
| What is the main cause of barotrauma on a ventilated pt? (Rq) | High peak pressures, high levels of PEEP with high Vt, etc. (KJ) |
| What is Oliguria? (RQ) | A diminished output of urine relative to fluid intake. (AB) |
| The level of reduction in cardiac output that occurs with PVV depends on what factors? (ApQ) | Lung and chest wall compliance, airway resistance and the duration and magnitude of the positive pressure. (AB) |
| You give your pt a PEEP of 5 and you find that their total PEEP is 12, what is their auto peep and what effect does it have on flow. (AzQ0 | Auto peep is 7cmH2O and it will decrease the flow to the pt. (AB) |
| What is it called when gas under pressure causes alveolar rupture? (Jenn B) | Barotrauma. |
| If the RR is set too low on the vent, how will this affect the patient's PaCO2 level? How will this change in PaCO2 affect the pH? (Jenn B) | The PaCO2 will rise. The pH will lower. |
| A patient comes into the ER with a closed head injury. What pressure do you need to be aware of when selecting your settings on the vent? What setting can you raise to try to reduce this pressure? (Jenn B) | ICP. RR. |
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