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Mech/Vent Unit 3
SPC Mechanical Ventilation Unit 3 Exam 2
| Question | Answer |
|---|---|
| What is the abbreviation for Acute Respiratory Failure? | (ARF) |
| What is Acute Respiratory Failure(ARF)? | Any condition in which respiratory activity is completely absent or is inadequate to maintain O2 uptake & CO2 clearance |
| What clinically is Acute Respiratory Failure? | The inability of the patient to maintain PaO2, PaCO2, and pH at acceptable levels |
| What are the ranges of PaO2, PaCO2, & pH to cause concern for Acute Respiratory Failure? | 1. PaO2 < normal range for age @ 21% FIO2 2. PaCO2 > 50mmHg & rising 3. pH < 7.35 & falling |
| (Remember The Wall) How do you fix O2? | With supplemental O2 and PEEP 1. O2 is for Responsive Hypoxemia 2. PEEP is for Refractory Hypoxemia |
| (Remember The Wall) How do you fix CO2? | Adjust Minute Ventilation(VE) i.e. Tidal Volume(VT) and Rate(f) |
| What is the difference between Hypoxia and Hypoxemia? | Hypoxia is failed O2 to the tissues where Hypoxemia is lack of O2 in arterial blood |
| What are some Respiratory findings of Mild to Moderate Hypoxemia/Hypoxia? | Tachypnea, Dyspnea, & Paleness |
| What are some Respiratory findings of Severe Hypoxemia/Hypoxia? | Tachypnea, Dyspnea, Cyanosis |
| What are some Cardiovascular findings of Mild to Moderate Hypoxemia/Hypoxia? | Tachycardia & Peripheral Vasoconstriction |
| What are some Cardiovascular findings of Severe Hypoxemia/Hypoxia? | Trachy-Bradycardia, Arrythmias, & Hypertension to Hypotension |
| What are some Neurological findings of Mild to Moderate Hypoxemia/Hypoxia? | Restlessness, Disorientation, Headaches, & Lethargy |
| What are some Neurological findings of Severe Hypoxemia/Hypoxia? | Somnolence, Confusion, Blurred Vision, Impaired Judgment, Anxiety, & Coma |
| A patient with pH under what gets an ET tube? | <7.25 |
| What is Hypercapnia? | CO2 Retention: a condition of abnormally elevated carbon dioxide (CO2) levels in the blood |
| What are some Respiratory findings of Severe Hypercapnia? | Tachypnea to Bradypnea |
| What are some Cardiovascular findings of Mild to Moderate Hypercapnia? | Tachycardia, Hypertension, & Vasodilation |
| What are some Cardiovascular findings of Severe Hypercapnia? | Tachycardia, Hypertension to Hypotension |
| What are some Neurological findings of Mild to Moderate Hypercapnia? | Headaches & Drowsiness |
| What are some Neurological findings of Severe Hypercapnia? | Hallucinations, Hypomania, Convulsions, Coma |
| What are some signs of Mild to Moderate Hypercapnia? | Sweating & Redness of the skin |
| What are some Respiratory findings of Mild to Moderate Hypercapnia? | Tachypnea & Dyspnea |
| What are the 5 physiological objectives of Mechanical Ventilation? | 1. To support or manipulate pulmonary gas exchange 2. Alveolar Ventilation - reduce PC02 3. Alveolar Oxygenation - (to maintain oxygen delivery) 4. Improve Lung volume 5. Reduce the work of breathing |
| What does "Improve Lung Volume" mean as an objective to mechanical ventilation? | Prevent or treat atelectasis with adequate end inspiratory lung inflation (PEEP) achieve and maintain adequate FRC |
| What is the normal and critical range for pH in ventilation? | Normal 7.35-7.45 Critical <7.25 |
| What is the normal and critical range for PaCO2 in ventilation? | Normal 35-45 Critical >55 |
| What is the normal and critical range for VD/VT in ventilation? | Normal 0.3-0.4 Critical >0.6 |
| What is the normal and critical range for PaO2 in Oxygenation? | Normal 80-100 Critical <70 (on O2) |
| What is the normal and critical range for P(A-a)O2 in Oxygenation? | Normal 5-15 Critical >450 (on O2) |
| What is the normal and critical range for a/A O2 in Oxygenation? | Normal 0.75 Critical <0.15 |
| What is the normal and critical range for PaO2/FIO2 in Oxygenation? | Normal 475 Critical <200 |
| What 5 disorders of the CNS(Central Nervous System) associated with REDUCED drive to breath? | 1. Depressant drugs 2. Brain or brainstem lesions (stroke, head/neck trauma, tumors, spinal cord injury) 3. Hypothyroidism (causes lethargy) 4. Sleep apnea caused by idiopathic central alveolar hypoventilation. 5. Inappropriate O2 therapy in retainer |
| What 3 disorders of the CNS(Central Nervous System) associated with INCREASED drive to breath? | 1. Increased metabolic rate 2. Metabolic Acidosis 3. Anxiety associated with dyspnea |
| What 2 brain disorders can alter the respiratory pattern? | 1. Cheyne Stokes 2. Biot's Respirations 3. Also tumors, stroke, and trauma from accidents can alter the pattern of respiration. |
| What is Cheyne Stokes? | Vt gradually increase and then decreases and is then followed by a brief apneic episodes. |
| What is Biot's Respirations? | The respiratory rate changes but tidal volumes all stay the same. |
| Brain disorders can also do what? So you must then do what? | Can also affect the glottis response, So you must protect the airway |
| What 4 disorders are associated with neuromuscular function? | 1. Paralytic Disorders 2. Paralytic drugs 3. Drugs affecting neuromuscular transmission 4. Impaired muscle function |
| What are 7 Paralytic Disorders associated with neuromuscular function? | 1. Myasthenia Gravis 2. Tetanus 3. Botulism 4. Guillain-Barre' Syndrome 5. Poliomyeltits 6. Muscular Dystrophy 7. Amyotrophic Lateral Scerosis |
| What are the 4 paralytic drugs associated with neuromuscular function? | 1. Curare 2. Nerve Gas 3. Succinylcholine 4. Insecticide Poisoning |
| What are the 3 type of drugs affecting neuromuscular transmission? | 1. Aminoglycoside Antibiotics 2. Long term Adrenocorticosteroids 3. Calcium Channel Blockers |
| What 5 disorders result in impaired muscle function? | 1. Electrolyte Imbalance 2. Malnutrition 3. Peripheral Nerve Disorders 4. Atrophy 5. Fatigue |
| What are the 1st 4 disorders the result in increased W.O.B. (Work of Breathing)? | 1. Pleural Occupying Lesions 2. Chest wall deformities 3. Increased airway resistance 4. Lung tissue involvement |
| What are the 2nd 4 disorders the result in increased W.O.B. (Work of Breathing)? | 5. Pulmonary Vascular Problems 6. Increased metabolic rates with accompanying pulmonary problems 7. Postoperastive Pulmonary Complications 8. Dynamic Hyperinflation (air trapping) |
| What pleural occupying lesions result in increased W.O.B.? | Pleural Effusions, Hemothorax, Empyema, & Pneumothorax |
| What chest wall deformities result in increased W.O.B.? | Flail Chest, Rib Fracture, Kyphoscoliosis, & Obesity |
| What increase airway resistance result in increased W.O.B.? | Increased Secretions, Mucosal Edema, Bronchoconstriction, Foreign Body Aspiration |
| What lung tissue involvement result in increased W.O.B.? | Interstitial Pulmonary Fibrotic Disease, Aspirations, ARDS, & Pulmonary Edema |
| What pulmonary vascular problems result in increased W.O.B.? | Pulmonary Thromboembolism & Pulmonary Vascular Damage |
| What is Normal W.O.B.? | A healthy persons normal W.O.B. is approximately 1-4% of their total oxygen consumption at rest. |
| W.O.B. may increase to as much as what in unhealthy adults? | 35-40% |
| What does MIP mean? | Maximum Inspiratory Pressure |
| What does NIF mean? | Negative Inspiratory Force |
| T/F MIP and NIF is the same thing? | True |
| What does MEP mean? | Maximum Expiratory Pressure |
| What does Vt mean? | Tidal Volume |
| What does VC mean? | Vital Capacity |
| What does PEFR mean? | Peak Expiratory Flow Rate |
| What is a Manometer used for measuring? | MIP (maximum inspiratory pressure) & MEP (maximum expiratory pressure) |
| What does FEV1 mean? | Forced Expiratory Volume in 1 sec. |
| What does PEF mean? | Peak Flow |
| Simplicity Spirometry System is used to measure what lung volumes? | Vt, VC, FEV1, PEF |
| What are the indications of MIP (Normal & Critical) of ARF and need for mechanical ventilator support. | Normal -50 to -100cmH2O Critical 0 to -20cmH2O |
| What are the indications of MEP (Normal & Critical) of ARF and need for mechanical ventilator support. | Normal +100cmH2O Critical <+40cmH2O |
| What are the indications of VC (Normal & Critical) of ARF and need for mechanical ventilator support. | Normal 65-75ml/kg Critical <15ml/kg |
| What are the indications of Vt (Normal & Critical) of ARF and need for mechanical ventilator support. | Normal 5-8ml/kg Critical <5ml/kg |
| What are the indications of RR (Normal & Critical) of ARF and need for mechanical ventilator support. | Normal 12-20bpm Critical >35bpm |
| What are the indications of FEV1 (Normal & Critical) of ARF and need for mechanical ventilator support. | Normal 50-60ml/kg Critical <10ml/kg |
| What are the indications of Peak Flow (Normal & Critical) of ARF and need for mechanical ventilator support. | Normal 100-850L/min or L/sec |
| What is the best indication of ARF or Ventilation? | PaCO2 |
| PaCO2 > 55mmHg & pH <7.35 indicates what? | Acute Hypoventilation or Hypercapneic Respiratory Failure |
| Hypoxemia with an increased W.O.B. is an indication for what? | That mechanical ventilator support is needed |
| How do you calculate PAO2? | FIO2 x (PB-47) - PaCO2/0.8 FIO2 >60% don't use 0.8 |
| What is PaO2? | Index of O2 loading of Hb in arterialized blood |
| What is normal PaO2 on room air? | 80-100mmHg |
| How can PaO2 an indication for ARF or Ventilation? | PaO2 <70mmHg on 60% O2 |
| What does P(A-a)O2 mean? | Also known as A-a gradient it is the difference between the alveolar and arterial O2? |
| T/F P(A-a)O2 is an indicator of oxygenation? | True |
| What is the normal and critical range of P(A-a)O2? | Normal 5-15mmHg on room air Critical >450mmHg on O2 |
| What is the normal range of A-a gradient of 21% O2 and 100% O2? | 5-15mmHg at 21% 100-150mmHg at 100% |
| T/F A-a gradient will decrease with age? | False-it will increase |
| T/F A-a gradient increase as the FIO2 increases? | True |
| T/F A-a gradient indicates the amount of shunt? | True |
| What is the Standard Criteria for Mechanical Ventilation? | 1. Apnea of absence of breathing 2. ARF 3. Impending Respiratory Failure 4. Hypoxemic Respiratory Failure with an increase W.O.B. or an ineffective breathing pattern. |
| What are the 1st 2 goals of Mechanical Ventilation? | 1. To Provide the pulmonary system with support to maintain an adequate level of alveolar ventilation 2. To reduce the W.O.B. until cause of ARF is removed |
| What are the 2nd 2 goals of Mechanical Ventilation? | 1. To restore pH balance to the arterial and systemic areas 2. To increase O2 transfer & oxygenation to body organs & tissues |
| Trying to fix CO2s with O2 or PEEP and O2 with rate or VT is like what? | Trying to teach a pig to sing-It wastes your time and is hard on the pig |
| How do you instruct a patient with a MIP/NIF and MEP maneuver? | The patient is to breath in from the device (manometer) while the respiratory therapist occludes the thumb port of the t-piece connector containing 2 one-way valves |
Created by:
Langhout1418
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