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Respiratory Support
Question | Answer |
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What is ideal breathing pattern for SMI, IPPB, Aerosol therapy, ect | slow, deep inspiration, inspiratory pause/hold 1-3 sec, exhalation is slow passive and relaxed, pt may relax in between maneuvers with normal tidal volume breathing |
How do you position a pt for breathing techniques | prone for ARDS, fowlers for CHF, lateral fowlers for the obese pt, good lung down for unilateral lung disease |
Ventilatory muscle training benefits pt by | increasing their muscle strength and endurance, decreaseing dyspnea, the need for medication and hospital visits |
What are the indications for SMI, incentive spirometry | prevention of atelectasis |
How do you perform SMI | hourly while the pt is awake for 10 breaths, date time and volume should be charted but not duration, increase or decrease volume goals based upon pt performance |
What are the indications for IPPB | prevent atelectasis, prevent or decrease pulm edema, decrease work of breathing, mechanical bronchodilation, distribute aerosols, manipulate of insp-exp pattern, improve alveolar collateral ventilation and cough mechanism |
What are the contraindications of IBBP | unskilled practitioners and users, massive pulm hemorrhage, untreated pneumo, dirty equipment |
What are the hazards of IBBP | hyperventilation, impeding venous return, gastric distention, pneumothorax, excessive oxygenation and increased air trapping in COPD pt, active tuberculosis |
What is the Bird Mark 7 | positive pressure, pneumoatically powered, time triggered, pt triggered, pressure cycled, assist and control modes, flow adjustable |
In a Bird Mark 7 flow rate control what ratio is adjustable | I/E ratio, increasing the flow will increase the E time and decreasing the flow will increase the I time |
In a Bird Mark 7 air-mix off will give | 100% source gas setting, flow rates are reduced because room air is not entrained, must increase flow setting when changing to 100% source gas setting |
In a Bird Mark 7 air mix on will give | oxygen concentration between 40-80% |
In a Bird Mark 7 what happens under pressure | volume is changed by adjusting the pressure limit, max pressure 60 cmH2O, leaks in the circuit will prevent normal cycling to exhalation, obstruction/coughing would prematurely end inspiration |
In a Bird Mark 7 what happens under sensitivity | higher the number indicates increased pt effort decreased sensitivity, lower number indicate decreased pt effort increased sensitivity |
What is a Bennett AP-4 and AP-5 Ventilators | positive pressure, electrically powered, compressor driven, pt cycled assist mode only, flow limited, pressure limited, appropriate for IPPB therapy in a home setting |
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, if you increase pressure then | increase FIO2 |
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, if you decrease flow | increased inspiratory time will increase FIO2 |
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, if the air mix is off then | increase FIO2 to 100% |
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, the use of a nebulizer will | increase the FIO2 on PR-11 |
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, the use of terminal flow on PR-11 will | decrease the FIO2 |
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, sensitivity has | no effect on the FIO2 |
Control changes that will change the Volume, increasing the pressure will | increase the volume |
Control changes that will change the Volume, decreasing the flow will | increase the volume increased inspiratory time |
Control changes that will change the Volume, increasing the flow will | increase turbulence and decrease volume decreased inspiratory time |
Control changes that will change the Volume, airmix and sensitivity have | no effect on volume |
Control changes that effect the I:E ratio, increased pressure or increased tidal volume will | increase the inspiratory time and therfore change the I:E ratio |
Control changes that effect the I:E ratio, increased flow | will decrease the inspiratory time and change the I:E ratio |
Changes in delivered volume with changing comliance and RAW, decrease compliance | decrease volume |
Changes in delivered volume with changing comliance and RAW, increase compliance | increase volume |
Changes in delivered volume with changing comliance and RAW, increase RAW | decrease volume |
Changes in delivered volume with changing comliance and RAW, decrease RAW | increase volume |
Changes in delivered volume with changing comliance and RAW, decrease compliance increase resistance | decrease volume |
Changes in delivered volume with changing comliance and RAW, increase compliance decrease resistance | increase volume |
Trouble shooting in pressure cycled ventilators if there is a loss of pressure | leak, not enough flow |
Trouble shooting in pressure cycled ventilators if there is excessive pressure | obstruction, too much flow |
Trouble shooting in pressure cycled ventilators if it fails to cycle into inspiration | adjust sensitivity, tight seal around mouthpiece |
Trouble shooting in pressure cycled ventilators if it fails to cycle off | leak, mouth piece/mask seal, cuff leaking, fenestrated trach tube open, loose equipment connection |
When do you use non invasive positive pressure ventilation | neuromuscular disease, central/obstructive sleep apnea |
What are the hazards of NPPV | poorly fitting mask, irritation or ulceration from mask, leaks around mask or in tubing, gastric distention from high pressures |
When is NPPV contraindicated | pt with dysphagia |
What is EPAP | same as CPAP and can be used to improve oxygenation or prevent airway closure in obstructive sleep apnea |
What is IPAP | when this mode is set at a higher pressure than EPAP then positive pressure will be applied during inspiratory phase, maintain patent airway in obstructive sleep apnea |
What is spontaneous/Timed (ST) | allows pt to breathe at a spontaneous rate with combined timed breaths as in SIMV, IPAP phase will deliver inspiratory assist and EPAP will provide continuous positive airway pressure during exhalation |
What is spontaneous/Timed (ST) controlled by | selecting a respiratory rate and an inspiratory time percent |
When using the timed mode of support for NPPV the pt cannot | trigger additional mandatory breaths |
A patient with uncomplicated obstructive sleep apnea will generally find relief with | EPAP pressures of 5-10 cmH2O |
Patients with neuromuscular disease will usually do well with | inspiratory pressures of 10-15 cmH2O |
Maximum pressure of 15-22 cmH2O may be necessary to achieve adequate | alveolar gas exchange |
During repiratory support oxygen must be titrated into the mask to achieve a desired | FIO2 |
What is BIPAP | bilevel positive airway pressure, non invasive ventilator |
What are the two levels of CPAP in BIPAP | IPAP one during inspiration, EPAP one during exhalation, IPAP (ventilation)should be greater than EPAP (oxygenation) |
BIPAP ventilator breaths are | flow triggered and require pt effort to be greater than 40 ml/sec to initiate inspiration |
In BIPAP what I:E ratio is preferred | 1:2 |
In BIPAP what is the maximum inspiratory pressure | 22 cm H2O |
During BIPAP the ventilator cannot provide adequate support for a pt with | high airway resistance or low lung compliance |
In BIPAP during operation the IPAP | is the inspiratory pressure needed to abolish hypopnea and desaturation |
In BIPAP during operation the EPAP | is the expiratory pressure needed to keep the airway open |
When is BIPAP contraindicated | pt with dysphagia |