Details Title: 000 Kettering E Mech Vent Description: mech vent Total Flash Cards: 78 Created: 09/21/2009 08:00:37		New Users: To study from this flashcard set, or to create your own your own study flash cards, REGISTER HERE. Existing Users: CLICK HERE. Additional Health Care Flashcards
Cards in this set: Term Power of mechanical ventilator Definition power source used to achieve either positive or negative pressure - electric or pneumatic Term Inspiratory Phase Variables that Determine Inspiration Definition three main types of mechanical breaths - mandatory, assisted, spontaneous Term Trigger Variable Definition Begins inspiration Term Limit Variable Definition limits the inspiratory factors - the max value a variable (pressure, volume, flow or time) can attain during inspiration and does NOT end the inspiratory phase Term Cycle Variable Definition Pressure cycled - inspiration ends when pre-set pressure is reached; volume cycled - inspiration ends when a pre-set volume is delivered; time cycled - inspiration ends when a pre-set time has been met; flow cycled - inspirations end when flow decreases to a pre-set level; manual cycled - operator or patient stops Term expiratory phase Definition period between inspirations, during mechanical ventilation, when inspiratory flow ends, the expiratory valve opens, and expiratory flow begins Term What two types of ventilators Definition positive pressure; negative pressure Term When to use chest cuirass Definition intermittent use, no ET tube; home care; neurological cases since nothing wrong with lungs, problem with ability to ventilate/move muscles. i.e. neurological patient, going home, recommend negative pressure vent Term chest cuirass troubleshooting Definition hissing - check leaks, patient breathing cycle is off from patient, adjust Term patient on ventilator, what is the biggest concern Definition pressure, which is applied during inspiration (opposite of natural breathing) pressure damage occurs during inspiration. Spend more time in expiratory phase with less pressure, I:E 1:2 or 1:3 Term Most common PPV Definition Volume Cycled - provide specific volume, reaches that volume, shuts off Term Basic components of ventilator circuit Definition inspiratory limb, expiratory limb, wye adaptor, nebulizer, humidifier, exhaled volume monitor Term What to do when change ventilator circuit Definition periodically changed, needs second person to manually ventilate while circuit is being changed out Term Common alarms Definition high pressure limit (10-15 above peak airway prssure); oxygen alarm (5% above and below set FIO2); PEEP/CPAP high and low level; failure to cycle - check power supply; loss of power - check power supply; oxygen failure - check oxygen source; minimum exhaled volume (100 mL below exhaled tidal volume); low pressure limit ( 10below peak airway pressure); temperature alarm (set low and high level) Term low pressure alarm - troubleshooting Definition disconnect/leak Term high pressure alarm - troubleshooting Definition equipment obstruction, insufficient flow, ET/Trach tube cuff leak Term which pressure alarm is most important Definition low pressure/low exhaled volume - could represent a disconnect and patient would not be ventilating Term low exhlaed volume alarm troubleshooting Definition equipment disconnect (vent circuit); low spontaneous tidal volume Term temperature alarm troubleshooting Definition high temperature alarm; check humidifier temp; low temp alarm - check humidifier temp may decrease during aerosol therapy Term time cycled pressure limited ventilator Definition inspriations and expirations are cycled by time, limited by pressure used for infants Term What are the three phases of ventilation Definition phase 1 - initiating mechanical ventilation' phase 2 caring for the patient receiving mechanical ventilation; phase 3 weaning a patient off mechanical ventilation Term Indications for continuous mechanical ventilation - when to recommend mechanical ventilation and you would use phase 1 rules Definition apnea, acute ventilatory failure - not breathing enough (one ABG); impending respiratory failure - rising PaCO2 - (serial ABGs); oxygenation - used to reduce work of breathing Term ABG critical (intubatable) values Definition <7.35; >45 PCO2; <80 PO2 Term Bedside PFT critical values Definition Vt - <5 mL/kg; VC <10 mL/kg; RR >20 b/min or < 8 b/min; VE >10 L/min; MIP < -20; MEP <40 Term What is the most important PFT critical value Definition Tidal Volume - anything less than < 5 mL/kg Term What is extremely important PFT critical value Definition Vital Capacity - (10xtidal volumes (volumes in the hundreds) tidal volumes in thousands) < 10 mLkg. Normal is 10 x Tidal volume, but critical is 2x tidal volume - vital capacity is less than 1,000!! Term Muscle strength value important PFT critical value Definition MIP - maximum inspiratory value. Comatose patient cannot get vital capacity, obtain MIP and if < -20 Term Good numbers to look at for bedside PFT summary Definition 1st - vital capacity (2xtidal volume is critical value) 2nd MIP, tidal volume (<5 mL/kg) Term Unacceptable physiological assessment/calculations Definition A-a DO2 on 100% - >300; Qs/Qt (shunting) >20%; Vd/Vt (deadspace) >60%; Cst <25 Term calculate minute ventilation Definition RR times Tidal Volume Term alveolar minute ventilation Definition "alveolar" means get rid of deadspace -(Vt - deadspace) x rate. Deadspace is estimated at 1 ml per lb - 150 lbs = 150 ml anatomical deadspace. VE vs alveolar minute ventilation is different Term Ventilation Initial set-up Definition mode, Vt, RR, FIO2 and PEEP - mode not very important in this step Term Ventilation modes Definition control, assist/control, IMV/SIMV - any mode is acceptable in this step, do NOT rule out an answer based on mode alone in the initial set-up phase. Term What are the most important modes in the initial set-up phase and should be set first to achieve adequate ventilation Definition Tidal volume and Respiratory Rate Term Initial Set-Up for Tidal Volume Definition 10 mL/kg of IDEAL BODY WEIGHT Term IBW formula Definition males 106+6lbs over 5 feet; females 105 + 5 lb/in over 5 feet Term Initial Set-Up for Respiratory Rate Definition between 8 and 12 Term Initial set-up FIO2 and PEEP Definition If you have no clinical information (prior o2/ABGs, etc) set to 40-60% with NO PEEP therapy; patient on oxygen prior to ventilation - same FIO2 and/or PEEP; Term Pressure Vs Volume - selecting best ventilator Definition drug overdose, post-op, neurological - either works well; problems with lungs or chest - COPD, flail chest, ards, copd - volume is better Term Dynamic Compliance Definition exhaled volume/peak inspiratory pressure - PEEP Term Static Compliance Definition exhaled volume/ plateau pressure - PEEP Term Troubleshoot rising pressures - ventilator patient maintenance Definition two reasons pressures would rise - increasing airway resistance, or decereasing lung compliance Term what makes peak pressure rise, but not plateau pressure Definition increased airway resistance - whenever get peak and plateau pressures, look at the difference between the two - if peak pressure is rising and plateau is staying same (PIP - Pplat) - that difference represents airway resistance and if rising - auscultate - bronchospasm or secretions (bronchodilator or suction) Term Pplat is increasing Definition Pplat is rising but resistance stays the same (the difference stays the same but pressures are rising), pressures are rising - lungs are involved ; atelectasis, edema, etc. - increase PEEP usually Term What should mean airway pressure be Definition 5-10 is normal; obstructive patients 10-20; ARDS 15-30 - keep below 20 (mean airway pressures - all factors on ventilator will affect - Vt, RR, PIP, peak flow, etc Term Phase II - what is most important thing to check Definition Mode - generally preferred SIMV (choose when in doubt) Term With regard to Phase II and mode choices, when to use a mode other than SIMV Definition if peak inspiratory pressures are very high (60-70) change to pressure control - but monitor tidal volumes and if fall, only choices are increase pressure (don't want to ) so adjust inspiratory time Term correct vent settings when ABG has a high PaCO2 Definition decrease or remove deadspace 1st - next, look to increase Vt (leave alone if at or near target), then change respiratory rate Term correct vent settings when ABG has a low PaCO2 Definition increase deadspace; decrease rate, decrease tidal volume ( target PaCO2 for closed heae injury patients should be 25-30 mmHg - hyperventilate and that is the target) Term correct vent settings when ABG has a low PaO2 Definition add more oxygen (up to max of 60%) - 5-10% at a time; then increase PEEP by 5 until acceptable oxygenation is achieved or unacceptable side-effects occur (decrease compliance, decrease cardiac function, barotrauma, etc) Term correct vent settings when ABG has a high PaO2 Definition decrease FIO2 to less than 60%, decrease PEEP Term When would high frequency ventilation be recommended Definition maintain good ventilation at lower patients, out of hand ARDS; bronchopleural fistula (hole high volumes are blowing it open) - or other air leak problems subcutaneous emphysema, etc Term When to recommend ILV Definition when one lung is different than the other Term calculate minimum flow rate Definition (tidal volume x rate) x (I + E) Term Graphics Definition either scalar (time across bottom allowing separation between inspiratory time and expiratory time and see what is happening). Loop is flow vs volume, or pressure vs volume Term spontaneous breathing vent graphics Definition slight negative when inspire and maeks standing up oval, assisted looks like fish, football is controlled breath, Term troubleshooting loop graphics Definition football, flat on bottom pressure problem - change peep; flat on top (loop bends over) volume problem - change volume (turn down tidal volume); Term flat flow volume loop Definition side to side is volume, up and down is flow - skinny means needs bronchodilator and it will open up. If it's broken, there is a leak Term ventilator pharmacology - fighting, agitated, pain Definition morphine - doesn't matter that decreases ventilatory drive Term ventilator pharmacology - fighting, agitated, pain - morphine not an option Definition valium/versed Term what are the paralyzing agents Definition pavulon and "curonium" drugs Term what is the deal with anectine Definition succinylcholine chloride - paralytic lasts for a short time used for intubation Term Weaning Vt Definition >5 Term Weaning VC Definition >10 Term Weaning f Definition 8-20 Term Weaning Ve Definition <10 Term Weaning MEP Definition >40 Term Weaning RSBI Definition rapid shallow breathing index < 100 Term weaning, besides specific data what is important before initiated Definition underlying disease process has been reversed Term Weaning A-a DO2 Definition <300 Term Weaning Qs/Qt Definition <20% Term Weaning Vd/Vt Definition <60% Term Weaning pulse and blood pressure Definition normal Term After determination has been made to start weaning, blood gas can help determine Definition decrease ventilator settings Term what are lowest settings prior to extubation Definition SIMV/IMV - 4 breaths per minute; Fio2 40%; PEEP 5 Term IMV/SIMV method for weaning, what is a consideration Definition pressure support is indicated due to WOB Term weaning and medications Definition be sure to discontinue morphine "ine" drugs that suppress the drive to breathe Term after weaning, what is the most important thing to monitor Definition the heart - increase of 20 beats or more; less than 20 beats continue weaning but observe closely (administer oxygen)