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PilbeamCHAPTER 3
Student Study Note Cards
| Question | Answer |
|---|---|
| Define the workload of a breath (RQ) (KH) | What work must be done to overcome the lung characteristics and deliver a breath. (RQ) (KH) |
| The last phase of a breath is exhalation. What is exhalation and is it active or passive? (ApQ) (KH) | The complete emptying of the lungs and complete relaxation of the thoracic cavity...Passive (ApQ) (KH) |
| What are the four control variables of a breath and what are they measured in? (AzQ) (KH) | Pressure..cwp...Flow...Lpm...Time...seconds...Volume...ml (AzQ) (KH) |
| The workload of a breath has 2 different pressures, what are they? (RQ) (MK) | Muscle pressure and ventilator pressure (RQ) (MK) |
| There are 4 phases of a breath. What are they and which ones are Active and which are passive? (AzQ) (MK) | Exhalation to Inspiration (active) Inspiration (Active) Inspiration to Exhalation (Active) Expiration (Passive) (AzQ) (MK) |
| Which phase variable causes the end of inspiration and the beginning of exhalation? (ApQ) (MK) | Cycling (ApQ) (MK) |
| What does PEEP increase in order to aid in improved gas exchange? (AT) | FRC and surface area (RQ) |
| What is an Expiratory Retard and when is it used? (AT) | An expiratory phase that causes a lengthened exhalation. It will causes the patient to mimic pursed lips, like COPDers. Best used to prevent early airway closure or air trapping.(AZQ) |
| How do you determine the time allowed for each breath? (AT) | 60 seconds divided by RR Ex. RR=14 The patient takes a breath every 4.3 seconds.(ApQ) |
| What is Triggering? (AB) | It is what causes the change from exhalation to inspiration. (RQ) |
| How would you prevent air trapping for a COPD pt who is using a ventilator and why do we do this? (AB) | Increase expiratory retard, to allow complete exhalation. (AzQ) |
| If your ventilator is set to give a breath every 3.75 seconds, how many breaths per min are they receiving?(AB) | 16 (ApQ) |
| List and describe the the three phase variables of a breath and then describe them. (AzQ) (BH) | triggering- what causes beginning of inspiration and causes the change from exhalation to inspiration cycling- causes the end of inspiration and the start of exhalation limiting- max value a variable can attain during inspiration (AqQ) (BH) |
| List two things that the muscle pressure and ventilator pressure are dependent on. (RQ) (BH) | Lung condition and Lung characteristics (RQ) (BH) |
| List the four phases of a breath. (ApQ) (BH) | 1. Exhalation to Inspiration 2. Inspiration 3. Inspiration to exhalation 4. Exhalation (ApQ) (BH) |
| What is cycling? (RQ) (JB) | Cycling causes the end of inspiration and the beginning of exhalation. (RQ) (JB) |
| This phase of a breath terminates a breath and allows the recoiling of the thoracic cavity to push the air inhaled out. (ApQ) (JB) | Inspiration to exhalation. (ApQ) (JB) |
| Out of the 4 phases of a breath which ones are active and which are passive? (AzQ) (JB) | exhalation to inspiration-active, inspiration-active, inspiration to exhalation-active, exhalation-passive. (AzQ) (JB) |
| What the respiratory muscles must do to get a breath in is what type of pressure?(RQ)(TM) | Muscle(RQ)(TM) |
| What is inspiration and is it active or passive?(ApQ)(TM) | The stretching of the thoracic cavity to allow for air to move into the lungs; active(ApQ)(TM) |
| What is Expiratory Hold and why do we use this?(AzQ)(TM) | A setting we set per breath, allows us to see the total PEEP a pt has; to see how much extrinsic and intrinsic PEEP a pt has and then to see if they are airtrapping(AzQ)(TM) |
| Why is exhalation passive? (CG) | It occurs naturally when the respiratory muscles relax. (RQ) |
| What is the purpose of PEEP? (CG) | To leave pressure in the alveoli to keep them open which results in better oxygenation. (ApQ) |
| Why would we use an expiratory hold versus PEEP? (CG) | when we need to measure the intrinsic PEEP of the patient (AzQ) |
| What are the 2 pressure for workload of a breath and what do we use? (KAH) | They are muscle pressure and ventilator pressure, we only use ventilator pressure! (ApQ) |
| What units are pressure in? (KAH) | Cwp, centimeters of water pressure (RQ) |
| Describe the inspiration to exhalation phase and is it passive or active? (KAH) | The termination of a breath and allowing the recoiling of the thoracic cavity to push the air inhaled out. It is active (AzQ) |
| What does the Expiratory Phase have the greatest affect on in the ventilation process. (NB) | Time & Pressure (RQ) |
| After increasing the PEEP on a vent; What are 2 benfits your patient may experience? What type of effects might this have on their Capacities? What capacity is most directly affected? (NB) | Increased Surface Area- resulting in Increased Oxygenation Increased Capacities FRC-directly affected (ApQ) |
| Once a patient meets a Limiting Phase Variable what will the ventilator do? (NB) | The ventilator will hold the limiting phase until the (Vt) cycling setting is met. (RQ) |
| Your Pt has a limiting phase variable of 30Lpm wich they have reached. This pt also has a Vt set at 600ml. They are currently sitting at a Vt of 425ml during inspiration. At this point how will the ventilator respond to this Limiting phase variable? (NB) | The ventilator will hold the Limiting varaible to 30Lpm while continuing inspiration until the Vt of 600ml's is met. (AzQ) |
| What is the difference between volume controlled breathing and flow controlled breathing? | volume controlled breathing is the amount of air for each breath. Flow controlled is how fast of slow a breath is delivered to the patient. (KM) |
| What problem do patients with chronic obstructve airway disease have with NEEP? | NEEP increases the risk of airway collapse and air trapping. (RQ) (KRM) |
| What is a limit variable? | The maximum value a varible can attain. This limits the variable during inspiration but does not end the inspiratory phase. (RQ) (KRM) |
| What are the 4 phases of a Breath? (MB) | Exhalation to inspiration, Inspiration, Inspiration to exhalation, Exhalation. (RQ) |
| So you are finding the pressure produced in one breath what units will it be in? (MB) | CmH2O ApQ |
| You Have a patient set at a PEEP of 10cmH2O and we do an expiratory hold and the vent says they have a total PEEP of 20cmH2O. What is the intrinsic PEEP (MB) | 10cmH2O ApQ |
| What does Expiratory retard mimic (RK) | Purse Lip breathing. (RQ) |
| what phase variable best describes exhalation to inspiration? and what is it commonly controlled by? (RK) | Trigger, Time, Flow, And/or Pressure (ApQ) |
| what phase of a breath can not be controlled, but there are a few ways to try to help different or calculations that can be found. (RK) | Exhalation, expiratory hold, expiratory retard, and PEEP (AzQ) |
| When a COPD patient is on the ventilator, what may happen over time? And how do we adjust for it? AzQ (ACE) | Due to their low compliance, their intrinsic PEEP will increase. Since we cannot control expiration, as it occurs passivly, we could take them off the vent momentarily to allow their lungs to deflate. (ACE) |
| What a difference between PEEP, NEEP, and ZEEP? RQ (ACE) | The baseline pressure. PEEP is a baseline above 0, NEEP is below 0, and ZEEP is 0 or atmospheric pressure. RQ (ACE) |
| When you change the Vt on a vent, which other factors will change? (AC) (AC) | flow and inhalation time (AC) |
| During which cycle of breath do most of our settings effect? (AC) | inhalation (AC) |
| If LPM is used for flow. What are the following units is for? ml,cmwp, bpm (AC) | ml=volume, cmwp=pressure,bpm=time (AC) |
| Most things that can be manipulated are done on the ______ phase. RQ (BL) | inspiratory |
| Triggering happens during which phase? Cycling? Limiting? AzQ (BL) | Exhalation to inhalation ; very end of inspiration to exhalation ; inspiration. |
| Why aren't there any phase variables for exhalation? ApQ (BL) | it is passive, little to no effects can happen |
| If a the volume waveform on a ventilator changes with changes in lung characteristics, how is the ventilator controlled? ApQ (RT) | By time |
| A patient has had damage to the phrenic nerve, which type of trigger would be most appropriate? RQ (RT) | Time trigger |
| A patient with reduced compliance will have what type of PIP compared to normal compliance? AzQ (RT) | Increased PIP |
| _________ is a constant flow until the designated volume is met. It is also known as the ________ phase. (KJ) AzQ | Limiting; final (KJ) |
| The phase that allows a maximum exhlation. COPD pts love this because we mimic pursed lip breathing? This is called_____? (KJ)RQ | Expiratory Retard (KJ) |
| The type of breath that is triggered by the vent is called? (KJ) ApQ | Mandatory breath (KJ) |
| What are the units pressure is measured in? (CZ)(RQ) | Pressure is measured in cmwp (centimeters of water pressure) (CZ) |
| You set a RR of 14 bpm on a triggered setting. How often is that ventilator going to start and deliver a breath? (CZ)(ApQ) | About every four seconds. 60 seconds/14 breaths per minute = 4.286 seconds |
| What are the three phases of breath that are active? Which phase is not active and why is this phase not active? (AzQ) (CZ) | The three active phases are: exhalation to inspiration, inspiration, and inspiration to exhalation. Exhalation is not and this is because it naturally happens. |
| The main variable that the ventilator changes to cause inspiration is called what? (Marianne B.) | Control variable (RQ) |
| In what cases would pressure limiting be important? (Marianne B.) | It would be important when treating someone with an issue like a COPD exacerbation because setting too high a pressure could potentially cause trauma where the patient would have a potentially large volume delivered. (ApQ) |
| When might time triggering be beneficial? When might patient triggering be beneficial? (Marianne B.) | Time triggering would be beneficial when a patient is paralyzed or apneic. Patient triggering would be beneficial when a patient makes identifiable inspiratory efforts. (AzQ) |
| What is the only passive phase of a breath? (JoeB) | Exhalation |
| What causes the end of inspiration and the beginning of exhalation? (JoeB) | Cycling |
| Why would we want to increase PEEP? (JoeB) | PEEP increases the FRC to help improve gas exchange for improved oxygenation. |
| If the thoracic cavity is being allowed to start recoiliing, what stage of breathing are you in? (JAB) | Inspiration to Exhalation |
| If the reading you are looking at is measured in units of LPM, what variable is this? How is this variable defined? (JAB) | Flow. The speed at which a breath is delivered. |
| If the ventilator has a limiting flow of 30 LPM, a Vt of 600 ml, and RR of 12 what is the maximum flow that can be reached before the breath cycles? (JAB) | 30LPM |
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MechVent
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