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Pilbeam CHAPTER 5
Student Study Note Cards
| Question | Answer |
|---|---|
| Which type of support has the patient doing some of the work and ventilator doing some as well.(RQ) | Partial Support (MK) |
| A patient has just been admitted to your floor who is a post op cardiac code. What type of support would you put this patient on? and what control mode?(AzQ) | Full Support on Volume control (MK) |
| What settings would you set if you had a patient in SIMV-Volume mode? And if the patient takes spontaneous breaths between the mechanical breaths what determines the rate and depth?(ApQ) | Vt, RR, Itime, FiO2, alarms, PEEP (optional) and pressure support (optional) the patient will determine the rate and depth (MK) |
| What are two types of minimal support modes? (RQ) | Pressure Support and Invasive CPAP (AT) |
| In which mode is there a set Vt for every breath and in which situations would you use this? (AzQ) | Volume Control. Situations where a patient has no lung damage but needs full support such as sepsis, head injusry, post-op cardiac code.. (AT) |
| Determine the type of humidification you would use for a patient who has thick secretions and will be on the vent for at least a week. (ApQ) | Heated Humidity - Concha Heater (AT) |
| What are the triggers for full support-pressure control? | Mechanical: Time Patient: Flow or pressure. (KM) |
| If you have a patient with a stable lung problem, what type of ventilation is best for them? | Pressure regulated volume control. (KM) |
| A patient comes in to the ER with a severe injury and the physician wants the patient put on mechanical ventialtion, what ype of support would be needed and in what mode? | Full support-Volume control(KM) |
| The 3 methods of providing noninvasive ventilatory support include? (RQ)(TM) | NPV (like iron lung), CPAP, NIV (BiPAP)(RQ)(TM) |
| For a trauma victim with with crushed chest injuries what would you use?(ApQ)(TM) | Pressure Control because you would expect HIGH PIP due to lung injuries. (ApQ)(TM) |
| In which mode do you NOT set a Vt and why?(AzQ)(TM) | Pressure control, SIMV PC PS, PS, and CPAP Because the pressure is set so Vt and flow vary(AzQ)(TM) |
| What are the 3 full support modes? (RQ) (KMH) | Volume Control, Pressure Control and Pressure-Regulated Volume Control (KMH) |
| A patient has just came to the ED and is having a COPD exacerbation and is in respiratory failure. What mode would you put them in? (ApQ) | Pressure Control (KMH) |
| A a physician has told you to set up a vent for a patient who is post op and is having trouble weaning off the vent. What mode would you put them in and what settings would you NOT set? (AzQ) | Volume Control PC and PS (KMH) |
| What situations would you use Full Support for? (RQ) | Post codes, trauma, critically ill patients, severe lung damage or disease. (CG) |
| In pressure control, if some one says they set PIP, what do they mean? (ApZ) | They set pressure control and PEEP. (CG) |
| When you set a respiratroy rate and Itime, what are 3 other settings you have set? (AzQ) | Etime, I:E ratio, and flow. (CG) |
| You are in volume control and need to set the trigger for the patient. Do you have to have: A. Flow Trigger B. Pressure Trigger C. You can choose A or B (RQ) | C. (BH) |
| You have a patient who is on the ventilator in VC with a RR set at 12 bpm. You notice that the patient is actually taking 20 bpm and their ABGs show Resp Alkalosis. What is happening, what action could you take to make this more effective? (ApQ) | The patient is becoming strong enough to trigger breaths on their own which shows that they are getting stronger. Switching modes to SIMV-volume will help the patient move toward doing more of the work on their own. (BH) |
| List the settings that you would need for SIMV-volume and tell whether the setting would change oxygenation or ventilation. (AzQ) | Vt-ventilation RR-ventilation I-time(or Flow)-oxygenation FiO2-oxygenation PS-ventilation PEEP-oxygenation (BH) |
| A patient comes in to the ER with an unknown injury to the head and the physician wants the patient put on mechanical ventilation, what type of support would be needed and in what mode?(AzQ) | Volume Control (rk) |
| Give the formula for Flow (RQ) | flow= (itime/vt(L))/60 (rk) |
| Why put a pt on SIMV over VC? (ApQ) | SIMV works there respiratory muscles and can be used to wean a pt off vent. (RK) |
| Which mode allows the pt to initiate a breath and the vent will provide a set pressure for every breath?(RQ) | Pressure control (JB) |
| What settings do you set for minimal pressure support?(ApQ) | alarms, FiO2, pressure support, PEEP, pt trigger (JB) |
| In what mode do you set the vt, RR, time, FiO2, PS, PEEP, Itime, Etime, I:E, Trigger and what kind of pt would use this mode? | SiMV-PRVC, post op pt woh needs to take over their own breathing. (JB) |
| During PSV mode what settings will you apply for the pt? What will the pt determine?(NMB) | You-alarms, inspiratory pressure, PEEP, flow-cycle criteria, & sensitivity level. Pt- RR, Inspiratory flow, Itime. (RQ) |
| You have concluded that your pt's lung characteristics have an increased compliance while the pt is currently being ventilated on a pressure-controlled ventilator mode. What is your greatest indicator of this? (NMB) | An increased volume for a given inspiratory pressure. (ApQ) |
| You have identified that your patient needs a support mode that will provide all the energy necessary to maintain effective alveolar ventilation. What type of support will offer this for your patient? (NMB) | FVC (Full Ventilatory Support) (AzQ) |
| When woking with a SIMV, can the patient take a spontaneous breath and is the breath supported(PS)? AC | Yes,the vent synchronizes with pts. own effort and allow for spontaneous breats. AzQ |
| When we set a target Vt, does the pressure vary breathe to breathe (this is with PRVC vent mode)AC | Yes, the vent varies the pressure breathe by breathe (at the beginning of the breath)in order to reach the target Vt. ApQ |
| Give some examples of pts who full support would be good for. AC | Post codes, traumas, critically ill pts, respiratory failure, sever lung damage/disease RQ |
| How often does a heat moisture exchange (HME) filter have to be changed? RQ (BL) | every 24 hours to 48hours |
| What is the mechanical trigger for SIMV Volume? What can the patient trigger be, who sets it, and in what measurements? AzQ (BL) | mechanical trigger is time (RR) and patient trigger is the set pressure if in cmH20, and in flow if Lpm. The RT sets the patient trigger. |
| If a patient's Vt is set at 680ml and an Itime of 1second, what is the set flow? ApQ (BL) | (.680L/1) x 60 = 40.8Lpm |
| What is patient support? (Marianne B.) | The patient and ventilator share WOB. (RQ) |
| When would we use minimal support? (Marianne B.) | We would use it when people are improving and can be weaned from a ventilator. (ApQ) |
| VC--what are some settings we set. trigger, cycling, and limiting? Why do we use it and what do we want to watch for? (Marianne B.) (AzQ) | Settings are FiO2, Vt, Itime, RR, and PEEP. Also alarms are set. Trigger is time, or flow or pressure. Cycle is time or volume. Limit is flow. We would want to watch pressure and use it when someone needs full support but doesn't have a pulm. hx. |
| What setting will prevent barotrauma when setting PRVC? RQ rt | High pressure limit (rt) |
| A patient on PRVC set at 20 Bpm has ABG's of 7.44/33/110/27. You should decrease RR because the patient is hyper ventilating. True or false? | False - attempt to wean with SIMV PRVC PS. Apq - rt |
| You've added PEEP, Increased RR, and the Ppeak is at 32 cwp, but oxygenation is still low. What should you look at? AzQ - rt | RBC and Hgb counts. AzQ - rt |
| What mode of ventilation would you use for a post op pt that is breathing shallow? (ApQ) | Volume control (ab) |
| Why do we use full support mode? (RQ) | To allow the pt to rest and give their body time to heal. (ab) |
| You are going to wean your pt off the vent today. They are currently in full support, what mode will you place them on and how long will you asses to determine if the pass or fail the wean? | SIMV- for at least 5 minutes (ab) |
| Patient is on full support pressure control. The doctor has ordered a target Vt of 650ml. In order to achieve this volume the pressure must be greater than 40cmH2O. What should you do? (AH) | Communicate with the doctor to let them know the target Vt is requiring too much pressure and see if he would like to lower the target Vt. (AH) |
| What mode will vary pressure from breath to breath to achieve the target Vt (AH) | Pressure-Regulated Volume Control PRVC (AH) |
| What settings are not allowed in Minimal Support Mode? (AH) | Rate and Volume. (AH) |
| In full support mode, what setting is not allowed? RQ (JM) | Pressure support |
| SIMV Volume support is set for a pt with 14 RR and 550 volume? What if the pt wants to take a spontaneous breath? ApQ (JM) | The pt may take spontaneous breaths and the vent won't determine the depth or rate of these breaths. It is skynchronized with the mechanical breaths. |
| If you had a pt on a vent with pneumonia and ARDS, which mode would you put the pt on? Why? AzQ (JM) | This pt needs full support because of her chronic lung condition and her need to clear the pneumonia. Full support will give pt time to rest and heal. |
| Which setting would you place a patient that you suspect high peak airway pressures and is having an Asthma Exacerbation? (RQ)(CZ) | Full Pressure Control |
| Your patient has a set rate of 12 bpm and is not initiating breaths on her own. How many seconds are in between each ventilator initiated breath? (ApQ)(CZ) | Every 5 seconds it will initiate a breath |
| In pressure support what is the mechanical trigger and cycle? (CZ)(AzQ) | In pressure support there is not a mechanical trigger and the cycle is patient determined. |
| Name 4 things you would set on Pressure Control ventilation? MB RQ | Pressure control level, RR, Itime, FiO2, Alarms, and PEEP MB |
| You have a patient that comes in the ER intubated after a motor vehicle accident and appears to have chest truama, What form of ventiation will you use? MB (ApQ) | It would be most appropriate to use Pressure Control ventilation. MB |
| You have a patient that is on the vent. with a set tidal volume, RR, FiO2, Peep, and ser Pressure support and is breathing outside of set RR, What what type of support is being given? MB (ApQ) | SIMV-volume with PS (MB) |
| If you have a post op pt who is having a hard time waking up what mode would be the best to put them in and what would the triggering, cycling, and limiting factors be? (Apq) | SIMV Volume, trigger mech time and pt flow or pressure, cycling time and volume, limiting flow (KAH) |
| What is the most common mode used? (RQ) | Full Support- volume (KAH) |
| What mode would you be in if your pt had a limiting mech of flow, a cycle of time and volume and is taking some breaths on there own and why? AzQ) | SIMV VOLUME, because the pt has some of there own spontaneous breaths SIMV and volume would have those limiting and cycling factors (kah) |
| What kind of PEEP can we not control? (Jenn B) | Intrisic PEEP or auto-PEEP |
| If you are using pressure ventilation and the patient's lung compliance increases what will happen to Vt? (Jenn B) | Vt will increase. |
| The doctor wants you to wean a patient from the vent. The are placed on PSV. What would be a normal PS setting? What RR would you set? (Jenn B) | Normal PS would be 10 cmH2O. The patient controls the RR. |
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