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Pilbeam CH 12 & 13

Student Study Note Cards

QuestionAnswer
What are some hazards and complications of suctioning on MV? (RQ) irritating the airway, anxiety, discomfort, coughing, hemorrhage, airway edema, and ulceration of the mucosal wall if preformed improporly. (CG)
How do you calculate the size of the correct catheter size based on ETT size? (ApQ) multiply ETT size by 3 then divide by 2. (CG)
How do we increase a low PaO2 on MV? (RQ) Increase FiO2 (give more O2 molecules), increase PEEP (increase FRC and surface area to participate in gas exhange), and increase Itime (more time for O2 to be in contact with membranes) (CG)
What 3 main settings we set that improve oxgenation? (RQ) Peep, FiO2, I Time (KMH)
If your patients FiO2 is set at 80% and there is little to no change in PaO2 what is the next setting you would change? (ApQ) Peep (KMH)
You have a patient is a PaO2 of48mmHg on 40%. You want your PaO2 to be 80mmHg. What FiO2 do they need? (AzQ) 80x 40/48=67% (KMH)
What is the normal PAO2 on room air? And what is the normal on 100%? (RQ) RA- >100mmHg 100%- >650mmHg (MK)
If you have tried increasing FiO2 and PEEP, and neither are working, what is the next thing you could do to try to improve the patients oxygenation? (ApQ) increase Itime (MK)
Increasing the PEEP will increase the FRC and surface area for gas exchange to happen. what will this treat? (AzQ) Refractory Hypoxemia (MK)
how many changes can be made for eaither oxygen or ventilation at a time? (RQ) one (RK)
what tells us a pt is oxygenating well? (APQ) Pao2, spo2, fio2, fao2/fio2, PAo2, cardiovasular status, ventilation. (RK)
how would you make a vent change with this abg. 7.55/75/85/40 (AZQ) no change. this is a metabolic issue. not respiratory. (RK)
What settings are used to improve oxygen and in the right order? (AzQ) BL 1)FiO2 2)PEEP 3)Itime 4)High Frequency Ventilation, ECMO, VDR
When increasing Itime, what must you be careful not to do unless it's ordered? (RQ) BL inverse the I:E ratio
If a patient has a RR of 10bpm, a PaCO2 of 48 and you want it at 40, what would be the desired RR? (ApQ) BL (48x10)/40 = 12bpm
What can you change to improve ventilation? (RQ) Respiratory rate, Tidal volume, PC level, Pressure support for Spontaneous breaths. (ACE)
When does changing the RR not change ventilation? (ap q) When the patient is initiating breaths greater than the set RR. This is because they are still breathing the same RR. To make a change you would have to set it higher than what they are currently breathing. (ACE)
A patient on VC with a RR of 16 bpm, FiO2 of 40%, VT of 0.6 L, I time of 0.8 sec, and flow of 45 lpm. PaCO2 is 67 mmHg and we want it at 45 mmHg. What is the first thing we would change? What would you change it to? (az q) After checking the settings are correct, we would change the RR. Desired RR = 67 * 16/45. Change the RR to 24 bpm. (ACE)
Pts on mechanical ventilation with artificial aw's are at high risk of what?(RQ)(TM) Upper AW infections and VAP(RQ)(TM)
What is the first thing we use to improve oxygenation and why?(AzQ))(TM) FiO2 b/c we want them to get O2 plus has the least affect or chance of causing barotrauma(AzQ)(TM)
A pt with ARDS has an ideal body weight of 53kg. An acceptable Vt would be what and why?(AzQ)(TM) 424ml-636ml b/c you don't want to go lower than 424 or you won't achieve ideal volumes but if you go over 636 you could over inflate lungs, cause air trapping etc(AzQ)(TM)
what number or oxygenation settings and ventilation settings are we allowed to change at the same time. One of each. (KRM)
Increasing PEEP also increases what? FRC and the surface area for gas exchange to occur. (KRM)
When a pt is hyperventilating, what are the 3 things we can change to improve their ventilation? Decrease RR, Decrease Vt or PC, Decrease sponatneous Vt by increaseing PS. (KRM)
What is intrinsic PEEP? Is it good or bad? How do we measure this with the ventilator? (AzQ) PEEP that is created by the internal characteristics of the lungs, also called "autoPEEP". This PEEP is BAD and can be measured by using and expiratory hold on the ventilator. (BH)
Why are respiratory rate and FiO2 the first things changed when we want to improve oxygenation or ventilation? (RQ) Because they are the settings that do not increase the risk of barotrauma. (BH)
You have a vent with the settings: Vt-650mL FiO2-40% RR-14 I-time-1 sec PEEP-5 ABG: 7.28/59/76/25 What is this patients biggest problem and how would you fix it? (ApQ) Ventilation, Increase the RR to 16-17 (BH)
What are three setting to improve Oxygenation and in order of importance? (RQ)(MB) FiO2, PEEP, Itime, (MB)
You have a patient on the vent in VC; with Vt:450,FiO2 100%, Itime 1sec, Peep 3, RR 14. with ABG 7.38/40/65/24. what would you do to increase Oxygenation? (AzQ) (MB) Increase peep to 5-8 cwp (MB)
What is the best indicator to determine ventilatory status on a vent patient? (ApQ)(MB) measuring the PaCO2 (MB)
What are some sign/symptoms of Pt CO2 production being greater than their CO2 elimination AC Acidotic, confusion, lethargic
What is the first step we take when we our patient has a decreased PaO2? Ac We first assess vent settings and also pts BP and Hg.
If your patient has a PaCO2 of 58 what would their desired Vt be? Current VT is 700ml. Desired value for PaCO2 is 45. AC 902ml.
How can you improve the ventilatory status of a patient with hypercapnic respiratory failure (i.e., reducing the partial pressure of carbon dioxide [PaCO2])? (AL) By improving alveolar ventilation, reducing physiological dead space, and reducing carbon dioxide (CO2) production.
A patient with myasthenia gravis is placed on mechanical ventilation. Initial ABGs on 0.25 FIO2 20 minutes after beginning ventilation are as follows:7.31/62/58/31. What changes in ventilator setting need to be made? (AL)  The patient has respiratory acidosis. The PaO2 indicates moderate hypoxemia. An increase in CO2 of 1 mm Hg will reduce the the PaO2 by 1.25 mm Hg. The most appropriate way to increase the PaO2 is to increase ventilation.
What are the goals of PEEP/CPAP therapy? (AL) •Enhance tissue oxygenation •Maintain a PaO2 ≥ 60 mm Hg and SpO2 at 90% or greater, at an acceptable pH •Recruit alveoli and maintain them in an aerated state •Restore functional residual capacity
What is one thing we can change that will be directed more towards patient comfort instead of an oxygenation change? (RQ) I-time, this can be changed to make the patient have more comfort (KAH)
What is the last resort thing we can use for oxygenation and what else should be considered before using this? (AZQ) HFV, ECMO, VDR, consideration should be taken if the pt is severely ill and we are having to use this lat option as survival rate is very low (KAH)
If we have a high PaCO2 = patient not breathing _________and/or _________ enough? (ApQ) Fast enough, deep enough (KAH)
What are the three easiest ways to improve a pt's oxygenation while on a ventilator? RQ MC FiO2, PEEP, Itime
A pt on a vent has the following ABG's after 1 hr 7.27/55/88/23 what settings should be assessed? ApQ MC ventilatory settings, RR, VT, or increase PS to achieve larger spontaneous VT
If a pt is continually having ABG's with low PaCO2 what should you do to try to increase it? AzQ MC Assess the pt's RR and what their spontaneous VT is. Possibly lower the PS and the VT to help the pt stop hyperventilating. MC
What does adding PEEP do to a low PaO2, and how? (AzQ) It increases PaO2, it does this by increasing FRC and surface area for gas exchange. (Marianne B.)
Calculate the catheter size for a size 7 ETT. (ApQ) (7x3)/2 = 10.5 (Marianne B.)
What is the normal PAO2 on an FiO2 of 1.0? (RQ) At least 650 mm Hg. (Marianne B.)
What are common parameters used to assess O2 stats in a pt?(RQ) FiO2 and ABGs(JB)
If your pt is not ventilation your O2 will do what? (ApQ) decrease (JB)
a woman in the er has a current FiO2 of .5 and and PaO2 of 75, you want a desired PaO2 of 90...(AzQ) 0.6 (JB)
Pt is not breathing fast and deep enough would show what? (RQ) high PaCO2 (JB)
This is a technique in which vent support is limited to avoid lung overdistention and injury of the lung...(ApQ) permissive hypercapnia(JB)
your pt has a Cstat of 69 and a desired VT of 700, whats desired PC level?????????(AzQ) 10.1 cmH2O (JB)
What are the two depths for suctioning and how far do they each go? (RQ) Shallow goes to the length of the artificial airway while deep goes until resistance is met. (CZ)
What additional setting do ARDS patients need while mechanically ventilated? What also does this restore? (ApQ) (CZ) They need PEEP in order to benefit from MV support. This restores their FRC by opening up closed alveoli.
A patient comes in with chest trauma from a tornado. What mode, range of Vt, and RR should this patient be set on initially? (CZ)(AzQ) Pressure Control, Vt: 7-12 ml/kg, RR: 12-14 bpm.
What is an absolute contraindication for PEEP? (RQ) An untreated pneumothorax or tension pneumothorax (NB)
In a patient with ALI or ARDS inflammation of the pulmonary capillaries & alveolar epithelials can result in what? What type of breath sounds are you likely to idetify with these types of pt's? (ApQ) These pt's are highly likely to suffer from excessive fluid/secretions In the alveoli & capillaries due to increased permeabilty from the inflammatory process. Crackles (NB)
What levels of pressure with a Nasal CPAP can provide a pneumatic splint that help to prevent pharyngeal obstruction? What type of pt would benefit from this device? What capacity might this icrease for the pt? (ApZ) 5-15cm H2O A pt with OSA FRC (NB)
What setting treats refractory hypoxemia when FIO2 isn't working? (RQ) PEEP, holds alveoli open and allows them to be oxygenated. (KJ)
You have a pt that is on the ventilator and they are on SIMV with a PS of 20, and still aren't reaching the Vt. In this case you will do what? As you are experiencing this, you will watch for what changes in the pt? (AzQ) When you have a PS >20, we need to switch the pt to a Full Support, as they are not ready to be worked. Also when this is happening, we need to watch for an increase in RR. (KJ)
What type of pts like an increase in Itime (allows alveoli to stay open for long periods of times)? (ApQ) Severe ARDS, sepsis, and pneumonia. (KJ)
What is a threshold resistor? (RQ) A device that provides a constant pressure throughout expiration regardless of the rate of gas flow. (AB)
Your pt who has an ET tube in place is not tolerating being suctioned, what other therapies can you provide to help your pt with secretion clearance? (ApQ) Postural drainage and chest percussion. (AB)
You go to do a routine neb tx and your pt is very lethargic and has a decreased LOC, what should you do? (AzQ) Determine if CO2 is increased and make appropriate changes. (AB)
What can result from an inverse I:E ratio? (Jenn B) Air trapping.
If your patient has PaO2 73 on FiO2 65% what would you do to correct this? If this correction does not work what condition does this patient probably have? (Jenn B) Start or increase PEEP. If this has no effect then the patient has ARDS (73/.65=112).
When you perform an expiratory hold the vent says the patient has 15cmH2O PEEP. When you release the expiratory hold button the vent says you have 5cmH2O PEEP. Why are these numbers different? (Jenn B) An expiratory hold will show you the total PEEP. If you subtract the set PEEP from the toal PEEP you will have the intrinsic PEEP.
Created by: MechVent