1. What two pressures act on the respiratory system during either spontaneous breathing or mechanical ventilation to produce Tran Respiratory pressure?

Muscle pressure + ventilator pressure

3. The equation for motion is

Muscle pressure + ventilator pressure = (volume / compliance) + (resistance / flow)

4. Explain both sides of the equation for motion.

The left side of the equation of motion represents the two forces that can provide ventilation. The right side of the equation represents the impedance that must be overcome to deliver a breath.

5. List three synonyms for volume ventilation.

Volume targeted ventilation, volume limited ventilation, volume control ventilation.

6. List three synonyms for pressure ventilation.

Pressure targeted ventilation, pressure limited ventilation, pressure controlled ventilation.

9. During pressure-controlled breaths, the compliance and resistance of a patient's lungs change. What happens to volume and flow?

The volume and flow vary with the patient's Lung characteristics during pressure controlled ventilation

10. During volume-controlled breaths the compliance and resistance of a patient's lungs change. What happens to the pressure?

The pressure varies with the patient's Lung characteristics during volume control ventilation.

11. During slow controlled breaths, the compliance and resistance of a patient's lungs change. What happens to volume and pressure?

The volume remains unchanged, but the pressure varies with the patient's Lung characteristics during flow - controlled ventilation.

13. What two types of ventilators are time-controlled

High frequency jet ventilators and oscillators control time

14. Describe the relationship between flow and volume in the form of a formula.

Flow = volume change per unit of time (leaders / minutes) or (liters / second)

15. When a volume waveform is selected by the operator, what happens to the flow waveform?

The flow waveform is established and will remain consistent.

16. List the three places where ventilators measure pressure.

Any of the following. At the upper, or proximal airway, where the patient is connected to the ventilator, internally near where the main circuit lines connect to the ventilator, and near the exhalation valve.

17. List the four phases of a breath.

Change from exhalation to inspiration, inspiration, change from inspiration to exhalation, and exhalation.

Help

Options

Question

2. Across. The variable that ends inspiration

click to flip

focusNode

Didn't know it?
click below

Knew it?
click below

Don't know

Question

4. Across. The specific amount that begins inspiration.

Remaining cards (154)

Know

retry

shuffle

restart

0:00

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

Normal Size Small Size show me how

resp 184 wkbk chap 3

How a Breath is Delivered

Question	Answer
2. Across. The variable that ends inspiration	Cycle
4. Across. The specific amount that begins inspiration.	Volume
6. Across. The gas law that governs tubing compressibility. 2 words.	Boyle's law
9. Across. Applying positive pressure during expiration during mechanical ventilation. Abbreviation.	Peep
11. Across. The ventilator begins inspiration. Two words.	Time trigger
12. Across. Applying negative pressure during expiration. Abbreviation.	Neep
17. Across. The maximum value a variable can attain.	Limit
22. Across. The primary variable the ventilator is using to cause inspiration. Two words.	control variable
23. Across. Gas speed reaches a maximum amount. 2 words.	Flow limit
26. Across. The pressure read during an inspiratory pause.	Plateau
27. Across. The maneuver performed to measure auto PEEP. 2 words.	Expiratory hold
29. Across. A baseline pressure at zero. Abbreviation.	ZEEP
One. Down. Gas speed begins inspiration. Two words.	Flow trigger
2. Down. The way of ventilator marks the end of inspiration. Two words.	Cycling mechanism
3. Down. The most common mechanism for ending inspiration in the pressure support mode. 2 words.	Flow cycle
5. Down. A breath initiated by a ventilator is a what breath.	Mandatory
6. Down. The pressure level from which a ventilator breath begins.	Baseline
7. Down. Max out at an amount. 2 words.	volume limit
8. Down. A pressure target ventilator mode where the patient breathes spontaneously. 2 words.	Pressure support
10. Down. The ventilator mode where the set limit is pressure. 2 words.	Pressure control
13. Down. Breathing out.	Exhalation
14. Down. The patient is making no effort ventilation is being, what, by the ventilator	Controlled
15. Down. Breathing in.	Inhalation
16. Down. A variable that begins inspiration.	Pressure
18. Down. The variable controlling a certain phase of breath. 2 words.	Phase variable
19. Down. A breath controlled by the patient.	Spontaneous
20. Down. A breath begun by the operator. 2 words.	Manual trigger
21. The ventilator ends inspiration. Two words.	Time cycle
24. Down. The variable that begins inspiration.	Trigger
25. Down. The method of applying pressure to a spontaneously breathing patient.	CPAP
28. Down. The type of ventilation that assist both inspiration and expiration. Abbreviation.	HFO
chapter review questions
1. What two pressures act on the respiratory system during either spontaneous breathing or mechanical ventilation to produce Tran Respiratory pressure?	Muscle pressure + ventilator pressure
2. The motion caused by the interaction of these two pressures is described as	flow
3. The equation for motion is	Muscle pressure + ventilator pressure = (volume / compliance) + (resistance / flow)
4. Explain both sides of the equation for motion.	The left side of the equation of motion represents the two forces that can provide ventilation. The right side of the equation represents the impedance that must be overcome to deliver a breath.
5. List three synonyms for volume ventilation.	Volume targeted ventilation, volume limited ventilation, volume control ventilation.
6. List three synonyms for pressure ventilation.	Pressure targeted ventilation, pressure limited ventilation, pressure controlled ventilation.
7. What are the four variables that a ventilator can control?	Pressure, volume, flow, time.
8. The primary variable that a ventilator is using to cause inspiration is called	The control variable
9. During pressure-controlled breaths, the compliance and resistance of a patient's lungs change. What happens to volume and flow?	The volume and flow vary with the patient's Lung characteristics during pressure controlled ventilation
10. During volume-controlled breaths the compliance and resistance of a patient's lungs change. What happens to the pressure?	The pressure varies with the patient's Lung characteristics during volume control ventilation.
11. During slow controlled breaths, the compliance and resistance of a patient's lungs change. What happens to volume and pressure?	The volume remains unchanged, but the pressure varies with the patient's Lung characteristics during flow - controlled ventilation.
12. Both pressure and volume waveforms can be affected by changes in Lung characteristics while what type of control variable is being used	Time control
13. What two types of ventilators are time-controlled	High frequency jet ventilators and oscillators control time
14. Describe the relationship between flow and volume in the form of a formula.	Flow = volume change per unit of time (leaders / minutes) or (liters / second)
15. When a volume waveform is selected by the operator, what happens to the flow waveform?	The flow waveform is established and will remain consistent.
16. List the three places where ventilators measure pressure.	Any of the following. At the upper, or proximal airway, where the patient is connected to the ventilator, internally near where the main circuit lines connect to the ventilator, and near the exhalation valve.
17. List the four phases of a breath.	Change from exhalation to inspiration, inspiration, change from inspiration to exhalation, and exhalation.
18. The phase variable that begins inspiration is known as the	Trigger variable
19. The ventilator has measured and elapsed amount of time and delivers a breath. What is the phase variable that is beginning this breath?	Time
20. What type of breath is described in the previous question?	Mandatory
21. A paralyzed patient who makes no effort to breathe can be said to be in this mode	Control mode
22. At what pressure should pressure sensitivity be set?	Approximately negative-1 centimeter h2o
23. Explain auto triggering.	If the ventilator is too sensitive, it will trigger on its own, without the patient making an effort.
24. If the flow sensitivity is set to 2 liters per minute and the baseline flow is 8 liters per minute, at what flow will the ventilator be triggered to give a breath?	6 liters per minute. Baseline flow minus - flow sensitivity = flow sensed at exhalation by the ventilator to trigger a breath. Example, 8 liters per minute - 2 liters per minute equals 6 liters per minute.
25. Describe volume triggering.	Volume triggering occurs when the ventilator detects a small drop in the volume in the patient circuit during expiratory time.
Questions 26 through 29 refer to figure 3-1. Taking a picture for Anki
26. What is the control variable?	Time trigger
27. What is the expiratory time?	3 seconds
28 what is the inspiratory time?	One second
29. What is the baseline?	5 centimeters h2o
30. What type of trigger does wave A have?	Time trigger
31. What type of trigger does wave B have?	Time trigger
32. What type of trigger does wave C have?	Patient trigger or pressure trigger
33. What is the baseline?	10 centimeters h2o
34. Name the three types of patient triggers.	Pressure, flow, volume
35. The type of trigger that occurs when a patient inhales a specific volume that begins inspiration is called	Volume trigger
36. The maximum value that a variable can attain is known as a	Limit variable
Questions 37-43: classify the following breaths as mandatory, assisted, or spontaneous.
37. Pressure triggered, pressure limited, time cycled.	Assisted
38. Flow triggered, volume limited, time cycled	Assisted
39. Time triggered, pressure limited, time cycled.	Mandatory
40. Flow triggered, patient cycled.	Spontaneous
41. Pressure triggered, flow limited, volume limited, volume cycled.	Assisted
42. When setting up flow triggering the higher the flow trigger setting, the ... what ... sensitive to the ventilator is the patient.	Less
43. What type of patient triggering mechanism requires less work of breathing?	Flow triggering
44. How should the maximum safety pressure be set?	The maximum safety pressure should be set at 10 centimeters h2o above the average peak inspiratory pressure during volume or pressure ventilation
45. When the maximum safety pressure setting is reached during inspiration what happens?	The ventilator will Alarm, pressure will be limited, and inspiration will end.
46. List at least three names for maximum safety pressure that are used by various ventilator manufacturers.	Any of the following, normal pressure limit, pressure limit, high pressure limit, or upper pressure limit.
47. What is the internal maximum safety pressure used by most ventilator manufacturers?	120 centimeters h2o
48. How do most ICU ventilators achieved volume cycling?	Most ICU ventilators measure the gas flow that has left the ventilator over a specific time and convert it to a volume reading. Flow times inspiratory time equals tidal volume.
49. What is the tubing compressibility factor for most adult ventilator circuits?	2 - 3 milliliters / centimeters h2o
50. How much volume will be lost in the patient circuit when the tubing compressibility is 2.5 milliliters per centimeter h2o, the set volume is 500 milliliters, and the peak inspiratory pressure is 25 centimeters h2o?	Pip times compressibility factor equals volume lost equals 25 times 2.5 equals 62.5 milliliters
51. Give two reasons why exhale title volume may not equal the set title volume when a breath is volume cycled.	1.When the machine is volume cycling, less volume may return from the patient because of tubing compressibility. 2. System leaks.
52. A large leak is detected in the ventilator system during pressure support ventilation. How will the ventilator and inspiration?	The ventilator will time cycle between three to five seconds.
53. The ventilator cycles to expiration when the patients exhaled gas flow drops to a certain percentage of the peak inspiratory flow rate. This describes what type of end to inspiration?	Flow cycled
54. When could a pressure cycled ventilator be used?	A pressure cycled ventilator can be used for short term ventilation of patients with stable lung conditions, such as the postoperative patient.
55. What happens to inspiratory and expiratory times during an inflation hold?	Inspiratory time will increase and expiratory time will decrease during and inflation hold.
56. Air trapping can occur by not having enough	Expiratory time
57. The pressure level from which a ventilator breath begins is called the	Baseline pressure
58. The addition of positive pressure to exhalation is called	Positive end-expiratory pressure. Peep.
59. What type of ventilator assists both inspiration and expiration by pushing air into the lungs and pulling it back out at extremely high frequencies?	High frequency oscillatory ventilator
60. A ventilator patient is allowed to exhale. The ventilator then closes both expiratory and inspiratory valves. This maneuver is known as, what, and measures the amount of, what.	Expiratory hold, end-expiratory pause. Auto PEEP.
61. The presence of air trapping may be observed on which type of graph?	Flow time curve
62. What are the three methods of detecting air trapping on a ventilator?	1. Mejor auto PEEP. 2. Observe the flow time curve. 3. Put a respirometer in line between the ventilator Y connector and the endotracheal tube and observe for continued movement at the beginning of inspiration. Patient still exhaling when next occurs
63. Increased resistance to exhalation may be caused by what device?	Ventilator circuits, expiratory valves, and bacterial filters.
64. Accumulation of moisture within and expiratory filter will cause	Increased resistance to exhalation
65. Breathing spontaneously at pressures above ambient is known as what ventilator mode?	Continuous positive airway pressure. CPAP.
66. Increase in the baseline during mechanical ventilation with intermittent mandatory breath is known as	Positive end-expiratory pressure. Peep.
67. Sleep apnea may be treated with either, what, or, what.	CPAP or bilevel positive pressure
68. How does Flo cycling occur with pressure support ventilation?	When inspiratory flow drops to a certain point, which is a set parameter on some ventilators and constant on others, the ventilator ends inspiration. He set parameter for flow termination is a percentage of the peak inspiratory flow.
69. What flow is needed to deliver 600 milliliters in 1 second with a constant gas flow?	Tidal volume equals flow times inspiratory time. Therefore, flow equals tidal volume / inspiratory time equals 0.6 liters / second or 36 liters / minute
70. The two pressures set during bilevel positive pressure ventilation are	IPAP. EPAP.
71. What are the trigger, limit, and cycle variables for bilevel positive pressure ventilation?	Patient triggered, pressure limited, and flow or time cycled.
Critical thinking questions
Questions 1-6 refer to Figure 3 - 3, which shows a pressure time curve and flow time curve. Pictures may be found in Anki.
1. What is the limit mechanism for these breaths?	Pressure
2. Name the three possible modes that these graphs represent.	Pressure control, pressure support, or BiPAP.
3. What is the trigger mechanism for the breaths shown?	Flow is the trigger mechanism.
4. What is the cycling mechanism for the breast shown?	Flow is the cycling mechanism
5. What is the inspiratory time?	One second
6. What is the expiratory time?	2 seconds
Questions 7-10 refer to Figure 3-4. Found in Anki and keep note.
7. What is the trigger variable for waveform a?	The trigger for, A, is time.
8. What is the trigger variable for waveform be?	The trigger for, B, is patient / pressure
9. The Trans airway pressure is	The trans airway pressure is 35 - 20 equals 15 centimeters h2o
10. What is the baseline?	The baseline is 5 centimeters h2o
Case studies
Case study number 1. You are a respiratory therapist assigned to the ICU of a local hospital and have been called to assess a patient who may require mechanical ventilation.	Physical exam reveals a respiratory rate of 25, blood pressure 145 / 90, pulse 115 and breath sounds are bilaterally decreased, especially in the bases.
ABG reveals: PH 7.44 Paco2 42 millimeters HG Sao 2 70% Hco3 - 22 MEQ / L on a non - rebreather mask. The patients Maps - 75 centimeters h2o, VC is 70 milliliters flash kg, and vt is 7 milliliters /kg.
1. Explain the primary area of concern for this patient.	The primary area of concern for this patient is hypoxemia. While receiving oxygen from a non rebreather mask, the patient has a pao2 of only 42 millimeters HG. The patient acid-base status is acceptable at this time.
2. What is the most appropriate type of ventilatory support for this patient at this time?	The most appropriate type of support at this time is continuous positive airway pressure via mask with supplemental oxygen
The following day you return to the ICU and find this patient receiving mechanical ventilation. Figure 3-5 shows the graphic display. Anki, keep notes.
3. What type of ventilation is this patient receiving?	The patient is receiving mechanical ventilatory support using volume control.
4. What is / are the limiting variable / variables?	The limit variables are volume and flow.
5. What trigger variable is being used at this time?	The trigger variable is patient, pressure.
In addition, you know that the patient is diaphoretic and is using accessory muscles while assisting.
6. Do any of the graphic displays give clues to the source of the patient's problem? If so, which ones?	Yes, the pressure time curve.
7. What is the source of the patient's problem?	The patient is pulling too hard to trigger the ventilator. The pressure time curve shows that the patient has to deflect from a PEP of + 10 cm h2o down to about + 3 cm h2o. That means that the machine is not sensitive enough to the patient effort.
8. To alleviate this problem, what must you do as the respiratory therapist?	The respiratory therapist must adjust the sensitivity to approximately 1 centimeter h2o below the bassline of 10 centimeters h2o
Case study number 2
A postoperative patient is being set up on a mechanical ventilator to receive volume control ventilation.
1. What parameters need to be set by the respiratory therapist?	Tidal volume, ventilator rate, fio2, baseline, flow rate, and sensitivity.
2. During Ventilation the patient's peak inspiratory pressure is reaching approximately 28 centimeters h2o. At what level should the maximum safety pressure be set?	Set the maximum safety pressure at 38 centimeters h2o.
3. What is the purpose of the maximum safety pressure?	To prevent excessive amounts of pressure from building up in the lungs.
While assessing the patient and checking the ventilator the respiratory therapist noticed that although a volume of 500 milliliters is set only 400 milliliters is being exhaled by the patient and the maximum safety pressure is being reached on each breath
4. What is the most likely cause of the low volume return? Explain your answer	Maximum safety pressure is cycling the vent, thereby stopping the vent from delivering all the set volume. The maximum safety pressure may be reached because of problems such as excessive mucus, bronchospasm, tension pneumothorax, or stiffening lungs.
5. If the maximum safety pressure was not being reached on each breath and the exhaled volume was 100 milliliters less than Set, what could be the possible cause for this?	Loss of volume due to tubing compressibility, a leak in the system, or air trapping.
NBRC - style questions
1. A breath that is triggered, limited, and cycled by the mechanical ventilator is which of the following? Assisted breaths, mandatory breaths, spontaneous breath, synchronized breasts?	Mandatory breaths
2. A breath that is triggered, controlled, and ended by the patient is which of the following? Assisted breaths, controlled breaths, spontaneous breaths, synchronized breast?	Spontaneous breaths
3. A breath that a patient triggered, ventilator controlled, and cycled is which of the following? Assisted breaths, controlled breaths, spontaneous breath, pressure supported breaths?	Assisted breaths
4. During pressure-controlled Ventilation the patient's airway resistance increases. Which of the following will occur? The peak pressure will increase, the peak pressure will decrease, the title volume will increase, the title volume will decrease?	The title volume will increase
5. During the volume control Ventilation the patient's lung compliance improves. This will cause which of the following to occur? The peak pressure will increase, the pressure will decrease, the tidal volume will increase, the title volume will decrease?	The peak pressure will decrease
6. During volume-controlled Ventilation which waveform remains unchanged with changes in patients Lung characteristics? Volume time curve, pressure time curve, flow time curve?	Volume time curve. &. Flow time curve.
7. When both pressure and volume waveforms are affected by changes in lung characteristics, which of the following variables is being controlled? Time, flow, volume, pressure?	Time.
8. A high frequency oscillator controls which of the following variables? Flow, time, volume, pressure?	time.
9. When the ventilator is time triggering and the rate is set at 20 breaths / minute, the time interval between breaths is which of the following? 2 seconds, 3 seconds, 4 seconds, 5 seconds?	3 seconds
10. During flow triggering the base flow is set at 5 L / min and the ventilator triggers when it senses 3l / min returning to its flow measuring device. The flow sensitivity setting is which of the following? 2L/min, 3L/min, 5L/min, 8L/min?	2 liters / minute
11. During pressure support ventilation the patient triggers the vent and the vent cycles @ 5 seconds. What is the cause of this time cycle? A leak in the system, this is the normal setting, increased lung compliance, change in the airway resistance?	A leak in the system
12. The most common cycling mechanism used for pressure support ventilation is which of the following? Time, flow, volume, pressure?	flow
13. The maneuver that is used to measure plateau pressure is which of the following? Flow limiting, expiratory hold, inspiratory hold, pressure limiting?	Inspiratory hold
14. What is the trans respiratory pressure if the ventilator is set at a volume of 500 mL with a flow of 60 L/min and the patient's lung compliance is 0.75 L/cm H2o and airway resistance is 6 cm h2o / L / sec?	6.7 cm h2o
15. What flow is needed to deliver 850 milliliters of volume to a patient in 0.75 seconds with a constant gas low? 53 liters per minute, 60 liters per minute, 68 liters per minute, 75 liters per minute?	68 liters per minute

Created by: johndreamer

"Know" box contains:
Time elapsed:
Retries: