Question Answer
When should you document on the ventilation record? before ABGs, when the doctor order is written, when vent changes are made, when vent performance is questionable.
If the PIP is 30 cmH2O, the Vt is 550 ml at the exhalation port, and the tubing compliance factor is 1.5, how much volume is lost in the circuit? PIPxCt=30cmH2Ox1.5ml/cmH2O=15ml
How do we measure PLAT, and how would you correct for decreasing compliance? Inspiratory Hold, switch from volume ventilation to pressure ventilation and maintain PIP<35 cmH2O.
If your BP decreases below 60, where does all the blood in the body go? Brain, Heart and Large Muscles
What are major organs of the respiratory system and what are some things we can monitor without any big machine? Lungs, diaphragm, trachea, bronchioles, RR, Breath Sounds, WOB, SpO2
What is the function of the urinary system and what are some things we monitor to determine if it is working efficiently? Rid of waste and fluid balance–urine sample, BUN, Creatinine, Ultrasound, I/O, Electrolytes
What are some major organs in the Lymphatic system? spleen, lymph nodes, thymus
If you think someone has a problem with their respiratory system, what are some things you can check right on hand without an order or leaving the room for machines? RR, SpO2, breath sounds, WOB
What is made up of the skeletal system and the muscular system? And what are some assessments you can monitor for both? bones, ligaments, tendons, and cartilage x-ray, ROM, ambulation, bone density, MRI, NIF, strength test
How many body systems are there in the human body? Name them: 9, urinary, respiratory, digestive, lymphatic, endocrine, circulatory, nervous, muscular, skeletal
name 5 ways to test the urinary system BUN, I/O urine sample, ct, ultrasound.
name organs and structures, ways to test and what they test for in the respiratory system. lung, trachea, upper airway, PFT-flows and volumes, ABG- ventilation and oxygen needs. RR-how fast breathing/wob spo2- % of o2 carried in alveolar level.
When blood is shunted, what 3 major parts does the blood go to to protect? heart, brain, and large muscles (fight or flight)
What test can you perform to test diaphragm strength? What part of ventilation will this tell you? NIF (negative inspiratory force) to tell if they will be able to have the strength to wean from the vent (generate a breath on their own)
Name the organs and 5 assessments you can do for the respiratory system? upper airways (nasal passageways, mouth, trachea, etc) lower airways (carina, bronchi, bronchioles, alveoli) lungs. BrS, PFT, volumes, EtCO2, ABG, CXR/CT, V/Q scan, pressures, deadspace, CNS, parameters, WOB, compliance, Raw, SpO2, NIF, RR, etc.
Before connecting a pt to the ventilator, the RT should verify what? That the ventilator has passed an operational verification procedure
A 36 yr old man with ARDS is ventilated with Vt of 400 ml, IBW of 176lb (80kg) and the HME has a volume of 50ml. What is an approximate alveolar volume for one breath for him? 400-140=260ml/breath
What is the pressure-time product and how can it be used in the management of mechanically ventilated pts? It’s an assessment of transdiaphragmatic pressure during inspiration and it’s a way of estimating the contributions of the diaphragm during inspiration.
What will cause an inaccurate measurement of Pplat? the patient making active respiratory efforts.
What is the most common cause of excessively high cuff pressure? overinflation of the tube.
If you walk in your pts room and notice that they have a low to nonexisting cuff pressure, whats the first thing you should do? Make sure the cuff is properly inflated and is in the appropriate position.
How can problems with the circulatory system cause problems with the respiratory system? can Name 4 ways to monitor the circulatory system. If there is low BP there wouldn’t be as much perfusion, and low blood volume could cause low Hgb, therefore low oxygen carrying capacity. Also, if there were blood clots that can become a PE. Monitoring: HR, BP, EKG, VQ scan, Qt, albumin
Explain reasons pressure can because elevated during mechanical ventilation, what it does to the respiratory system, and how it is monitored. Anything increasing AW resistance will increase the PIP, this can be bronchoconstriction, secretions or obstructions. A high PIP can result in barotrauma and damage to the lungs. To monitor we set high-pressure alarms or use a PC setting.
Name three things that we can monitor to ensure the ET tube is placed correctly. Ausculation of breath sounds Look for chest rise CXR
What are the three kinds of muscle found in the body? Cardiac, smooth, and skeletal muscle
What is a test we perform to see if a patient is ready to be weaned from the ventilator? A NIF test, reduce PS and see how the patient tolerates
What are things we as Respiratory student check on a patient to assess their respiratory status? we can assess the patient’s HR, RR, LOC, WOB, Breath sounds, and we can also ask the patient.
Using what technique can we figure out the nutritional status of our patients to ensure that they are not underfed nor overfed? Indirect Calorimetry uses oxygen consumption and carbon dioxide production to estimate the patient’s energy expenditure.
Your patient over the past 2 hours had PIP’s of 25,28, and 34. They had Pplats of 17,17,18. Do they have a resistance problem or a compliance problem? They have a resistance problem as their PIP is changing but their Pplat is not.
How is Cstat and Cdyn affected by CHF? What type of medication is given to help these values? CHF will reduce Cstat and Cdyn values. Diuretics can improve Cstat and Cdyn.
What does NIF test for? diaphragm strength
Name some skeletal system tests? xray, ambulation, CT scan
What could it mean for your patient if their input is greater than their output (I/O)? patient is retaining fluids
What could we use to measure the VE on a ventilator patient? Respirometer
You’ve intubated a patient and placed a capnometer on the ET tube. The capnometer is blue. What does that tell you? That no CO2 or very little CO2 are expiring. This could be due to an ET tube that is placed incorrectly or a patient who is not ventilating. Other things that may affect it are hypothermia, starvation, and sedation.
What organs are involved in the endocrine system? pituitary gland, pineal gland, hypothalamus, ovaries, testes, thyroid gland.
What is Operational verification procedure (OVP)? A checklist used to verify that the ventilator systems are fully functional and safe before use with a patient.
Physicians orders should include what? Desired range for the arterial carbon dioxide partial pressure (PaCO2), transcutaneous carbon dioxide partial pressure (PtcCO2), or end-tidal carbon dioxide partial pressure (PETCO2) and for the arterial oxygen partial pressure (PaO2), oxygen saturation.
What are some of the clinical laboratory test that might be included in the initial evaluation of the patient? •Complete blood count (CBC) •Blood chemistries (glucose, sodium, potassium, chloride, carbon dioxide [CO2], blood urea nitrogen, creatinine, phosphate, magnesium) •Prothrombin time, partial thromboplastin time, and platelet count •Blood, sputum.
What is the importance of doing respiratory parameters on a pt on a vent? To determine if the pt has the strength and ability to breathe on their own during weaning.
What can cause a pt’s plateau pressure reading to be inaccurate while doing a vent check? If a pt is spontaneously breathing while doing the inspiratory hold.
What organs receive blood if the BP drops to an extremely low pressure? Brain, Heart, and Lungs
What are some of the organs involved in the nervous system? Brain, spinal cord, and the nerves
If we were looking at the urinary system what organs would be involved and what would be some test you would use to check the functionality of these organs? Kidneys, bladder, urethra, ureters, and TTs would be BUN, I/O, CT, ultrasound, electrolytes
If we were to check a patient’s swallow test results what system would be checking and why? The digestive system, to see if the patient is swallowing properly and it’s going into the stomach, this also will make sure the pt can eat or drink without aspirating.
How often should an ET tube be repositioned and why? An ET tube needs to be repositioned once every shift (8-12 hrs) to prevent pressure injuries to the gums, mouth and lip.
why is it important to monitor cuff pressure? To reduce pt leak and damage to the AW.
What is a Scalar? A way to specify the waveforms for pressure, flow, and volume that are graphed against time.
Why do we use indirect calorimetry? To look at their nutritional state and see how that might be affecting their ventilation.
What is a definitive way to know the ET tube is in the right place? The CXR is a good way to make sure it is in the right spot.
What indicates diaphragm strength? Why is this important? NIF indicates diaphragm strength. This is important because it can give an idea if we should try to wean the pt.
What is airway resistance? total resistance is the sum of Raw and tissue resistance.
What are some values that are measured during each patient-ventilator system check? volumes, pressures, temperature, vital signs, FiO2
The assessment for a pt about to go on a ventilator should have what? evaluation in physical appearance, vital signs, ABGs, SpO2, volumes and pressures.
What are some noninvasive monitors we use to evaluate pt’s? pulse oximeters, capnography, transcutaneous monitors.
Indirect calorimetry provides what? insight about the nutritional status of pts.
the work of breathing is influenced by what? intrinsic and extrinsic factors
30 minutes after your pt has been placed on a vent what should you check on your vent? What are 2 items you may need to recommend be ordered? Your alarms have been activated & are correct- apnea, low pressure, low Vt, High-pressure limit Pt data is adequate or moving in the correct direction. Vent Data- is acceptable for pt Recommend orders for- ABG’s, & CXR to confirm ETT placement
All hospitalized pt’s on vent support must be continuously monitored with what? A 3 lead ECG
What 4 conditions will ensure an accurate indirect calorimetry measurement? What will this reading tell you about your pt? What type of pulmonary disease pt’s often do we find that are not getting their caloric needs met? 1- pt at rest & in a supine position 30mins prior to measurement 2-room temp between- 20-25* C 3-keep pt relaxed-no movement 4-15-30min measurements or until stable measurements measures- o2 consumption &CO2 expenditure and metabolic rate at rest
What are the main rules to follow when checking a pts SpO2 with an oximeter? make sure they are free of nail polish, that their fingers are warmed (having cold fingers gives a false reading), and make sure that they are still
What is the equation for Raw, and what does this tell us? How can we reduce Raw? (PIP-PLAT)/ flow/ 60. Raw tells us that it takes a lot of flow to pass through the airway because it is obstructed. To reduce Raw, we give inhaled bronchodilators.
What is the cause of a high cuff pressure, and how does this relate to the pt? How can we check our cuff to make sure they are doing their job? most common cause is high cuff pressure is an overinflated cuff. Causes could be the ET is too small for the pt. If changes aren’t made this can cause tracheal injuries.
What is Capnography? The visual display of carbon dioxide measured during breathing by using a capnometer.
If your pt’s Cstat is low (15 mlcmH2O), how is their WOB? Work of breathing is very high.
After getting the following ABG’s (7.30/6288/24) you make a few changes to the settings, what should you do after this? Preform a vent check and document.
What is the form on which we document patient information and ventilator settings? Ventilator flow sheet.
Your patient has an IBW of 66kg. What is their Vdanat? 145.2 ml
How do you determine a patient’s Pplat? If you have Vt 500ml, PIP 35cmH2O, Pplat 27cmH20, PEEP 5cmH2O, and TCF 3; what is the static compliance? Press the inspiratory pause/hold button on the vent. 18.6 ml/cmH2o.
Question Answer
What is the normal range for cardiac output? 4 to 8 L/min
To reduce the risk of barotrauma on PCV the flow pattern should be set to ____. descending ramp
Which of the following is NOT associated with an increase in central venous pressure? Dehydration
One of the ways of providing mechanical ventilation is the use of a volume-targeted breath with a constant inspiratory gas flow. The resulting flow scalar will be configured as a(n) ____. rectangular or square wave
The relationship, “the pressure delivery to the lungs will depend on the stiffness of the lung,” can be graphically and mathematically represented as ____. ΔP = ΔV/C
The alveolar pressure curve will resemble in appearance the volume delivery curve, regardless of the type of volume waveform that is present. True
These curves were measured on a mechanically ventilated patient: Curve A was measured at 7 a.m. Curve B was measured at 11 a.m. There was no change in delivered tidal volume between 7 and 11 a.m.
The pressure (PIP) required to ventilate the patient increased True
Between 7 and 11, the patient’s airway resistance (Raw) decreased False
Many of the newer microprocessor ventilators have very high gas pressure sources, in the range of 400 to 700 cm H2O. This is enough pressure to produce a constant flow of gas during inspiration for any clinical situation one might encounter. True
Another type of ventilator graphic is called a loop. These are displays of two variables plotted on the x-y coordinates. True
The purpose of ventilator graphics includes all of the following except ____. making an assessment of the supply pressures to the ventilator
With a constant flow, the rise in volume is expected to be displayed at a non-constant rate. False
The following graphic is a ____________________ and represents ___________________. volume scalar, increased expiratory volume and possible dyssynchrony
What is the normal range for mean arterial pressure? 80 to 100 mm Hg
When PC CMV is the mode of ventilation, the resulting flow scalar will be configured as a(n) ____. descending ramp
Scalars displayed during mechanical ventilation include all of the following except ____. flow vs. volume
What is the normal central venous pressure reading? 2 to 6 mm Hg
The greater this pressure gradient, the faster the flow of gas and the sooner the lungs fill: this could be graphically and mathematically stated as ____. Flow = V/TI
What is the normal range for pulmonary capillary wedge pressure? 5 to 10 mm Hg
The curve representing PTA will not always resemble the curve for flow. False