Test 3- Ch. 4 Pilbeam.docx

What are the physiological objectives of mechanical ventilation? - correct answer 1. Support or manipulate pulmonary gas exchange -Achieve eucapnic ventilation or allow permissive hypercapnia and maintain adequate oxygenation and oxygen delivery 2. Increase lung volume Prevent or reverse atelectasis with adequate PEEP to restore the FRC 3. Reduce the work of breathing -It shouldn't be more work to breathe with a ventilator than it is to breathe without one. What are the clinical objectives of mechanical ventilation? (8) - correct answer 1. Reverse acute resp failure 2. Reverse resp distress 3. Reverse hypoxemia 4. Prevent/reverse atelectasis and maintain FRC 5. Reverse resp muscle fatigue 6. Permit sedation or paralysis 7. Reduce systemic or myocardial O2 consumption 8. Minimize associated complications and mortality What is (ARF) acute respiratory failure? - correct answer When respiratory activity is completely absent or is inadequate to maintain oxygen uptake and carbon dioxide clearance, in spite of initial therapy. How you recognize a patient is in respiratory distress? (13) - correct answer 1. (LOC) Level of conciousness decreased 2. Color is pale or cyanotic 3. Presence of diaphoresis (sweating) 4. Tachypnea 5. Tachycardia 6. Hypertension 7. Desaturation 8. Anxious appearance 9. Tripod positioning 10. Accessory muscle use 11. Retractions 12. Paradoxical chest abnormal movements of abdomen and thorax 13. Abnormal BS What are the 2 types of acute respiratory failure ? - correct answer 1. Hypoxemic respiratory failure 2. Hypercapnic respiratory failure What is hypoxemic respiratory failure? - correct answer Life-threatening or vital organ-threatening tissue hypoxia. What causes hypoxemic respiratory failure? (2) - correct answer 1. Result of severe (V/Q) ventilation/ perfusion mismatching 2. Can occur with diffusion defects, right-to-left shunting, alveolar hypoventilation, aging, and inadequate inspired oxygen. How is hypoxemic respiratory failure treated? (4) - correct answer 1. Oxygen 2. (PEEP) positive end-expiratory pressure 3. (CPAP) continuous postive airway pressure 4. Mechanical ventilation if accompanied by hypercapnic respiratory failure What is a ventilatory pump? - correct answer Consist of respiratory muscles, thoracic cage, and nerves work together for optimal ventilation. If any of the contents of the ventilatory pump is not functioning optimally, pump failure can occur which leads to which type of ARF? - correct answer Hypercapnic respiratory failure What is hypercapnic failure? - correct answer AKA ventilatory failure Occurs when a person cannot achieve adequate ventilation to maintain a normal PaCO2. What causes hypercapnic failure? (4) - correct answer 1. When the ventilatory pump fails (consists of respiratory muscles, thoracic cage, and nerves that control respiratory centers of the brain) 2. Central nervous system disorders 3. Neuromuscular disorders 4. Disorders that increase WOB How is hypercapnic failure treated? (2) - correct answer 1. BIPAP 2. Mechanical ventilation What breathing patterns are commonly encountered in patients with CNS dysfunction? (2) - correct answer 1. Cheyne-Stokes 2. Biots What disorders/agents are associated with hypoventilation reduce the drive to breathe? (4) - correct answer Central Nervous System Disorders: 1. Depressant medications 2. Brain/brainstem lesions 3. Hypothyroidism 4. and central sleep apnea all reduce the drive to breathe (the CNS no longer sends proper signals to the respiratory muscles of ventilation.) What disorders/agents are associated with hypoventilation/resp failure due to poor neuromuscular function - correct answer 1. Paralytic disorders (such as tetanus, polio, botulism, BG, ALS, and MD) *-render the muscles incapable of responding to a nerve signal to contract.* 2. Paralytic drugs *(do the same thing.)* 3. Drugs that affect neuromuscular transmission: (calcium channel blockers, aminoglycoside antibiotics (gentamycin, tobramycin, streptomycin and long-term use of corticosteroids.) *-don't paralyze the muscles, but they reduce the muscle's ability to respond to transmit a nerve signal* 4. Impaired muscle function: (malnutrition, electrolyte imbalances, peripheral nerve disorders, atrophy of muscles, fatigue, and COPD (because air trapping impedes diaphragm contraction). *-muscles do not properly contract.* What parameters would you monitor in a patient with a neuromuscular disease and how often would you monitor them? What are the normal and critical values for each? - correct answer Parameter Frequency NL Critical 1. MIP Q2-4h -50 to -100 0-20 2. VC Q2-4h 65-75 mL/kg 10-15 mL/kg What are the critical values for MIP and VC that would indicate mechanical ventilation is needed? (2) - correct answer 1. VC falls below 10-15 mL/kg 2. MIP is between 0 and -20 What pulmonary diseases cause increased airway resistance. (6) How do they affect the WOB? - correct answer 1. asthma 2. emphysema 3. chronic bronchitis 4. croup 5. epiglottitis 6. acute bronchitis (An increase in airway resistance results in an increase in the WOB.) How do you the RT do a rapid assessment of a patient in respiratory failure? - correct answer A quick check of vital signs, pulse oximetry, BS and LOC can rapidly pinpoint patient's experiencing respiratory failure. What are the clinical respiratory, cardiac, and neurologic findings that indicate mild to moderate hypoxia? - correct answer Respiratory Findings: 1. Tachypnea 2. Dyspnea 3. Paleness