N324 Medsurg Ii Final Exam

Front 1

Vent Settings - Normal range of:

minute ventilation (VE)

Back 1

5-7 L/min

Front 2

Vent Settings - Normal range of:

respiratory rate (f)

Back 2

6-20 breaths/min

Front 3

Vent Settings - Normal range of:

tidal volume (VT)

Back 3

5-12 mL/kg (Table 11-3)

alt: 7-9 mL/kg or 500-800 mL (adult)

Front 4

Vent Settings - Normal range of:

fraction of inspired oxygen (FiO2)

Back 4

0.21-1.0

expressed as % of oxygen concentration inspired (max 1.0 or 100%)

Front 5

Vent Settings - Normal range of:

positive end expiratory pressure (PEEP)

Back 5

5-20 cm H20

Front 6

Vent Settings - Normal range of:

pressure support (PS)

Back 6

5-15 cm H20

Front 7

Vent Settings - Normal range of:

peak pressure (Ppeak) or peak inspiratory pressure (PIP)

Back 7

< 40 cm H20

Front 8

What is tidal volume (Vt or TV)?

Back 8

the amount of air that moves in and out of the lungs in one normal breath. It is also an important setting on a mechanical ventilator - if set too high the patient is hyperventilated (risk for pneumothorax), if set too low the patient is hypoventilated.
• Amount of air that moves in/out of lungs in one normal breath
• Goal: keep peak airway pressure while maintaining adequate ventilation

Front 9

What is FiO2?

Back 9

fraction of inspired oxygen - that portion of the total gas being inspired that is composed of oxygen; expressed in decimals from 0.21 to 1.0.
• Expressed as decimal, but discussed in % in terms of O2 concentrations

Front 10

What is respiratory rate (f)?

Back 10

properly setting the respiratory (breathing) rate (f) on the ventilator is important in establishing adequate minute ventilation (VE). Minute ventilation is the amount of air that moves in and out of the lungs in one minute.

Front 11

What is PEEP?

Back 11

the application of positive pressure to the airway at the end of expiration such that the airway pressure never returns to ambient.

Front 12

What is Ppeak or PIP?

Back 12

Peak Airway Pressure (PPEAK) or Peak Inspiratory Pressure (PIP)

- amount of pressure required to deliver a volume of gas. PIP levels < 40 cm H20 are considered desirable. High PIPs greatly increase risk of barotraumas & have negative effects on other body systems.

Front 13

What is PS or PSV?

Back 13

Pressure Support (PS) or Pressure Support Ventilation (PSV)

- type of mechanical ventilatory support in which a preset level of positive pressure augments the inspiratory effort required to attain a tidal volume, thereby decreasing the work of breathing.

Front 14

What is positive pressure ventilation

Back 14

(the mainstay of ventilator support in acute care settings): Most commonly require an artificial airway to deliver ventilator support. Gases are driven into the lungs through the ventilator’s circuitry, which is attached to an artificial airway (ET or tracheostomy tube).

Front 15

Positive pressure ventilation:

Describe pressure cycled vent

Back 15

Pressure-cycled ventilation delivers a preset pressure of gas to the lungs.
The pressure delivered (expressed in cm H2O) is constant while the volume of air it delivers varies with the lungs compliance and airway resistance.

Pressure-cycled ventilation is increasingly used as a method to protect the injured lung from further damage from high pressures and is an option on most ventilators.

Front 16

Positive pressure ventilation:

Describe volume cycled vent

Back 16

Volume-cycled ventilation delivers a preset volume of gas (measured in mL or L) to the lungs, making volume the constant and pressure the variable.
Within a certain preset safety range (pressure limits), the ventilator will deliver the established volume of gas regardless of the amount of pressure it requires. This has the advantage of being able to overcome changes in lung compliance and airway resistance.
E.g. as lung compliance decreases or airway resistance increases, the pressure at which the gas is delivered to the lungs will increase sufficiently to deliver the desired volume of gas to the lungs.

**potential to generate high pressures, especially in less compliant lungs in order to deliver the set volume. Therefore, the risk of barotraumas is greater.

Front 17

Positive pressure ventilation:

Describe time cycled vent

Back 17

When time-cycled ventilation is used, the length of time allowed for inspiration is controlled. These ventilators hold time constant but volume and pressure may vary.
Time-cycled ventilators frequently are referred to as time-cycled-pressure-limited ventilators b/c they also limit the maximum amount of pressure that can be delivered.
The microprocessor ventilators can use time cycling and also have the advantage of being able to limit volume and pressure.

Front 18

Positive pressure ventilation:

Describe flow cycled vent

Back 18

Pressure support ventilation (PSV) is an example of flow-cycled ventilation. A preset pressure augments the Pt’s inspiratory effort and continues as long as the Pt continues to inhale at a certain flow rate. As the Pt reaches the end of inspiration, flow decreases. At a predetermined level of flow (e.g, 25% of peak inspiratory flow) inspiration ends.

Tidal volume (VT), rate, and time are variable.

Front 19

Ventilator modes:

Assisted-Control (AC) +/-?

Back 19

(+): Every breath is guaranteed set TV.
Takes over work of breathing, respiratory muscle rest

(-): Risk of hyperventilation. Respiratory muscle atrophy

Front 20

Ventilator modes:

Synchronized Intermittent Mandatory Ventilation (SIMV) +/-?

Back 20

(+): Prevents respiratory muscle atrophy.
Decreased risk of hyperventilation.
Better vent-perfusion distribution

(-): Tachypnea & fatigue if set rate too low

Front 21

Ventilator modes:

Pressure Support Ventilation (PSV) +/-?

Back 21

(+): Improved pt-ventilator sychrony.
Prevents respiratory muscle atrophy.
Facilitates weaning

(-): Requires spontaneous respiratory effort.
Tachypnea & fatigue if pressure support is too low.

Front 22

Ventilator modes:

Pressure-Regulated Volume-Controlled Ventilation (PRVC) +/-?

Back 22

(+): Guaranteed VE.
Improved pt-ventilator synchrony.
Decreased risk of barotrauma.

(-): Respiratory muscle atrophy.
May result in unequal vent-perfusion distribution

Front 23

Which of the following is a FALSE statement about aspirin administration?

A. It should be given within 24 hours of thrombolytic therapy.
B. It should not be given within 24 hours of thrombolytic therapy.
C. It should not be used as a substitute for rtPA.
D. Less is known about the use of aspirin with cerebral ischemia.

Back 23

A. It should be given within 24 hours of thrombolytic therapy.

Rationale: The administration of aspirin as an adjunct therapy within 24 hours of the use of thrombolytic agents is NOT recommended. No recommendation can be made about the urgent administration of other antiplatelet aggregating agents.

Front 24

Central Venous Pressure (CVP) or RAP (Right Atrial Pressure)

normal value?

Back 24

1-8 mm Hg (says ATI)
2-6 mm Hg (says Wagner txt)

Front 25

Pulmonary Artery Systolic (PAS)

normal value?

Back 25

15-26 mm Hg (says ATI)

20-30 mm Hg (says Wagner txt)

Front 26

Pulmonary Artery Diastolic (PAD)

normal value?

Back 26

5-15 mm Hg (says ATI)

8-15 mm Hg (2 to 5 mm Hg higher than PAWP) (says Wagner txt)

Front 27

Pulmonary Artery Wedge Pressure (PAWP)

normal value?

Back 27

4-12 mm Hg

Front 28

Cardiac Output (CO)

normal value?

Back 28

4-6 L/min (says ATI)

4-8 L/min (says Wagner txt)

Front 29

Mixed venous oxygen saturation (SvO2)

normal value?

Back 29

60-80%

Front 30

Hemodynamic parameters:

CI = CO/BSA

Back 30

2.4-4.0 L/min/m2

Front 31

Hemodynamic parameters:

LVSWI = [(MAP - PAWP) x (SVI) x (0.0136)]

Back 31

50-62 g/m^2/beat

Front 32

Hemodynamic parameters:

MAP = [(SBP) + 2 (DBP)]/3

Back 32

12-20 mm Hg

Front 33

Hemodynamic parameters:

PVR = [(Mean PAP) - (PAWP) x 80]/CO

Back 33

50-250 dynes*sec*cm^-5

Front 34

Hemodynamic parameters:

PVRI = [(Mean PAP) - (PAWP) x 80]/CI

Back 34

255-315 dynes*sec*cm^-5/m^2

Front 35

Hemodynamic parameters:

RV pressures (RV systolic/RV diastolic)

Back 35

RV systolic: 20-30 mmHg / ...
RV diastolic: 2-8 mm Hg

Front 36

Hemodynamic parameters:

RVSWI = [(Mean PAP - RAP) x (SVI) x (0.0136)]

Back 36

7.9-9.7 g/m^2/beat

Front 37

Hemodynamic parameters:

SVI = CI/HR

Back 37

25-45 mL/beat/m^2

Front 38

Hemodynamic parameters:

SV = CO/HR

Back 38

50-100 mL/beat

Front 39

Hemodynamic parameters:

SVR = [(MAP) - (RAP) x 80]/CO

Back 39

800-1200 dynes*sec*cm^-5

Front 40

Hemodynamic parameters:

SVRI = [(MAP) - (RAP) x 80]/CI

Back 40

1,970-2,390 dynes*sec*cm^-5/m^2