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Adult Ventilatory Care

RT 132

Adult Ventilatory Care

RT 132

Course Description

Prerequisites: Prerequisites: RT 117, RT 118, RT 121, RT 126,and RT 131.

RT 135, RT 146, and RT 149 must be taken concurrently. Presents the theory and application of skills required to provide adult mechanical ventilatory care. (39-12)

Outcomes and Objectives

Demonstrate, through successful completion of written examination and/or return demonstration, the ability to:

Objectives:

  • Define the following terms: ventilation, internal and external respiration, trans-airway pressure, transpulmonary pressure, transrespiratory pressure, transthoracic pressure, pressure at the body surface, mouth pressure, airway opening pressure, airway pressure, alveolar pressure, and intraalveolar pressure.
  • Explain the concept of normal ventilation.
  • Define compliance and resistance in relation to ventilation.
  • Describe negative pressure ventilation and compare its function to normal lung ventilation.
  • Graph a positive pressure curve for a mechanical breath, and label plateau pressure, peak pressure, and baseline pressure.
  • Graph changes in flow, volume, alveolar pressure, upper airway pressure, and transairway pressures against time with a constant flow ventilator.
  • Give an equation for calculating time constants and discuss their importance in determining inspiratory and expiratory time.

Demonstrate, through successful completion of written examination and/or return demonstration, the ability to:

Objectives:

  • Define acute respiratory failure and respiratory insufficiency.
  • List respiratory, cardiovascular, and neurologic findings in mild to moderate hypoxia and severe hypoxia.
  • List respiratory, cardiovascular, and neurologic findings in mild to moderate hypercarbia and severe hypercarbia.
  • Name three categories of disorders that may lead to respiratory insufficiency or acute respiratory failure.
  • Give normal values for vital capacity, maximum inspiratory pressure, peak expiratory pressure, FEV1, peak expiratory flow rate, VD/VT ratio. P(A - a)O2, and arterial:alveolar Po2 ratio and shunt.
  • List critical values that indicate the need for ventilatory support for the following: vital capacity, maximum inspiratory pressure, peak expiratory pressure, FEV1, peak expiratory flow rate, VD/VT ratio, P(A - a)O2, and arterial:alveolar Po2 ratio and shunt.
  • Name the five standard criteria for the institution of mechanical ventilatory support.
  • Give the four goals of therapy for the mechanically ventilated patient.
  • From a case study, identify the findings that indicate the need for ventilatory support.

Demonstrate, through successful completion of written examination and/or return demonstration, the ability to:

Objectives:

  • Name the five components of the internal control system of ventilators.
  • Describe the eight mechanical drive mechanisms available on mechanical ventilators.
  • Explain the function of each of the four output control valves discussed in the text.
  • Define internal and external circuit.
  • Give the functional parts of an external circuit and added optional components.
  • List and explain the three most frequent methods of triggering inspiration.
  • Describe the following: IMV, SIMV, PS, PC, MMV, HFV, APRV, IPPB, and inflation hold.
  • Explain the function of volume controllers, flow controllers, and pressure controllers.
  • Discuss how changes in patient lung characteristics affect PA, PTA, and PIP with a constant flow controller.
  • Describe the effects of changing lung characteristics on the flow pattern of a ventilator with low to moderate pressure drive.
  • Explain how pressure, volume, and flow are limited during inspiration and how they can alter volume or pressure delivery.
  • List the four cycling mechanisms and describe their function.
  • Define the following: NEEP, PEEP, CPAP, IPAP, EPAP, expiratory retard, PEP and expiratory hold.
  • Classify a ventilator based on power source, triggering mechanism(s), inspiratory phase delivery, cycling mechanism(s), and expiratory phase variables.
  • Describe the appropriate use of:

Demonstrate, through successful completion of written examination and/or return demonstration, the ability to:

Objectives:

  • Select the appropriate type of ventilator and mode or method of ventilation for a patient.
  • Calculate initial tidal volume, rate, minute ventilation, and FIO2 SIGH and PS settings.
  • Choose an appropriate flow rate and pattern.
  • Determine the I/E ratio from total cycle time and inspiratory time.
  • Calculate the expiratory time from total cycle time and inspiratory time.
  • Determine the inspiratory time from tidal volume and flow.
  • Determine tidal volume from inspiratory time and flow.
  • Calculate flow from tidal volume and inspiratory time.
  • Estimate appropriate alarm settings.
  • List the considerations necessary in preparing the final ventilator setup.
  • Describe the steps in beginning ventilatory support.
  • Identify the parameters to be completed on a ventilator flow sheet.
  • Calculate tidal volume, minute ventilation, alveolar ventilation, anatomic dead space, and tubine compliance.
  • Demonstrate the ability to assemble, check for proper function, identify malfunctions, and take action to correct malfunctions of those ventilators and airway pressure devices currently used in respiratory care, including:
  • Demonstrate the ability to change external circuits on the above devices.
  • Demonstrate the ability to provide appropriate IPPB therapy.
  • Demonstrate the ability to measure vital capacity, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP).

Demonstrate, through successful completion of written examination and/or return demonstration, the ability to:

Objectives:

  • Explain the effects of positive pressure ventilation on cardiac output and venous return to the heart.
  • Discuss the three factors affecting cardiac output during IPPV.
  • Describe how IPPV increases intracranial pressure.
  • Summarize the effects of IPPV on renal response and humoral response in the body.
  • Describe the effects of abnormal arterial blood gases on renal function.
  • Explain the effects of IPPV on gas distribution and pulmonary blood flow in the lungs.
  • List the effects of mechanical ventilation on ventilatory status.
  • Define auto-PEEP and list its complications.
  • Name three physiologic factors which lead to the occurrence of auto-PEEP.
  • Describe the procedures for measuring auto-PEEP.
  • List three potential methods for reducing auto-PEEP.
  • Discuss one benefit of auto-PEEP.
  • Explain the three primary hazards of oxygen therapy with mechanical ventilation.
  • List and describe four types of barotrauma associated with mechanical ventilation.
  • Define the following terms: work of breathing, intrinsic work, extrinsic work, and system-imposed work of breathing.
  • From a graph, explain the components of work of breathing.
  • List the steps to take to reduce the work of breathing in mechanically ventilated patients.
  • From a description of a malfunction on a ventilator, determine the possible cause of the malfunction.
  • Name five ways of assessing a patient's nutritional status.
  • Describe techniques that can be used to reduce some of the complications associated with mechanical ventilation.