RT 132 - Adult Ventilatory Care

1. Demonstrate an understanding of ventilator mechanics.
   1. 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.
   2. Explain the concept of normal ventilation.
   3. Define compliance and resistance in relation to ventilation.
   4. Describe negative pressure ventilation and compare its function to normal lung ventilation.
   5. Graph a positive pressure curve for a mechanical breath, and label plateau pressure, peak pressure, and baseline pressure.
   6. Graph changes in flow, volume, alveolar pressure, upper airway pressure, and transairway pressures against time with a constant flow ventilator.
   7. Give an equation for calculating time constants and discuss their importance in determining inspiratory and expiratory time.
2. Demonstrate an understanding of the physiological response of a patient who is on mechanical ventilation
   1. Define acute respiratory failure and respiratory insufficiency.
   2. List respiratory, cardiovascular, and neurologic findings in mild to moderate hypoxia and severe hypoxia.
   3. List respiratory, cardiovascular, and neurologic findings in mild to moderate hypercarbia and severe hypercarbia.
   4. Name three categories of disorders that may lead to respiratory insufficiency or acute respiratory failure.
   5. Give normal values for vital capacity, maximum inspiratory pressure, peak expiratory pressure, FEV1, peak expiratory flow rate, VD/V ratio. P(A - a)O2, and arterial:alveolar Po2 ratio and shunt.
   6. 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.
   7. Name the five standard criteria for the institution of mechanical ventilatory support.
   8. Give the four goals of therapy for the mechanically ventilated patient.
   9. From a case study, identify the findings that indicate the need for ventilatory support.
3. Demonstrate an understanding of the modes of mechanical ventilation
   1. Name the five components of the internal control system of ventilators.
   2. Describe the eight mechanical drive mechanisms available on mechanical ventilators.
   3. Explain the function of each of the four output control valves discussed in the text.
   4. Define internal and external circuit.
   5. Give the functional parts of an external circuit and added optional components.
   6. List and explain the three most frequent methods of triggering inspiration.
   7. Describe the following: IMV, SIMV, PS, PC, MMV, HFV, APRV, IPPB, and inflation hold.
   8. Explain the function of volume controllers, flow controllers, and pressure controllers.
   9. Discuss how changes in patient lung characteristics affect PA, PTA, and PIP with a constant flow controller.
   10. Describe the effects of changing lung characteristics on the flow pattern of a ventilator with low to moderate pressure drive.
   11. Explain how pressure, volume, and flow are limited during inspiration and how they can alter volume or pressure delivery.
   12. List the four cycling mechanisms and describe their function.
   13. Define the following: NEEP, PEEP, CPAP, IPAP, EPAP, expiratory retard, PEP and expiratory hold.
   14. Classify a ventilator based on power source, triggering mechanism(s), inspiratory phase delivery, cycling mechanism(s), and expiratory phase variables.
   15. Describe the appropriate use of:
       1. Chest Cuirass
       2. Rocking Beds
       3. Negative Pressure Ventilators
4. Demonstrate an understanding of the initial parameters when establishing mechanical ventilation on patient.
   1. Select the appropriate type of ventilator and mode or method of ventilation for a patient.
   2. Calculate initial tidal volume, rate, minute ventilation, and FIO2 SIGH and PS settings.
   3. Choose an appropriate flow rate and pattern.
   4. Determine the I/E ratio from total cycle time and inspiratory time.
   5. Calculate the expiratory time from total cycle time and inspiratory time.
   6. Determine the inspiratory time from tidal volume and flow.
   7. Determine tidal volume from inspiratory time and flow.
   8. Calculate flow from tidal volume and inspiratory time.
   9. Estimate appropriate alarm settings.
   10. List the considerations necessary in preparing the final ventilator setup.
   11. Describe the steps in beginning ventilatory support.
   12. Identify the parameters to be completed on a ventilator flow sheet.
   13. Calculate tidal volume, minute ventilation, alveolar ventilation, anatomic dead space, and tubine compliance.
   14. 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:
       1. Pneumatic, electric, and micro processor ventilators.
       2. CPAP (BIPAP) devices
       3. PEP masks
   15. Demonstrate the ability to change external circuits on the above devices.
   16. Demonstrate the ability to provide appropriate IPPB therapy.
   17. Demonstrate the ability to measure vital capacity, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP).
5. Demonstrate an understanding of positive pressure ventilation on the cardiovascular and renal systems.  
   1. Explain the effects of positive pressure ventilation on cardiac output and venous return to the heart.
   2. Discuss the three factors affecting cardiac output during IPPV.
   3. Describe how IPPV increases intracranial pressure.
   4. Summarize the effects of IPPV on renal response and humoral response in the body.
   5. Describe the effects of abnormal arterial blood gases on renal function.
   6. Explain the effects of IPPV on gas distribution and pulmonary blood flow in the lungs.
   7. List the effects of mechanical ventilation on ventilatory status.
   8. Define auto-PEEP and list its complications.
   9. Name three physiologic factors which lead to the occurrence of auto-PEEP.
   10. Describe the procedures for measuring auto-PEEP.
   11. List three potential methods for reducing auto-PEEP.
   12. Discuss one benefit of auto-PEEP.
   13. Explain the three primary hazards of oxygen therapy with mechanical ventilation.
   14. List and describe four types of barotrauma associated with mechanical ventilation.
   15. Define the following terms: work of breathing, intrinsic work, extrinsic work, and system-imposed work of breathing.
   16. From a graph, explain the components of work of breathing.
   17. List the steps to take to reduce the work of breathing in mechanically ventilated patients.
   18. From a description of a malfunction on a ventilator, determine the possible cause of the malfunction.
   19. Name five ways of assessing a patient's nutritional status.
   20. Describe techniques that can be used to reduce some of the complications associated with mechanical ventilation.