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RC3334 NEO EXAM 3 WITH COMPLETE SOLUTIONS
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A fluidics CPAP system is considered a ___________ system - ANSWER>>variable flow
Initial pressure settings for nasal CPAP would be: - ANSWER>>3-6 cmH2O
For bubble CPAP, the flow rate of humidified gas entering the circuit should be set high enough to rinse the system of exhaled carbon dioxide. - ANSWER>>True
Which of the following would indicate nasal continuous positive airway pressure therapy is failing? baby is not fighting the interface FIO2 has increased above 0. CPAP pressure has increased to 12 cmH2O PaO2 is 85 torr - ANSWER>>2 and 3 only
Bubble nasal continuous positive airway pressure was first implemented by Jen-Tien Wung at: - ANSWER>>Columbia University Medical Center
You are treating a patient on nasal continuous positive airway pressure. with the following settings:nCPAP = 4 cmH2OFIO2 = 0.7It is advised to reduce the FIO2 first before reducing the pressure. - ANSWER>>True
Nasal continuous positive airway pressure should be considered in an newborn with: grunting PaCO2 above 60 torr pH less than 7.
nasal flaring - ANSWER>>1 and 4
Maximum pressure setting for nasal CPAP is: - ANSWER>>
Indications: - ANSWER>>- PaO2 <50 mmHg
- FiO2 >0.
- Adequate ventilation: .PaCO2 <50mmHg .pH > 7.
- Abnormal Physical Exam: .Increase RR, grunting, nasal flaring, retractions, cyanosis, agitation.
- Poorly expanded lung fields: .CXR, BS
Effects of CPAP: - ANSWER>>-Pushes down on the diaphragm -Prevents small airway/alveoli closure -Increase FRC -Increase lung compliance -Stabilizes the Chest Wall -Normalize alveolar ventilation -Decrease WOB -Increases water movement out of the alveoli -Increase Surfactant release
Contraindications to CPAP: - ANSWER>>-Severe cardiovascular instability -Choanal atresia -Cleft palate
-Initial flow rate of 6-8 L/min are standard.
Signs of failure of CPAP: - ANSWER>>-Decreasing pH: <7. -Increasing PaCO2: >60 torr -Increasing FiO2: >0. -Decreasing PaO2: <50 torr -Increasing pressure: CPAP>12 cmH2O -Apnea episodes -Bradycardia episodes -Poor lung volumes -Physical exam: Breath sounds, nasal flaring, grunting, retracting, CXR will assess lung volumes.
Weaning of CPAP: - ANSWER>>-Is pt stable? -Is pt having apnea episodes? -Acceptable vitals?Blood gases? -Decrease FiO2 first and then decrease pressure -Once on 21% and CPAP 2-3 cmH2O try Nasal Cannula.
Which of the following uses a variable or fixed orifice to restrict exiting gas flow? - ANSWER>>Flow resistor
Which of the following applies an opposing force to prevent gas from escaping? - ANSWER>>-Water column -Spring valve
Fluidics system uses the Coanda effect to direct gas flow to the nose during inspiration and away from the nose during exhalation. - ANSWER>>True
Which of the following is an interface that can be used for CPAP therapy? - ANSWER>>-Short double prongs -Long double prongs -Nasal mask -Single tube
Which of the following is consistent with neonatal lung physiology? - ANSWER>>-High opening pressures -Surfactant deficiency (premature infants)
Which of the following is a physiological effect of CPAP? - ANSWER>>-Stabilize the chest wall -Increase surface area -Pushes down on the diaphragm
Which of the following is a contraindication for nCPAP therapy? - ANSWER>>-Neuromuscular disease -Upper airway abnormalities -Untreated diaphragmatic hernia
Which of the following is an indication for starting CPAP therapy? - ANSWER>>-Nasal flaring -Grunting
Which of the following indicates optimal CPAP level has been exceeded? - ANSWER>>-Rise in PaCO -Fall in PaO -Decreased cardiac output
An increase in the power setting will cause which of the following blood gas value changes? - ANSWER>>Decrease PaCO
Adjusting the Power setting will have a direct impact on which of the following? - ANSWER>>Amplitude and Delta P
The percent inspiratory time (%Ti) will determine: - ANSWER>>-The time the piston is pulling backward -The time the piston is pushing forward
An increase in the MAP setting will cause which of the following blood gas value changes? - ANSWER>>PaO2 will increase
An increase in the Power setting will cause which of the following tidal volume changes?
- ANSWER>>Tidal volume will increase
An increase in the Hertz setting will have which of the following changes in the blood gas values? - ANSWER>>PaCO2 will increase and pH will decrease
An decrease in the Hertz setting will cause which of the following tidal volume changes?
- ANSWER>>Tidal volume will increase
You are caring for a 900g newborn, what is the initial Hz setting for this patient? - ANSWER>>15Hz
You are caring for a 32 week newborn in the NICU. The patient is currently on Pressure A/C with a MAP of 10. The decision is made to switch to HFOV. What is the starting MAP setting on the HFOV? - ANSWER>>MAP 12 cmH2O
You are caring for a 34 week 2200g newborn in the NICU. The patient is currently on Pressure A/C. The decision is to switch to HFOV. What is the starting power setting on the HFOV? - ANSWER>>3.
What is the MAP goal for an newborn on conventional mechanical ventilation? - ANSWER>>5-15 cmH2O
You are setting up the ventilator in a volume control strategy for a 10Kg patient. An unacceptable tidal volume would be which of the following? - ANSWER>>90mL
Pneumotachometers do not add deadspace into the ventilator circuit. - ANSWER>>False
Inadvertent trigger is possible when using a Graseby Capsule - ANSWER>>True
Decreasing the inspiratory time will increase MAP. - ANSWER>>False
When considering motion triggering, abdominal movement occurs 100ms before air flow in the lungs. - ANSWER>>True
Which of the following is an acceptable initial inspiratory time for a neonate? 0.15 sec 0.25 sec 0.35 sec 0.45 sec 0.55 sec 0.65 sec - ANSWER>>II, III, IV only
Premature infants need longer inspiratory times compared to pediatric patients. - ANSWER>>False
What is the cycle variable for pressure control ventilation for a neonate? -
-Tidal volume monitoring -Inspiratory flow monitoring -Volume leak from the system
The Graseby capsule is associated with which of the following? - ANSWER>>-Patient triggering
Which of the following will increase MAP during conventional mechanical ventilation? - ANSWER>>-Increasing PIP -Increasing Ti -Increasing RR -Decreasing Te
Indications for conventional MV in infants: - ANSWER>>-Respiratory failure despite CPAP: .pH<7. .PaO2<50mmHg .PaCO2>60mmHg .FiO2 >0. .Grunting, nasal flaring, retractions, cyanosis.
Mean airway pressure - ANSWER>>(PIP-PEEP)(Ti/TCT)+PEEP
