Mechanical Ventilation #4

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This module includes questions related to maintaining adequate ventilation. Specific questions include PEEP/CPAP therapy, ABG interpretation and management, SMI/Incentive Spirometry therapy and pharmacology.

A 58 year old, 65 kg (143 lbs) women arrives to the surgical ICU following aortic adbominal aneurysm repair surgery. She has 40 pack year history of cigarette smoking and is currently smoking 1 pack a day. The physician has writtten an order to initiate mechanical ventilation. All of the following controls need to be adjusted by the respiratory care practitioner prior to starting mechanical ventilation for this patient, EXCEPT:
A. FiO2
B. VT
C. f
D. PEEP

PEEP

Which of the following is NOT an indication for continuous positive airway pressure?
A. a Qs/Qt of < 15%
B. PaO2 < 50 mmHg on an FiO2 > 0.60
C. a spontaneously breathing patient
D. an increased A-a DO2 gradient

a Qs/Qt of < 15%

A spontaneously breathing 76 year old patient who weighs 60 kg (132 lbs) is on a FiO2 of 0.45 via a trach collar has had a change in their tidal volume from 600 ml to 300 ml and their respiratory rate went from 12 br/min. to 24 br/min.. Which of the following changed due to the change in the tidal volume and rate?
A. minute ventilation
B. alveolar ventilation
C. anatomical deadspace
D. mechanical deadspace

alveolar ventilation

During an incentive spirometry treatment using a volume orientated device, the patient inhales to TLC and exhales slowly to FRC what other instructions would you give to improve distribution?
A. continue with the current instructions
B. switch to a flow orientated device
C. initiate IPPB
D. inspiratory hold

inspiratory hold

A 75 kg (165 lbs) patient is receiving volume-cycled mechanical ventilation, the respiratory care practitioner notes the following:

Mode SIMV
Set rate 12 br/min.
Total rate 16 br/min.
FiO2 0.35
VT 700 ml

The arterial blood gases are as follows:

pH 7.28
PCO2 53 mmHg
PO2 79 mmHg
HCO3- 24 mEq/L

Which of the following would you recommend at this time?
A. increase the FiO2 to 0.40
B. add 5 cmH2O PEEP
C. increase VT to 750 ml
D. increase SIMV to 14 br/min.

increase VT to 750 ml

A 15 year old female patient who weighs 55 kg (121 lbs) has multiple trauma from a four wheeler accident and has developed ARDS. The respiratory care practitoner notes the following data:

Mode SIMV
Set rate 12 br/min.
Total rate 14 br/min.
FiO2 0.60
PEEP 10 cmH2O
VT 600 ml

The arterial blood gases are as follows:

pH 7.34
PCO2 38 mmHg
PO2 79 mmHg
HCO3- 21 mEq/L

The patient becomes agitated and is using accessory muscles and is attempting to pull out the IV lines. Which of the following would you recommend at this time?
A. switch to assist/control mode
B. curare
C. pavulon
D. versed

versed

A 70 kg (154 lbs) post-cardiopulmonary arrest patient is on a volume-cycled ventilator in the assist/control mode. The respiratory care practitioner notes the following data:

Set rate 8 br/min.
Total rate 8 br/min.
FiO2 0.65
VT 850 ml

The arterial blood gas results are as follows:

pH 7.30
PCO2 56 mmHg
PO2 78 mmHg
HCO3- 21 mEq/L

Which of the following ventilator adjustments would you recommend first?
A. institute PEEP therapy at 5 cmH2O
B. increase the rate to 12 br/min.
C. increase the FiO2 to 0.70
D. increase the VT to 900 ml

increase the rate to 12 br/min.

A 62 year old patient weighing 50 kg (110 lbs) with a history of emphysema is on a volume-cycled ventilator due to acute respiratory failure. The respiratory care practitioner notes the following:

Mode SIMV
Set rate 6 br/min.
Total rate 16 br/min.
VT 600 ml
FiO2 0.28

Arterial blood gases are as follows:

pH 7.37
PCO2 56 mmHg
PO2 65 mmHg
HCO3- 32 mEq/L

Which of the following would you recommend?
A. increase the SIMV to 8 br/min.
B. increase the FiO2 to 0.30
C. maintain the current settings
D. increase the VT to 650 ml

maintain the current settings

Which of the following pathologies would be LEAST appropriate for pressure-cycled ventilation?
A. kyphosis
B. muscular dystrophy
C. chronic CO2 retainer
D. drug overdose

chronic CO2 retainer

A 12 year old female weighing 40 kg (88 lb) is receiving continuous mechanical ventilation following an accidental drug overdose. The respiratory care practitoner notes the following:

Mode SIMV
Set rate 12 br/min.
Total rate 12 br/min.
VT 750 ml
FiO2 0.30

Arterial blood gases are as follows:

pH 7.58
PCO2 23 mmHg
PO2 141 mmHg
HCO3- 22 mEq/L

Which of the following would you recommend?
A. decrease the tidal volume
B. decrease the respiratory rate
C. decrease the FiO2
D. add mechanical deadspace

decrease the tidal volume

Which of the following parameters are acceptable for weaning a patient from continuous mechanical ventilation?

I. VD/VT 65%
II. MIP -18 cmH2O
III. Qs/Qt 10%
IV. A-aDO2 12 mmHg (21% oxygen)
A. III & IV only
B. I & II only
C. I, II & III only
D. I, II, III & IV

III & IV only

During an incentive spirometry treatment using a flow device, the float will not rise during inspiration. This may be due to all of the following, EXCEPT:
A. a crack in the casing
B. an obstructed mouthpiece
C. inspiratory effort is too strong
D. inspiratory flow is too slow

inspiratory effort is too strong

Which of the following can help decrease auto PEEP for a patient who is receiving continuous mechanical ventilation?

I. increase the flow
II. change from a decelerating wave to a constant square wave
III. add expiratory retard
IV. add inspiratory hold
A. I & III only
B. II & IV only
C. I, II & III only
D. I, II, III & IV

I & III only

A 39 year old male weighing 85 kg (187 lbs) is on a volume-cycled ventilator following mitral valve replacement surgery. Ventilator settings are as follows:

FiO2 0.45
Set rate 12 br/min.
Total rate 22 br/min.
VT 900 ml
Flow rate 30 LPM
Mode SIMV

The patient appears to be agitated and restless. The physician asks for your recommendation. You would recommend which of the following?
A. switch to pressure support ventilation
B. switch to pressure control ventilation
C. administer Versed
D. increase the flow

increase the flow

A 46 year old female patient weighing 65 kg (143 lbs) is on a volume-cycled ventilator following a motor vehicle accident. Ventilator settings are as follows:

FiO2 0.40
Mode SIMV
Set rate 6 br/min.
Total rate 16 br/min.
VT 700 ml
Pressure support 25 cmH2O

Arterial blood gas results are as follows:

pH 7.51
PCO2 29 mmHg
PO2 140 mmHg
HCO3- 22 mEq/L

Based upon the above information, you would recommend which of the following at this time?
A. decrease pressure support to 20 cmH2O
B. decrease FiO2 to 0.30
C. place on a T-tube at 50% oxygen
D. decrease SIMV to 3 br/min.

decrease pressure support to 20 cmH2O

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