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Advanced Exam
Advanced Practice Exam
| Question | Answer |
|---|---|
| A capillary refill time of 6 sec reflects a _____ peripheral perfusion. | decreased |
| Capillary refill is determined by... | Compressing the nailbed of the patient and after releasing it, observing the time required fort the nail to return to its original color. |
| Normal Capillary refill time is .. | Less than 3 sec |
| Decreased perfusion to the extremities could be caused by decreased _____. | QT: Cardiac output (Both extremities should be checked because reduced perfusion to one extremity could be the result of vasospasm or clot.) |
| The reservoir bag of a partial or non-rebreathing mask should remain one-half to one-third full at all times during the breathing cycle. If it collapses at any time, it is an indication of.. | Inadequate flow to the mask |
| A reservoir bag on a patients rebreathing mask completely deflates as the patient inspires. What should be recommended? | Increase flow to the mask |
| Transcutaneous Monitoring reflects | PaO2 Good for neonate Measurement by electrodes placed on the skin instead of a single measurement with a blood sample |
| Pulse Oximetry reflects | SpO2 (Monitors Oxygen Saturation (SpO2)and Pulse) Normal: 93-97% |
| Capnography reflects | PETCO2 (Measures exhaled carbon dioxide content) Normal: 3-5% |
| Pulmonary Artery Catheter reflects | PVO2 |
| Co-Oximeter/Hemoximeter | diagnose carbon monoxide poisoning (>20% COHb) Normal COHb: 1-3% COHb for smokers: 5-10% Heavy Smokers: 10-15% |
| Co-Oximeter/Hemoximeter | Best way to evaluate oxygenation in a patient with CO Poisioning |
| There is no palpateable pulse on a patient, but the ECG monitor shows QRS complexes on the tracing. You should..... | Begin cardiac compressions |
| Regardless of what the ECG monitor is recording, if a patient has no pulse..... | compressions must be started immediately |
| Pulseless electrical activity (PEA) | The ECG monitor does not reflect the actual mechanical activity of the heart |
| The low pressure alarm is sounding on a CPAP machine via mask at 8 cmH2O. Manometer is reading 2 cm H2O. What may cause this? | Loose-fitting mask Leak around the tubing connections |
| If a low-pressure alarm is sounding on a CPAP Machine, then.... | leaks are present somewhere in the system alarm is not set appropriately (should be set about 2 to 4 cm H2O below the CPAP level) |
| A pulse dose O2 sysetem conserves O2 by.. | sensing the patients inspiratory effort and delivering O2 during inspiration only |
| Calculating duration of flow for a liquid O2 system | Gas remaining: Liquid wt lb X 860/2.5 lb/L Duration of contents (min): gas remaining(L) /flow (L/Min) |
| A patients Hb level is 20 g/dL and SpO2 is 80%. This patients HbO2 level is _____. (see pg 222 GPersing) | Normal (16 g/dL of saturated Hb, which is a normal value) |
| Hemoglobin Hb | is the portion of the RBC that carries oxygen, so it is an indicator of the oxygen carrying capacity of the blood. |
| Hemoglobin Hb Normal Levels | Males: 13.5 -18.0 g/dl Female: 13 - 16 g/dl |
| A decreased Hb level indicates _______ oxygen-carrying capacity in the blood. Treatment is a ____ ____. | inadequate blood transfusion |
| A motor vehicle accident patient in mild respiratory distress and complaining of soreness on the left side of the chest with diminished breath sounds in the left lung. After placing the patient on Oxygen you should recommend.... | Stat chest radiograph (symptoms suggest a pneumothorax) |
| Total flow | flowmeter setting X factor {Air + O2} |
| A patient having difficulty cycling the IPPB machine into the inspiratory phase. The respiratory therapist should adjust what control? | Sensitivity |
| On an IPPB machine the sensitivity control determines the ___ ___ required to cycle the machine into the inspiratory phase. | inspiratory effort |
| On an IPPB machine, if more than -2cmH2O is required by the patient to cycle the machine on, the ..... | Sensitivity should be increased |
| Oxygenation 2nd Low PaO2 | 1st: Increase FIO2 (by 5-10%) up to 60% 2nd: Increase or add PEEP CPAP (by 2-5cmH2O) |
| Chronic Obstructive Pulmonary Disease (COPD) serious lung disease that usually causes breathing to get worse over time. COPD includes ..... | chronic bronchitis, emphysema, or both. |
| Because COPD patients are difficult to wean from a ventilator, it is to their advantage to attempt _______ first. | noninvasive mask ventilation |
| In order to knock out a patient's "hypoxic drive" the PaO2 must be higher than_______. | 65 torr |
| Approximate Normal PaO2 on a given O2 Percent | Multiply the percentage times 5. patient is on 50% O2 so: 50 X 5 = 250 |
| The C(a-v)O2 is the difference between the O2 content in ____ and _____ blood. | Arterial Venous |
| C(a-v)O2 Normal value... | 4-6% |
| PCWP (PAWP) normal value.... | 4-12 mm Hg |
| A decreased value in PCWP indicates... | lower pressure in the left side of the heart as a result of the decreased venous return caused by a decreased QT (cardiac output) or hypovelmia. Treated by increasing fluids. |
| Card 1 An elevated C(a-v)O2 value indicates a greater difference between the two, suggesting... | less O2 in the venous blood This results from a decreased QT (cardiac output). |
| Card 2 Even though blood is flowing through the circulatory system at a slower rate (decreased QT), the tissues will extract the O2 at | the same rate. (This causes less O2 Content in the venous blood, resulting in an increased C(a-v)O2.) |
| Weaning parameter MIP | > -20cmHg |
| Weaning parameter P(A-a)O2 | <350 torr on 100% O2 |
| Weaning parameter VC (Vital Capacity) | >10 mL/kg of body weight |
| When calibrating a helium analyzer to room air, the analyzer should read | 0% |
| Helium is a trace element found in... | atmospheric air |
| A patient receiving 40% O2 by air entrainment mask has a PaO2 of 58 torr and his calculated shunt is 6%. What is a possible cause? | Hypoventilation (hypoventilation is an example of V/Q mismatch, which will not result in increased shunt levels.) (see Q17) |
| Pulmonary edema, labar pneumonia, and pneumothorax would all cause shunts of ______. | more than 6%. |
| To determine V/Q ratio | Ventilation (numerator) / Perfusion (denominator) |
| Normal alveolar ventilation is approximately ____, with an average pulmonary blood flow of about ____. What is the V/Q ratio. | 4 L/min 5 L/min 4/5 =.8 V/Q Ratio |
| In a normal individual in the upright position, the upper portion of the lung receives greater ventilation than perfusion, and therefore has an.. | increased V/Q scan (more than .8) |
| In a normal individual in the upright position, perfusion is greater than ventilation in the lower portions of the lungs as a result of gravity, therefore the V/Q ratio is | decreased (less than .8) in those areas. |
| A V/q scan shows normal ventilation and no perfusion in the left upper lobe on a patient with suspected with a pulmonary embolism. The V/Q ratio should be estimated approximately ..... | more than 2.0 (Classic example of PE, pulmonary blood flow is obstructed while ventilation remains normal) (see Q 19)(see Egans chart pg235) |
| A high V/Q (ventilation/perfusion)ratio indicates that ventilation is _____ than normal and perfusion is _____ than normal or both. | greater less (in ares with high V/Q, the PO2 is higher and the PCO2 is lower than normal) |
| A low V/Q (ventilation/perfusion)ratio indicates that ventilation is _____ than normal and perfusion is _____ than normal or both. | less greater (in ares with low V/Q, the PO2 is lower and the PCO2 is higher than normal) |
| An ET-tube cuff pressure is measured to be 40 mmHg. At peak inspiratory pressure air is passing around the cuff. What should be done? | Change to a larger tube.(Cuff pressure should be maintained no more then 20mmHg. If there is twice that amount of pressure and a leak is still present, the tube is to small and should be replaced with a larger one.) |
| An increase in C(a-v)O2 often indicates decrease in ... | Cardiac output (since mixed venous PO2 decrease when cardiac output decreases, the difference between arterial and venous O2 content increases.) |
| ABG result reveal respiratory acidemia as a result of increase PaCO2 on a pressure ventilator. This indicates ventilatory failure that may be reversed by increasing minute ventilation. On a pressure ventilator this is accomplished by.. | increasing inspiratory pressure or ventilator rate |
| A bronchoscope should be disinfected with.. | glutaraldehyde (soak in for 15-20 min) |
| Total immersion in a liquid disinfectant and sterilant, such as Cidex,is necessary to expose both the inside and outside of the bronchoscope to the cleaning agent. Submerging the bronchoscope for..... | 10 to 15 minutes in Cidex will produce disinfection, soaking for 3 to 10 hours will produce sterility and should be done after every use. |
| Trendelenburg postion, the patients head is.. | down to drain the lower lobe |
| A patient receiving postural drainage and percussion with right lower lobe atelectasis. The cardiac monitor (ECG) shows sinus bradycardia which is most likely the result of _____ caused by _____. | hypoxemia placing the patient in a head down position (Trendelenburg) to drain the right lower lobe. |
| What complications of a bronchoscopy would result in the high peak inspiratory pressure alarm... | Pneumorthorax Bronchospasm Pulmonary hemorrhage |
| Hypotension would _____ result in high peak ventilatory pressures. | NOT |
| QS/QT shunt equation | (PAO2- PaO2) X.003 /CaO2-CvO2) + (PAO2-PaO2) X .003 |
| PCWP (Pulmonary Capillary Wedge Pressure) | Measure of left atrial pressure Normal: 4-12 mmHg |
| QT (Cardiac Output) | Normal:4-8 L/min |
| PAP (Pulmonary Arterial Pressure) | Normal: 25/8 |
| BP (blood pressure) | Normal: 120/80 less than: 100/60 = hypertension greater than 140/90 = hypertension |
| Decreased blood pressure (hypertension) would indicate a decreased ____. | SVR (Systemic Vascular Resistance) |
| Decrease QT (cardiac output) would indicate ____ would also be decreased. | SV (stroke volume) |
| Increased PAP (Pulmonary Arterial Pressure) indicates an ______ resistance to blood flow in the pulmonary vasculature. | increase |
| Needle aspiration is indicated for a ______ ___ is present. | tension pneumothorax |
| A patient in mild respiratory distress with a 10% pneumothorax would indicate treatment of ... | O2 therapy to help absorb the air in the pleural space. Continuous pulse oximetry to monitor SpO2 to determine the patients oxygenation Status |
| A ____ may be used temporarily in place of an ET tube if intubation is difficult. | LMA (Laryngeal mask airway) |
| An infant has just been delivered at 30 weeks gestation and appears cyanotic. While administering O2, the respiratory therapist should recommend..... | Determine the Apgar score of the infant |
| An Apgar score should be obtained .... | at 1 and 5 min after delivery to asses the overall status of the neonate. |
| A patient with chest trauma is on a volume ventilator and a VT of 800 mL. The returned exhaled volume is 500mL. What could cause this problem? | Leak around the chest tube |
| Leaks of any kind, including a chest tube, result in ... | reduced exhaled volume readings |
| Low H2O level in the humidifier will result in more volume being compressed into the walls of the device, resulting in less volume being delivered to the patient, BUT | the volume leaves the humidifier during expiration and is measured as part of the exhaled VT. |
| The RT is having difficulty calibrating a transcutaneous O2 monitor to room air that is to be placed on an infant in the NICU. This is likely because... | the membrane is torn |
| A transcutaneous monitor is calibrated to room air while off the infant therefore, any difficulty calibrating can not be related to the infants hemodynamic status but.... | with the monitor itself |
| After administering 200J with a defibrillator, ventricular fibrillation continues. What appropriate measure should be taken? | Repeat defibrillation with 300J (the initial amount of energy is 200J and if defibrillation is not reversed, a maximum of 360 J may be used) |
| Card 1 A patient on a volume ventilator, ABG are: pH 7.51, PaCO2 30torr, PaO2 57torr, HCO3 25, RR 10, Vt 750, FIO2 60%,PEEP 6. What should be recommend based on this information? | Increase PEEP to 8cmH2O. The patient remains hypoxemic on 60% O2, the PEEP level should be increase not the FIO2. The patient is hyperventilating but in response to hypoxemia. |
| Card 2 | Therefore, the RR and TV should not be decreased. As oxygenation improves, hyperventilation should subside resulting in the PaCO2 returning to normal. |
| The Peep level that provides the best static compliance (CL) indicates | the optimal PEEP |
| To find Optimal PEEP in 36 pg224 (Persing), Simply | subtract the PEEP level from its corresponding plateau pressure, and the lowest number of the four choices will produce the highest number when divided into the TV of 600. |
| During insertion of the Swan-Ganz catheter, you would know it is in the pulmonary artery when _____ value is observed. | 24/10 mmHg (normal value of PAP) |
| The pressure support needed to overcome resistance to breathing through a ventilator tube and ET tube is only about... | 5-10 cmH2O |
| Card 1 Patients with restrictive disease have no trouble exhaling air normally but have difficulty... | getting air in on inspiration |
| Card 2 The reason an FEV1 is decreased is not because of airway obstruction during exhalation, but rather because the .. | patient did not get the predicted normal volume of air in to begin with, therefore a volume of air is not exhaled out in 1 sec. |
| Card 3 An FEV1/FVC value of 75% indicates obstructive disease is _____ present. | NOT |
| Card 4 Even though an FEV1 is decreased, when coupled with a normal FEV1/FVC, a ______ process is the cause. | Restrictive |
| Card 5 To rule out obstructive disease the TLC would need to be ______. | normal (TLC is increased in obstructive disease) |
| Card 6 To rule out obstructive disease the Peak Flow would need to be ______. | Normal (Peak Flow is below normal in obstructive disease) |
| FVC normal value exhaled in 1 sec is .. | 75 to 85% |
| Below normal values of FEV/FVC indicate _____ disease. | obstructive |
| Normal or above normal values of FEV/FVC indicate _____ disease. | Restrictive |
| Look for an FEV1/FVC of less than 75% to indicated an________ disease. | Obstructive |
| Card 1 (Q40) A high PaO2 (more than 65torr) in a COPD patient is sufficient to reduce the drive to breathe, therefore... | the PaCO2 level can begin to increase resulting in the patient to become drowsy and lethargic.. called CO2 narcosis. |
| Card 2 (Q40) By decreasing the liter flow, the PaO2 should decrease and, as long as the PaO2 is maintained in the 50 to 65 torr range, CO2 narcosis will ... | subside and the patients ventilatory status will improve. |
| CO2 narcosis | refers to higher levels of PaCO2 having a narcotic like effect on the patient |
| A COPD patient on mechanical ventilation for 2 weeks in extubated. Hours after the patient complains of SOB while on a nasal cannula at 2L/min. RR increases from 16/min to 26/min. What should be done... | Initiate noninvasive positive pressure ventilation. (It is appropriate in COPD patients to attempt noninvasive ventilation initially, because if it is successful, intubation can be avoided.) |
| Increased PVR (pulmonary vascular resistance) may result from ... | Hypoxemia Acidemia PEEP |
| Pulmonary blood vessels constrict in response to hypoxemia and acidemia resulting in and _______ Pulmonary Vasculature resistance (PVR). | Increased |
| PEEP applied to the lungs compresses blood vessels within the lungs, _____ PVR (pulmonary vascular resistance) and restricting blood flow. | Increased |
| Hypocapnia (decreased PaCO2) results in ______ and a ______ in PVR (pulmonary vascular resistance). | Pulmonary vasodilation Decrease |
| Hypocapnia | decreased PaCO2 |
| After increasing PEEP level from 8 to 12 cmH2O, the PVO2 drops from 37 torr to 33 torr. This indicates... | QT cardiac output has decreased |
| A drop in PVO2 (mixed venous PO2) is indicative of | decreased QT (cardiac output) |
| Card 1 (Q43) A drop in PVO2 occurs because.. | the tissue extract O2 from the blood at the same rate, even though the blood is slowing slower past the tissues (decreased QT). |
| Card 2 (Q43) Therefore, more O2 is extracted and by the time the blood reaches the pulmonary artery, which is where PVO2 is measured.... | there is less O2 in the blood. |
| PVO2 is measured in the | pulmonary artery |
| A patient has an FRC of 127% of predicted. The patient most likely has.. | Emphysema (patient traps air during exhalation, more air stays in the lungs after exhalation and FRC increases. |
| FRC is.. | the amount of air remaining in the lungs following a normal exhalation. |
| The high pressure alarm is activated on a patients volume ventilator. (Q45) | suction the patient |
| The high pressure alarm indicates | resistance to gas flow through the tubing or airway |
| Secretions can cause an increased Raw and by ______ the patient, Raw can be decreased with a corresponding decrease in ________. | suctioning peak inspiratory pressure |
| Normal Pulmaonary Wedge Pressure (PCWP) | 4- 12 mmHg |
| Normal Pulmaonary Wedge Pressure (PCWP) 4-12mmHg indicates... | normal left heart function |
| Increased PAP and PVR indicates | restriction to blood flow through the pulmonary arterial system, most likely the result of a pulmonary embolism. |
| Overhydration should be suspected when the PCWP is ______. | elevated |
| Hyperbaric O2 therapy is indicated for ______ patients. | CO poisoning |
| The affinity of Hb for Co is ____ to ____ times greater than for O2. _____ PaO2 levels will decrease this affinity, so that Hb will release CO more readily. this is the reason a patient exposed to CO should be placed on a _______ mask initially. | 200 to 250 High Non-rebreathing |
| The higher the PaO2, the more CO is released from the Hb. By placing the patient in an HBO chamber,______%O2 can be delivered at____. | 100% 2 to 3atm PaO2 levels of 2 to 3 times normal on 100% O2 can be achieved. |
| Normal PaO2 levels on 100% O2 is 500 to 600 torr. This means PaO2 levels on 2 to 3 times atmospheric pressure may reach 1000 to 1800 torr. This enhances .. | CO release from Hb. |
| Hypoventilating | High PaCO2 |
| Normal P(A-a)O2 on room air is .. | Less than 15 torr |
| A patient that has chronic hypoxemia would have elevated... | HCO3(bicarb) to compensate for the chronic hypercapnia that accompanies chronic hypoxemia |
| hypercapnia | Increased PaCO2 |
| Hypoxemia | decreased O2 in blood |
| Initial ventilator rate setup is | 8 to 12 breaths/min |
| Ideal Body Weight Formula for Obese patients | Males 106 lb + 6 lb/in over 5 feet Females 105 lb + 5 lb/in over 5 feet (remember to convert to kg, 2.2 lb per 1kg) |
| Initial tidal volume set is | 8-12 mL/kg of ideal body weight |
| In question 50 pg 216 (Persing), this volume tracing shows the volume not returning to basline, indicating a low exhaled VT. This result from ... | a leak somewhere in the tubing circuit, around the ET-tube cuff or out the chest tube drainage system. |
| A patient with ARDS is on a volume ventilator with a PEEP of 15cmH20 and an FIO2 of 1.0 (100%) and remains hypoxemic. What should be recommended? | Place on pressure control ventilation |
| Pressure control ventilation is a useful mode for patients with... | noncompliant (stiff) lungs, such as those seen in patients with ARDS. |
| Volume ventilation on ARDS patients leads to.. | high peak pressures and an increased potential of barotrauma by overdistention of the alveoli. This leads to pneumothorax. |
| Using inspiratory pressures that deliver lower VT (6 to 9 mL/kg) and maintaining plateau pressures at 35 cmH20 or less will .. | reduce the risk of overdistention of alveoli. |
| Pressure control ventilation (PCV) has been used as a general mode of ventilation, especially for adult patients with ... | ARDS in whom conventional volume ventilation with PEEP has not improved ventilation or oxygenation. |
| Specific indication of PCV vary but generally the patients with ARDS may be on ventilator parameters before PCV is instituted such as.. | FIO2: 1.0 (100%) PEEP: >15cmH20 PIP: >50cmH2O Assist/Control rate: >16/min |
| PIP (Peak Inspiratory Pressure) should be set to obtain a specific exhaled VT. In other words, if the target exhaled VT is 600 mL and the actual exhaled VT is 500 mL, then PIP should be _____. | Increased |
| Initial ventilator setting for COPD patinet are... | VT of 6-10 mL/kg Rate of 8-12 FIO2 of 30-40% |
| COPD patients generally require lower VT levels to ventilate because | their lungs are hypercompliant and require less pressure to ventilate. Therefore, a lower VT may be used. |
| High FIO2 levels on a COPD patient should be avoided to.. | Reduce the possibility of blunting the respiratory drive and increasing V/Q mismatching. |
| The optimal PEEP is determined by | the level that produces the highest PVO2 |
| The PEEP level at which PVO2 decreases is the point at which... | QT (Cardiac output) decreases. (go back to the PEEP level before the drop in PVO2 (optimal PEEP level) |
| Normal PCO2 for an infant is | 40 to 50 torr |
| An acidic pH (7.26) is caused by | increased PaCO2 or decreased HCO3 |
| A patient receiving helium/O2 therapy through a Simple O2 Mask. The patients experiences SOB, what should the RT do? | Change to a non-rebreathing mask |
| Because He/O2 mixtures are lighter than oxygen mixtures, leaks around the mask and exhalation ports are more prevalent therefore a.... | tight-fitting non-rebreathing mask reduces the potential for leaks |
| P(A-a)O2 short cut calc | PAO2 = FIO2 X 7 -(PaCO2 + 10) PAO2 - PaO2 |
| Weaning from vent | MIP > -20 cmH2O VD/VT <60% VC >10 mL/kg |
| DLCO (Diffusion Capicity) is the measurement | of the diffusion of CO across the alveolar capillary membrane into the pulmonary capillaries |
| Pulmonary Fibrosis and Emphysema will have a _____ DLCO. But FEV1 or FEV1/FVC will be _____ in Emphysema. | Decreased Abnormal |
| The longer the time that positive pressure is in the airways, the | higher the MAP |
| A 2-week old infant on pressure limited, time cycled ventilator, The PIP is 24cmH2O, I-Time is .5sec and MAP is 14cmH2O. If the I-Time is increase to .8 sec, what will occur? | MAP will increase |
| A patient having difficulty cycling the IPPB machine into the inspiratory phase. What modifications will correct the problem? | Increase the sensitivity Make sure the patients lips are sealed tight around the mouthpiece make sure all tubing connections are tight |
| Sensitivity control on an IPPB machine adjusts | the amount of negative pressure the patietn must generate to cycle the IPPB machine on. (the patient should never have to initiate more than -2mH2O to cycle the machine into inspiration) |
| On an IPPB machine any leaks in the system or around the mouth can make it difficult for the patient to | cycle the machine in inspiration |
| A patients C(a-v)O2 increases from 4.0 vol% to 8.5 vol% after increasing the PEEP level from 5 to 10 cmH2O. This suggests | QT decreased (see question 15 pg 223) |
| The respiratory therapist has just intubated the patient and the CO2 detector on the proximal end of the ET tube reads 6%. This indicates .. | the tube is in the airway |
| A normal PETCO2 is | 4.5% to 7% |
| PETCO2 values between 4.5% to 7% the tube is in the ______. | Airway |
| PETCO2 of zero or near zero, the tube is in the ______. | Esophagus |
| Patient on a volume ventilator, SIMV, RR 6,VT 700mL, FIO2 35%, pH 7.44, PaCO2 34torr, PaO2 89 torr, HCO3 23. What should be recommended? | Decrease Ventilator Rate to 4/min (PaCo2 is slightly decreased indicating mild hyperventilation, which is corrected by increasing deadspace, reducing RR or TV. Because this patient is weaning, reducing the rate will continue the weaning process.) |
| A reservoir tuning on a patient's T-piece has fallen off. How can this effect the operation of this device? | The FIO2 will decrease |
| Card 1 The 50 CC tubing attached to the opposite end of the T-piece (Briggs adaptor) serves as a reservoir for the O2 that is continuously flowing through the T-piece past the patient. When the patient inspires, | gas flowing through the T-piece as well as from the reservoir will enter the ET tube or tracheostomy tube for the patients inspired gas supply. |
| Card 2 If the reservoir falls off on a T-piece (Briggs adaptor) room air will likely be drawn in, diluting the supplemental O2 and resulting in a .... | decrease in the delivered O2%. |
| Inspiratory time is calculated as | Total cycle time divided by total I:E ratio parts: Total cycle time = 60/rate Inspiratory time = Ans in sec/ total I:E ratio parts |
| Ventricular Tachycardia is a life threatening arrhythmia and must be reversed immediately by (see 67 pg 218) | defibrilation |
| Ventricular Tachycardia (V-Tach) | Ventricular rhythm with rate >100 Defibrillate (if no pulse) Lidocaine & Cardiovert (if pulse is present) |
| In Pressure Control Ventilation, each ventilator breath delivers the ______ PIP | same |
| In Pressure Control Ventilation, pressure is _____ and _____ increase if there is an increase in airway resistance or a decrease in compliance. | limited cannot |
| In Pressure Control Ventilation,when a patients exhaled VT decreases with no change in in PIP a decrease in _________ is indicated. | lung compliance (the lungs have become stiffer and harder to ventilate, requiring higher inspiratory pressure to deliver the same volume, but pressure is limited, therefore VT has to decrease. |
| Minute Ventilation VE (See Q 69 pg 218 Persing) | VE = RR X VT |
| Alveolar Minute Ventilation | VE = (VT - VD) X RR |
| Card 1 A patients pH is 7.17 and PaCO2 is 23 torr. The respiratory therapist should recommend? | Administer Sodium Bicarbonate (acidotic pH has to be metabolic indicated by decrease PaCO2. A decreased PaCO2 increases pH, but decreased pH indicates HCO3 has decreased) |
| Card 2 The decreased PaCO2 is a sign of hyperventilation, compensating fro the metabolic acidemia. This metabolic problem is corrected by | administration of HCO3 |
| UAC is an | Umbilical Artery Catheter that allows blood to be taken from an infant at different times, without repeated needle sticks. |
| Two hours after insertion of a UCA in a 1 day old infant, cyanosis of the lower extremities is noted. What should be recommend... | Withdraw the catheter to the level of T8 on radiograph |
| The distal tip of an UCA should rest at the level of T6 to T10. If the catheter is placed to low, interference with blood flow to the lower extremities may occur and would be detected by... | Cyanosis of the legs and feet. |
| An intubated patient is being ventilated by a self-inflating manual resuscitator. When the bag is squeezed, there is little resistance met and the patients chest does not rise. What should be done? | Check the bag intake valve for proper function |
| If there is a leak around an self inflating manual resuscitator bag inlet valve, the bag will not | pressurize as O2 leaks out of the valve |
| Since all bags used to manually ventilate are self-inflating bags used to manually ventilate are self-inflating bags, even if there is no O2 flowing into the bag, and if there is no leaks in the system, the bag will | pressurize when compressed (the only problem is the patient will receive only room air from the bag, not supplemental O2) |
| While transporting a patient on a 4-L/min nasal cannula with an E cylinder, the cannula tubing becomes kinked between the mattress and the bed rail. The Bourdon gauge flowmeter device would... | show a higher flow reading than the patient is actually receiving |
| The Bourdon gauge measures _____ not ______. | pressure not flow |
| A Bourdon gauge is recalibrated in liters per minute when used as a flow metering device. If the tubing becomes kinked, back pressure builds in the gauge and the reading goes _______. | up |
| After setting up a cannula and kinking the tubing, a whistle should be heard coming form the humidifier. This is the pressure pop-off valve indicating | that there are no leaks in the setup |
| After setting up a cannula and kinking the tubing, a whistle is not heard (pop-off valve) there is a .. | leak present and the set up should be check for leaks around the jar top or in the tubing itself |
| After setting up a 6-L/min cannula, respiratory therapist kinks the cannula tubing an a high pitched whistle is heard coming from the humidifier. The therapist should... | place the cannula on the patient as orderedxc |
| A patients chest radiograph shows hyperinflation, right ventricular hypertrophy, and diffuse infiltrates. During a pulmonary assessment, what would likely be observed? | Pedal edema Barrel chest Distended neck veins |
| Card 1 The hyperinflation on the radiograph will result in an increased AP chest diameter _________. | Barrel chest |
| Card 2 Barrel chest | increased AP chest diameter |
| Card 3 Right ventricular hypertrophy (enlarge right heart) is caused from... | chronic pulmonary hypertension, which results from chronic hypoxemia, which in turn results in right-sided heart failure (cor pulmonale). |
| Card 4 Because of Cor pulmonale (right-sided) heart failure, blood from the right heart backs up into the venous system, leading to distended neck veins and pooling of blood in the ankles _________. | pedal edema |
| A drug overdose unconscious pt via volume ventilator. Peak Inspiratory pressure is 30cmH20,high pressure limit set at 40cmH2O. 1 hr later the patient is agitated combative & high pressure alarm sounds with with each breath. What should be recommend? | Administration of Vecuronium (seditive) (Muscular paralysis should be initiated when a patient is fighting the vent. |
| Card 1 Each time the high pressure alarm is activated, inspiration ends without delivering the set VT. If this continues, the patients PaCO2 will begin to increase and the patient will go into ... | ventilatory failure. By paralyzing the patient with vecuronium , ventilation can continue uninterrupted. |
| A patient on 5L/min nasal cannula. The patient is not cyanotic, ABG results reveal a PaO2 of 45torr and an SpO2 of 98%. To better assess oxygenation status assess ... | Hb level (anemic = low Hb level) |
| A patient who is anemic (low Hb level) may have a normal SpO2 value. But if the patients Hb level is only 8g/dl (normal value is 12-16 g/dl) the tissues are ... | not receiving an adequate amount of O2. |
| For cyanosis to be present there must be ... | 5 g/dL of unsaturated Hb |
| Remember, 99% of O2 delivery to the tissues is accomplished .... | bound to Hb |
| A patient may have a Hb level of 8 g/dl and be 98% saturated, meaning the patient is not cyanotic, but the patient is most likely | hypoxix (do not be deceived by a normal SpO2 reading, always check the Hb level) |
| While making O2 rounds, the respiratory therapist observes H2O bubbling in the aerosol tubing connected to a jet nebulizer set on 40%. What is a true statement? | This is a heated nebulizer: because condensation forms in the tubing when heated aerosol travels through the tubing, which is exposed to room temperature. |
| With a heated nebulizer, because the tubing is cooler and cant hold as much water, condensation forms in the tubing. H2O in the aerosol tubing causes | a resistance to gas flow, resulting in back pressure into the nebulizer. As pressure increases in the nebulizer, less air is able to be entrained into the nebulizer through the entrainment ports resulting in a increased O2% delivered from the nebulizer |
| A 2 week old infant is being ventilated on a time cycled pressure limited vent. The physician wants to increase MAP. What could accomplish this? | PEEP PIP Inspiratory time (Higher pressures and a longer time with positive pressure in the airways will increase MAP) |
| The lower the peak pressure and number of positive breaths the fewer___________ effects. | cardiac side effects |
| In assist/control mode, every breath is a ______ breath, even if the patient breaths above the set rate. | positive pressure |
| SIMV and Control mode will deliver the _____ number of positive pressure breaths if set on the same rate. | same |
| The lower the VT, the lower the | PIP |
| Initial Settings for Mechanical Ventilation (see pg E-11) | Tidal Volume: 8 -12 mL/kg of ideal body weight RR: 8 -12 breaths/min FIO2: 40-60% PEEP: 0 -10 cmH2O |
| When plateau pressures are getting progressively higher, which indicates more pressure is required to ventilate the alveoli on the same volume. This means | that the lungs are getting stiffer and harder to ventilate, indicating a decreasing static CL (compliance) |
| The most accurate method of determining how well an emphysema patient is ventilating is by | obtaining ABG samples |
| The effectiveness of any patients ventilation is measured by the PaCO2, this is best accomplished by.... | ABG analysis |
| After repeated attempts to wean a patient from mechanical ventilation without success, the respiratory therapist should recommend obtaining... | serum electrolytes |
| The determination of the level of specific _______ that effect muscle strength, such as potassium, magnesium, phosphorus, sodium, chloride is essential. | electrolytes (If the level of these electrolytes are low, the muscles of ventilation may be too weak for the patient to be weaned from a ventilator. Supplemental IV administration of the electrolytes will increase muscle strength) |
| A ventilator patient is on a PEEP of 8 and FIO2 of 50%. After increasing the PEEP to 10 his QT (cardiac output) drops from 4.8 to 3.3 L/min. What should be recommend? | Decrease the PEEP to 8 cmH2O and increase the FIO2 to 60% (the increased PEEP level decreased QT, therefore, the PEEP should be reduced back to its original level. The hypoxemia should be treated by increasing the FIO2) |
| On a volume ventilator, an increase in Peak Inspiratory pressure could be caused by | Decreased CL Partially occluded ET-tube High Inspiratory flow setting |
| A decrease CL (compliance) indicates | the lungs are stiffer and harder to ventilate, therefore more pressure is required to ventilate the lungs |
| Any resistance to flow, such as a partially clogged ET-tube, _______ inspiratory pressure and the higher the inspiratory flow the more _____ to flow as it rubs against the sides of the ventilator tubing causing... | increases resistance an increased inspiratory pressure |
| Before administering IPPB, the RT notes subcutaneous emphysema around the neck tissues of the patient. What should the RT do? | Withold IPPB and recommend a chest radiograph |
| Subcutaneous emphysema, or air in the subcutaneous tissues indicates | an air leak from the lung |
| When an air leak from the lung is present, positive pressure should not be introduced into the airway because this may further complicate the potential pneumothorax ... | a chest radiograph should be ordered to confirm the diagnosis and determine the severity of the leak. |
| An I:E ratio alarm is sounding on a volume ventilator. What ventilator setting change will correct this problem? | Increase the flow rate |
| An inverse I:E ratio alarm indicates | that inspiration is longer than expiration. |
| To shorten inspiratory time on a volume ventilator, the VT may be | decreased or the flow rate may be increased |
| We do not want to alter alveolar ventilation by decreasing the VT to shorten inspiratory time, so getting the volume to the patient faster by increasing | the flow will end inspiration sooner, decreasing the inspiratory time. This will return the I:E ratio back to a more normal ratio of 1:2 or 1:3. |
| A Normal PCWP (pulmonary capillary wedge pressure) is 4- 12mmHg. This indicates adequate | left heart function (mitral valve regurgitation and aortic stenosis can be ruled out, these conditions would cause an increase in PCWP) |
| Normal CVP is | 2-6 mm Hg |
| Normal PAP is | 25/8 mm Hg |
| In pulmonary hypertension PAP and CVP are | increased |
| Normal QT (cardiac output) is | 4-8 L/min |
| Pulmonary Vasoconstriction causes an increase in CVP because | the right side of the heart must work harder to pump blood through constricted pulmonary vessels. |
| If Right Ventrilcular Failure is present the CVP would be much ______ than 10mmHg | higher |
| A Ventilator patient is likely ready to wean when the VD/VT is | less than 0.60 |
| A Ventilator patient is likely ready to wean when the MIP | is at least >-20 cm H2O |
| A Ventilator patient is likely ready to wean when the VC is | more than 10 to 15 mL/kg |
| A patient becomes Tachycardic and agitated, the high pressure alarm sounds. Patient has diminished breath sounds in the right lung and the trachea is palpated left of the midline. What should be recommended. | This patient is exhibiting signs of a tension pneumothorax. Insert a needle into the second intercostal space will relieve pressure in the pleural space and mediastinum and allow the lung to reexpand. (this life threatening immediate action required) |
| H2O in the Water (H2O) seal bottle of a chest tube drainage system fluctuates 5 -10 cm H2O as the patient is breathing. This is most likely the result of ... | This is a normal occurrence with chest tube drainage systems. |
| During normal breathing, pleural pressure increases and decreases, this is indicated by the H2O fluctuating in the H2O-seal bottle. If the H2O level is not fluctuating | a clot in the tube should be suspected |
| A patient has SOB with RR of 32/min and a VT that fluctuates between 350 and 500 mL. What would be an appropriate device to deliver approximately 40% O2. | Air entrainment mask |
| Low flow devices, Nasal cannula, Simple Mask, Partial Rebreathing Mask should never be set up on a patient with a RR of_________ or an _____VT. | respiratory rate of more than 25/min or an inconsistent VT (O2% delivered by theses devices can not be determined) |
| Air entrainment Mask (High Flow Device) | delivers more consistent O2 percentages at higher flows than a low-flow device can. |
| A patient on a volume Ventilator with an HME, over the past 4 hours the patients sputum has become thicker and more difficult to suction through the catheter. | Replace the HME with a heated humidifier |
| A HME or (artificial nose) provides less H2) to the patients airway than a conventional heated humidifier. If secretions begin getting thicker... | more H2O must be delivered and a heated humidifier is indicated. |
| Very little mist is being produced by a jet nebulizer attached to an aerosol mask. What would cause this? | The capillary tube filter is clogged The jet is obstructed The liter flow is too low |
| In a jet nebulizer, if the capillary tube is clogged, H2O cannot be drawn up into it so | H2O output diminishes |
| In a jet nebulizer, if the jet is obstructed | gas cannot pass through it as readily to create the pressure drop necessary to draw the H2O up the capillary tube, therefore H2O decreases. |
| In a jet nebulizer, an excessively low liter flow... | delivers less H2O per minute, which is indicated by a decreased mist output |
| Using a size 12 French suction catheter to suction a female patient who is intubated with a 6.5 mm ET-tube. The therapist is having difficulty aspirating the thick secretions. What would be appropriate to do? | Instill 5mL of normal saline down the ET tube |
| Instilling normal saline down an ET tube will help loosen secretions, making them easier to | aspirate |
| Suction pressure should not exceed more than | -120 mmHg |
| To determine the proper size of a catheter.. | multiply ET tube size by 2 then select the next smaller size (lower numbered catheter) example: 6.5 mm X 2 = 13 Catheter sizes (6.5, 8, 10, 12, 14, 16) |
| Coude tip suction catheter | catheter is angled to help suction the LEFT main stem bronchus |
| Card 1 Air is instilled into an ET-tube cuff so a slight leak is heard with a stethoscope at peak inspiration. PIP is 30 cmH2O at that time. 4hrs later the PIP increases to 40. What could be true regarding ET tube cuff care? | The leak around the cuff is larger Minimal leak technique should be used at 40cm H2O |
| Card 2 Minimal leak technique was initially performed when PIP was 30cm H2O. If the PIP increases to 40cmH2O, less pressure is exerted on the tracheal wall around the cuff at peak inspiration, resulting in | a larger leak around the cuff. Minimal leak technique should be done at the higher peak pressure so that not as much volume is lost around the cuff. |
| While ventilating a patient with a manual resuscitator, ABG results indicate a PaCO2 of 50 torr. What would increase the O2 being delivered by the bag? | Add a reservoir to the bag Increase the O2 flow to the bag |
| As a manual resuscitator is compressed, the O2 inlet valve closes preventing O2 form entering the bag. As the bag is released, a | negative pressure is created inside the bag, which draws air into it. |
| If a reservoir filled with O2 is attached at the O2 inlet valve of a manual resuscitator.. | O2 enters the bag instead of room air. This increases the delivered O2%. |
| A higher flow rate to a manual resuscitator bag provides | O2 to the bag at a faster rate, making more O2 available with each breath |
| When using a manual resuscitator bag, Increasing the ventilation rate will decrease the delivered O2% because | less time is allowed for the bag to refill. |
| When using a manual resuscitator bag, Increasing the ventilation rate to high, excessive.... | amounts of CO2 will be blown off leading to respiratory alkalosis. |
| Alkalosis results in a leftward shift of the HbO2 dissociation curve. This causes Hb to | have a greater affinity for O2, meaning it will puck up O2 more easily but will not release it as readily to the tissues. |
| Alkalosis may result in | electrolyte imbalances. During manual resuscitation this is detrimental (BAD) |
| An infant presents with vital signs after delivery: HR 52/min, RR 22/min, Color: cyanosis. What is the appropriate treatment at this time? | Chest compressions and manual ventilation with 100% O2. |
| Chest compressions should be initiated on a neonate if Heart Rate is | below 60/min |
| Manual Ventilation should be initiated on a neonate if RR is | 22/min (Ventilatory Failure) |
| To most accurately measure the volume delivered from a ventilator, the Respirometer should be placed on the ventilator | outlet (before the bacterial filter) Because leaks can occur throughout the circuit, the respirometer would not measure the volume as accurately downstream from the ventilator outlet |
| On a volume ventilator set on VT of 700mL but the exhaled volume reads 400 mL. There are no leaks in the circuit. To determine the volume the ventilator is actually delivering, the Respirometer should be placed at | the ventilator OUTLET |
Created by:
Max912