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211 EXAM I
| Question | Answer |
|---|---|
| Static Compliance Equation? | CS = V/(Pplat-PEEP) |
| What is the patients effective static compliance if the corrected tidal volume is 500 ml, the ventilators peak pressure is 46 cmH20, the plateau pressure is 37 cmH20, and there is 12 cmH20 of PEEP? | 500 ml / (37-12) = 20 mL/cmH20. |
| A decrease in compliance will tend to ___________. | Decrease vital capacity |
| How do you calculate resistance? | (PIP-Pplat)/flow or P/Flow HINT: adjust l/min into l/sec by dividing 60sec |
| PIP 30, Pplat 22 cmH20, Flow 50 L/min. Calculate the Resistance. | 30-22 = 8cmH20/.83 = 9.6 cmH20/L/sec |
| A patient is being maintained on a mechanical ventilator in AC/VC. After endotracheal suctioning, which of the following would show that airway resistance has been decreased? | Lower Peak Pressure |
| Normal I:E ratio | 1:2 to 1:4 |
| I:E ratio for COPD | Up to 1:8 |
| Total Cycle Time (TCT) | Time it takes for inhalation and exhalation |
| How to calculate TCT? | TCT= Ti + Te OR TCT= 60sec/f |
| What is the I:E ratio when the set rate it 20 breaths/min and the Ti is .80 seconds? | 1:2.75 |
| clinician has a set ventilator so that the inspiratory time is 33% of the total cycle time. This would result in an I:E ratio of ______. | 1:2 |
| An I:E ratio that will provide the greatest amount of time for exhalation is what? | 1:4 |
| How do you get I-time (Ti)? | Ti (sec) = Vt/FLow |
| A ventilator is set at a VT of 0.6L and constant flow rate of 30 L/min. What is the inspiratory time? | .6L / .5 L/sec (30/60) = 1.2 seconds = Ti |
| Oxygen content | Actual amount of O2 bound to hemoglobin |
| How do you calculate oxygen content? | CaO2=[(1.34 x Hgb x SaO2) + (0.003 x PaO2)] |
| Hb=10.8, SaO2=93%, PaO2=68, find the O2 content. | (1.34 x 10.8 x .93) + (0.003 x 68) = 13.6 |
| Which of the following blood gases is likely to be found in a 74 year-old chronic CO2 retainer with a history of COPD who is stable and feeling "well"? | pH 7.38 | PaCO2 60 | PaO2 61 | HCO3 36 (HINT: 60/60 club) |
| Blood gas that indicates "acute on chronic" respiratory failure? | pH 7.25 | PaCO2 79 | PaO2 54 | HCO3 33 |
| What would a blood gas look like that indicates the need for mechanical ventilation? | pH 7.24 | PaCO2 61 | PaO2 59 | HCO3 25 | on FiO2 .50 |
| Blood gas evaluation is done for an unconscious patient brought to the emergency room. On room air, the results are pH 7.23, PaCO2 81, PaO2 43, HCO3 33, SaO2 71%. With no history or other data available, what therapy is indicated? | Mechanical Ventilation |
| A cardiac patient has an ABG drawn on room air. The results are pH 7.47, PaCO2 33, PaO2 57, HCO3 25. What treatment is indicated for this patient? | Oxygen therapy |
| A 74 year old women is admitted with acute on chronic respiratory failure with history of COPD, being treated with NIV. Due to increasing confusion, a blood gas is drawn: pH 7.16, PaCO2 88, PaO2 45, HCO3 33. What is your recommended to treat this patient? | Switch to invasive ventilation |
| Normal adult values for Maximum Inspiratory Pressure (MIP) are _______. | -50 to -100 cmH20 |
| Normal range for vital capacity (VC)? | 65-75 *anything below 15 ml/kg is critical, anything above is reasonable |
| MIP measurement stops when the lowest negative value is reached, which can take up to ___ seconds. | 20 seconds |
| What is another name for MIP? | PIMAX or NIF |
| What two measurements should be used to monitor a patient with neuromuscular disorder and respiratory fatigue to test for muscle strength? | MIP and VC |
| How to calculate Raw (Airway resistance)? | (PIP-Pplat)/Flow |
| PIP 30, Pplat 22, Flow 50 lpm. Calculate airway resistance. | 50/60= .83 (30-22)/.83 = 9.6 cmH20/L/sec |
| If there is a difference between _____ and _____, it shows resistance present. | PIP and Pplat |
| During AC/VC, which of the following will increase peak pressure? | 1. Increased airway resistance 2. Decreased lung compliance 3. Increased inspiratory flow rate |
| Which flow wave pattern is seen in spontaneous breaths (without pressure support)? | Sine wave flow waveform |
| determines how fast inspired gas is delivered to the patient (Set I-time) | Flow |
| Airway resistance is _________ when an artificial airway is inserted. The smaller internal diameter of the tube, the greater resistance to flow. | Increased |
| Factors causing an increased peak pressure without changing the static (plateau) pressure include _____________. | 1. Airway Secretions 2. Bronchospasm 3. Bitting the tube 4. Positioned into the right mainstem |
| Factors that causes change in lung compliance ? | 1. Fluid overload 2. Pulmonary Edema 3. CHF |
| All of the following could be the cause of a patients peak pressure increasing from 35 to 45 cmH20 except _______. A. Bronchospasm B. Resolving pulmonary edema C. The patient biting on the endotracheal tube D. Secretions in the airway | B. Resolving pulmonary edema |
| A patient in CHF is being ventilated non invasively with BiPAP, using a P-low of 10 and a P-high of 25. The P-high could also be termed ________. | PIP (Peak Inspiratory Pressure) |
| What modes uses full ventilatory support? | Control or Assist Control (A/C) |
| What modes uses partial ventilatory support? | SIMV, SPONT, PSV |
| What kind of mechanical support can lead to respiratory muscle atrophy? | Full support |
| Indications of A/C | 1. When your patient needs a rest from increased WOB 2. Ventilate with no effort by patient 2. If patient is incapable of controlling their breathing from neuromuscular disease |
| Indications of SIMV | 1. Partial support strategies 2. Helps to not get muscle atrophy 3. Helps enhance distribution of blood 4. Helps weaning from ventilator |
| Indications of NPPV | 1. Respiratory rate >25 breaths/min 2. Moderate to severe acidosis 3. COPD 4. Can protect airway 5. Alert 6. Can eat or drink 7. Can communicate 8. Avoids complications with artificial airways |
| Indications of BiLevel | 1. A variation of pressure control ventilation allowing better patient comfort 2. Intended as a protective ventilation strategy in ARDS 3. Reduces risk of barotrauma |
| Indications for APRV | 1. Bilevel with inverse ratio 2. Not natural breathing 3. Intended for severe ARDS or very poor compliance 4. Patient can spontaneously breathe at the higher pressure level |
| How to get minute ventilation (VE)? | VE = Vt x RR |
| If a patient has a tidal volume of 550 ml and her respiratory frequency is 12 breaths/min, what is her minute ventilation? | 550 ml x 12 breaths/min = 6600 ml or 6.6 L |
| The primary goal of mechanical ventilation is to achieve a _______________ that matches the patients needs. | Minute Ventilation |
| Vt and RR for normal lung | 10-20 RR and 5-8 ml/kg |
| Vt and RR for COPD | 8-12 RR and 8-10 ml/kg |
| VC and RR for ARDS | 15-25 RR and 4-6 ml/kg |
| What is a normal P50 value? | 27 mmHg |
| The Oxyhemoglobin dissociation curve will shift to the right under which of the following circumstances? | High CO2 |
| Blood gas evaluation is done for an unconscious patient brought to the emergency room. On room air, the results are pH 7.23, PaCO2 81, PaO2 43, HCO3 33, and SaO2 71%. With no history or other data available, what therapy is indicated? | Mechanical Ventilation |
| A cardiac patient has an ABG drawn on room air with the following results; pH 7.47, PaCO2 33, PaO2 57, HCO3 25. What treatment is indicated for this patient? | Oxygen Therapy |
| A 74-year old women is admitted with acute-on-chronic respiratory failure with a history of COPD, being treated with NIV. Due to increasing confusion, a blood gas is drawn: pH 7.16, PaCO2 88, PaO2 45, HCO3 33. What is your recommendation? | Switch to invasive ventilation |
| Normal adult values for Maximum inspiratory pressure (MIP) are ____ | -50 to -100cmH2O |
| In which of the following situations is noninvasive ventilation (NIV) Contraindicated? | Respiratory Arrest |
| A patient who is triggering each inspiration for a ventilator in the AC/VC mode will be able to establish his or her own ____. | Frequency and Minute Volume |
Created by:
monkeeyy246