RSP 306: Exams Lookover

PEEP is used primarily to:

prevent atelectasis

Positive end-expiratory pressure (PEEP) is most therapeutic for ___ due to ___

hypoxemia, intrapulmonary shunting

which of the following physiological benefits dose PEEP offer?

increased functional residual capacity, improves V/Q mismatch, lowers all distending pressure

the physician is concerned about the risk of barotraumas and asks you to outline some potential criteria for more prudent ventilator management. you would recommend all of the following criteria except

keeping the PEEP less than 5 cmH2O

PEEP is usually indicated in severe restrictive lung disease because it can:

reduces alv distending pressure and correct refractory hypoxemia

complications and hazards of increasing PEEP include all of the following except:

Decreased intracranial pressures

When the p-v loop moves towards the right, what is the lung characteristic changes

Decreased static compliances

On the following P-V loop what does lower inflation point indicate?

ALV recruitment

which graphic would tell you if a bronchodilator was effective

flow-time scalar

What action should be taken to improve flow-time scalar waveform in image A to look more like image B

Administer a bronchodilator

P-V loops what does the upper inflection point indicate

overdistention of the lungs

Increased RAW vs decreased CL

What is the P/F ratio

- PaO2/FiO2

- 83

What is the estimated ALV min vent?

- (VTe-VD)xRR

- 3.5

what the ABG & what mode would you switch it to correct FRIST.

- uncomp resp ACD with uncorrected hypoxemia

- Increases RR

based on the PEEP study above, what is the optimal PEEP by CL

15

what is contributing to the worsening hypoxemia despite oxygen therapy

refractory hypoxemia due to atelectasis

the absolute contraindication to mech vent

untreated tension pneumothorax

which of the following P-V segments above is most likely to reflect the highest driving pressure

R-93% - R100%

what the ABG

uncomp resp ACD with uncorrected hypoxemia

which of the following conditions contributes to the results noted in the ABG

increased in RAW

the following are vent management recommendation that are reasonable EXCEPT

changing to HFOV mode mech vent

estimated ALV VE

13.4

all of the following signs on chest radiograph indicate COPD except

increased vascular marking

all the following breaths types are available in PRVC and SIMV except

intermittent

all vent parameters should be considered when managing a TBI patient except

utilize permissive hypercapnia

prime risk of hyperventilating a TBI patient is

ischemic brain injury

total min vent

7

All of the following approaches should be considered EXCEPT

increases the PEEP or changing to APRV mode

Which control cycles inspiration

time

according to the Berlin definition of ARDS, the p/f ratio indicates

Severe ARDS

How is RR determined in ARDV mode?

total cycle time

what's the ABG and how would you NOT correct it

- partially comp resp ACD uncorrected hypoxemia

- decrease the Plow

all o the following contribute to the benefits of proning except

reduced surface area in the alveoli

what is the ALV min vent and how to improve it

- 1.5

- Increase the pressure support

which of the following is the limiting variable on the vent setting above?

pressure

ARDSnet guideline require specific modes of mechanical vent

False

ARDSnet Guidlines utilize tables that include a lower peep/higher Fi02 and higher PEEP/Lower FiO2 to improve management of type 1 resp failure

Ture

ARDSnet guidelines publish oxygenation goals of

PaO2 55-80mmHg

Relative contraindications of PEEP therapy includes all of the following except

untreated tension pneumothorax

High frequency oscillatory vent utilizes all of the following except

high tidal volumes

which of the following condition is affecting your patient? and how would you correct it?

- Obstructive

- bronchial hygiene, bronchodilator, and corticosteroid

which of the following are true regarding PC vent

- used for time-triggered and patient-triggered mechanical breaths

- flowrate is variable

PS Is an adjunct mode that supports spontaneous tidal volume by decreasing work of breathing

Ture

in VC vet, what is set by the clinician

Tidal volume

In PC vent, which parameter is fixed

Pressure

Pressure support cannot be used with which of the following modes

CMV

Mr. Camper is being vent mech with control mode. which of the following parameters is determined by the pt

a. Vt

b. insp flow rate

c. RR

d. none

d. none

Mrs. Smith being vent with assist control mode at a set rate of 6 breaths per min and an assisted rate of 4 breaths per min. Under this mode, a vent-triggered breath will be delivered every ___ sec.

10

the major advantage of assist control mode ventilation is that the patient can:

breath at a min volume necessary to normalize the PaO2

during SIMV, the breaths delivered may be:

a. mandatory

b. assisted

c. spontaneous

d. all

d. all

when the pressure is released in APRV, it stimulates an effective _____ maneuver.

Exhalation

when pt are being vent in APRV, spontaneous breathing is available

true

all of the following problems concerning the artificial airway and ventilator circuits that would increases airways resistance EXCEPT

increasing the PS

CPAP provides positive airway pressure during the ____________ phase and it _______________ include mechanical breaths

Inspiratory and expiratory; does not

which of the following conditions is affecting your pt

restrictive disorder

what FiO2 would you select to normalize the PaO2?

.70

The p/f ratio is used to evaluate the severity of ARDS based on the Berlin def to determine mortality risk

ture

id ti was determined that switching form VC to PC mode was appropriate for your pt, how would you set the insp pressure

use the monitored plateau pressure

In a VC mode, the _____ is preset by therapist with a variable ____ depending on the compliance and airway resistance of the lung

- VT

- PIP

Which of the following modes delivers mandatory breaths and allows spontaneous breathing?

SIMV

Which of the following modes delivers pt-triggered and time-triggered mandatory breaths?

Assist control

for a pt who are placed on mech vent for non-cardio complications where no ABG has been taken, the initial FiO2 may be set at

40%

what range is recommended for Vt in pt with severe ARDS who is being mech vent

4-6 ml/kg

what peak insp pressure should be avoided when managing vent pt

40 cmH2O

what static (plateau) pressure should be avoided when managing mech vent pt

30 cmH2O

Refractory hypoxemia is preset when the PaO2 is less then ___ mmHg at an FiO2 of greater than ____ percent

60; 50

ALV min vent

5.5

What's the ABG and how to fix

- uncomp resp ACD with corrected hypoxemia

- increase RR

how would you protect the trachea for this pt who is anticipated to be on mech vent for extended period

Monitor cuff pressure

what the condition based on ABG and how to correct it first

- increased RAW

- increase the insp pressure

all of the following recommendation would be reasonable to make to a physician regarding vent management EXCEPT

changing to ASV mode

adaptive and combo modes of mech vent may not be appropriate for this pt due to

higher risk of irregular breathing patterns

due to the need for extended vent support, the cuff pressure should not exceed

20-15 mmHg

Airway care should include all of the following EXCEPT

routine suctioning

Total min vent

9.9

VD %

13%

P[a-et]CO2 difference

5 mmHg

what mode for when pt wake up after surgery

SIMV