Clinical application of mechanical ventilation Exam Questions and Answers 2024, Exams of Nursing

Download Clinical application of mechanical ventilation Exam Questions and Answers 2024 and more Exams Nursing in PDF only on Docsity! 1 Clinical application of mechanical ventilation Exam Questions and Answers 2024 What are the 3 phases? - correct answer 1. putting a pt on a ventilator 2. caring for a pt while on a ventilator 3. weaning a pt off the ventilation Phase 1 - correct answer indications for mechanical ventilation & initial ventilator settings Indication for continuous mechanical ventilation? (5) - correct answer 1. apnea 2. acute ventilator failure (not breathing enough 1 ABG) 3. impending respiratory failure (on the way to not breathing enough serial ABGs) 4. Oxygenation failure 5. Prophylactic ventilator support Apnea - correct answer observation Acute ventilator failure (not breathing enough - one ABG) CRITERIA: - correct answer CO2>55 with a pH <7.25 2 Exception with acute ventilator failure - correct answer COPD retainer > acute increase in CO2> decrease in pH from their normal Increase in ___________ always occurs with ___________ unless __________. May try a trial of __________. - correct answer CO2; hypoxemia; supplemental O2 ; biapap 1st Impending respiratory failure (on the way to not breathing enough- serial ABGs) - Progressive increase in - correct answer CO2, decrease in pH; seen on serial ABGs respiratory alkalosis to respiratory acidosis Idea is to intervene early to - correct answer reduce stress on the cardiopulmonary system before code happens. may try trial of bipap 1st Oxygenation failure: Severe hypoxemia - correct answer Pa02 < 40 on any FI02; PaO2<60 on FiO2 >60% may try trial of cpap Prophylactic ventilator support: Primary goal is to - correct answer decrease stress on cardiopulmonary system & maintain airway. Examples - correct answer major surgery, burn pt, head injury, and flail chest. Goals for mechanically ventilated pt - correct answer -provide respiratory support to maintain an adequate level of alveolar ventilation. 5 Disadvantages: Set flow not meeting the pts demand - correct answer which leads to ventilatory asynchrony Indication for targeted volume control variable? - correct answer Initial type of ventilation chosen for most pts Pressure ventilation characteristics: Operator sets a _______ to be delivered during the _______ or _______ breath regardless of changes in compliance and resistance. - correct answer pressure; mandatory or assisted I time is - correct answer set Flow pattern is - correct answer descending Tidal volume determined by - correct answer pressure gradient between actual baseline and PIP pts compliance & resistance, & I time if there is available flow Actual baseline includes - correct answer autoPEEP Actual pressure gradient will be decreased if - correct answer autoPEEP is present decrease PG = decrease Vt Actual PEEP - correct answer PIP - Total PEEP = PG 6 Baseline PEEP - correct answer PIP - Set PEEP= PG Flow & volume are variable: Decrease in compliance? - correct answer decrease in Vt Flow & volume are variable: Increase in airway resistance? - correct answer decrease in Vt Advantages of pressure ventilation? Can control - correct answer pressure to reduce risk of alveolar overdistention, & volutrauma Advantages of pressure ventilation? Descending - correct answer flow pattern promotes laminar flow which will decrease resistance deadspace ventilation & allow for more equal gas distribution Advantages of pressure ventilation? - correct answer flow will meet pts demand Disadvantages of pressure ventilation? When pt's lung condition worsens, - correct answer Vt decreases, so unless adjustments are made, pt may not receive adequate ventilation Disadvantages of pressure ventilation? MD's & RT's - correct answer are less familiar with pressure ventilation 7 Indication for pressure ventilation? - correct answer Used with pts with status astmaticus due to extreme increase in airway resistance which will result in high pressure Volume targeted, pressure controlled (VTPC) most common; Servo I: - correct answer PRVC- pressure regulated volume control Volume targeted, pressure controlled (VTPC) most common: PB 840 - correct answer VC+ volume control plus Volume targeted, pressure controlled (VTPC) most common: Drager - correct answer CMV with autoflow on Volume targeted, pressure controlled (VTPC) most common: Others - correct answer APV adaptive pressure ventilation PVG- pressure control volume guarantee Characteristics of VTPC: Operator sets a ___________ to be delivered during a ________ or ________ breath. The ventilator starts out at __________ & then automatically, the breath by breath, adapts the _______________ level in small increments (1-3cmH20) according to the CL and Raw of the lungs to deliver the ________ and/or ____ volume with the lowest possible pressure needed. And weans pressure in same way at as Cl and Raw improves; Tidal volume is _______________ - correct answer target Vt mandatory or assisted 10 Advantages of VTPC: A _______ flow pattern & ______ flow is used - correct answer decelerating flow pattern & variable flow is used improving gas distribution & meeting pts inspiratory demand. Disadvantage of VTPC: - correct answer Vt may not be met; requires intervention Mode options: - correct answer CMV, AC or VTPC, IMV-V, SIMV - Controlled mandatory ventilation (CMV): All breaths are - correct answer mandatory What's set in CMV? - correct answer Vt, flow, & I time CMV triggered by? - correct answer Time triggered based on set RR How is CMV limited? - correct answer Volume limited How is CMV cycled? - correct answer Time cycles based on set I time CMVP: What's set? - correct answer Set IP inspiratory pressure & I time CMVP: Triggered by? - correct answer time triggered based on set RR 11 CMVP: limited by? - correct answer Pressure limited CMVP: Cycled by? - correct answer Time cycled based on set I time CMVP: Vt determined by? - correct answer Set IP, I time, compliance, & resistance CMVP: Ve is controlled by set? - correct answer RR & Vt CMVP: NO _______________ allowed. - correct answer Spontaneous breaths; Ve will vary more in CMVP because compliance & resistance is going to change in pts lungs. Newer vents do not have a button to select for "Control mode" If really want to control breathing completely, place on AC mode and....... - correct answer Sedate & paralyze pt, so they can't do anything (if can't sedate decrease sensitivity (increase #) so pt can't trigger breath) Indications for AC mode - correct answer 1. if pt is apneic 2. if pt is fighting vent 3. pts with seizure activity or dysfunctional CNS 4. pt needing complete rest 24hrs post surgery or trauma 5. crushed chest injuries 12 Complications with AC mode: pt completely dependent on ventilator.....so - correct answer 1. atrophy of respiratory muscles 2. potential for apnea or hypoxemia if pt becomes disconnected or by chance ventilator fails Complications with AC mode: - correct answer Drug effects on other organs Assist control (AC) or VTPC: Types of breaths offered - correct answer machine or assist ACV trigger variable for assist - correct answer pt triggered when they meet a flow or pressure sensitivity setting ACV trigger variable for mandatory - correct answer time triggered based on set RR Pt may trigger additional breaths, increasing ventilators ___________& total _______; pt can be spontaneously breathing but no spontaneous Vt - correct answer respiratory rate; Ve; Vt Indications for ACV mode - correct answer Pts who can't maintain adequate ventilation so need full ventilator support to reduce WOB, provides a chance for pt to intitate breaths to control total Ve; more comfortable for pt less drugs needed.