Clinical application of mechanical ventilation Exam Questions (Verified Answers) 2023, Exams of Nursing

Download Clinical application of mechanical ventilation Exam Questions (Verified Answers) 2023 and more Exams Nursing in PDF only on Docsity! Clinical application of mechanical ventilation Exam Questions (Verified Answers) 2023 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 Exception with acute ventilator failure - correct answer ✅COPD retainer > acute increase in CO2> decrease in pH from their normal Clinical application of mechanical ventilation Exam Questions (Verified Answers) 2023 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. -restore normal acid-bade balance - reduce cardiopulmonary stress while primary cause can be treated -increase tissue oxygenation pvo2>30mmhg svo2>56mmhg Clinical application of mechanical ventilation Exam Questions (Verified Answers) 2023 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 Baseline PEEP - correct answer ✅PIP - Set PEEP= PG Clinical application of mechanical ventilation Exam Questions (Verified Answers) 2023 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 Clinical application of mechanical ventilation Exam Questions (Verified Answers) 2023 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 cmh20 Clinical application of mechanical ventilation Exam Questions (Verified Answers) 2023 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 CMVP: limited by? - correct answer ✅Pressure limited Clinical application of mechanical ventilation Exam Questions (Verified Answers) 2023 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 Complications with AC mode: pt completely dependent on ventilator.....so - correct answer ✅1. atrophy of respiratory muscles Clinical application of mechanical ventilation Exam Questions (Verified Answers) 2023 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.