mechanical ventilation exam 2024 with verified answers, Exams of Nursing

Download mechanical ventilation exam 2024 with verified answers and more Exams Nursing in PDF only on Docsity! mechanical ventilation exam 2024 with verified answers force x distance = - ANSWER: ✔✔work pressure change X volume change is the function of ? - ANSWER: ✔✔work PSV - ANSWER: ✔✔often used in conjunction with IMV, but can be used as a primary mode of ventilation With PSV patient dictates? - ANSWER: ✔✔F, IFR, TI, VT Clinician sets what in PSV - ANSWER: ✔✔Pressure support level, Trigger sensitivity, Optimal elevated baseline pressure (CPAP) With PSV Every breath is? - ANSWER: ✔✔patient triggered, pressure-limited, and flow-cycled ↑PSV →↑VT → =? - ANSWER: ✔✔↓WOB ↓PSV→↓VT→ =? - ANSWER: ✔✔↑WOB or acceptable WOB Weaning PSV - ANSWER: ✔✔drop pressure 2-4 cm H20 at a PSV of 5-8 cm H2O - ANSWER: ✔✔extubation is possible Volume Support - ANSWER: ✔✔•Form of PC ventilation with adaptive breath targeting Volume support (VS) - ANSWER: ✔✔•PSV with a targeted VT• VS mechanism of action - ANSWER: ✔✔•Initially, a test pulse at 10 cm H20 above PEEP is delivered •Compliance and exhaled VT are measured •Automatic adjustment of PS level or ¯ on a breath-to-breath basis to achieve targeted VT Volume-Support Ventilation (VSV) - ANSWER: ✔✔Spontaneous mode •Every breath •Patient-triggered •Pressure-limited •Flow-cycled•Flow-cycled PRVC (pressure regulated volume control) vent names - ANSWER: ✔✔•Servo-i, Servo u, Yvaire AVEA •Adaptive targeting scheme "APC" does what? - ANSWER: ✔✔Auto adjusts pressure between breaths to reach targeted VT in response to varying patient conditions •Mechanism of action with Servos - ANSWER: ✔✔•Test breath VT is delivered with inspiratory hold and Pplat is assessed •Measure Pplat is given for next breath •Exhaled VT is compared to target VT •Inspiratory pressure is regulated to provide clinician set VT from breath-to-breath PRVC Volume-Targeted Pressure Controlled Breaths - ANSWER: ✔✔•Delivered VT is measured and compared with target VT •PC gradually or ¯ until target VT is reached •+- 3 cm H20 increments •Provides stable VT with changes in compliance, resistance, pt effort PRVC Patient-triggered or Time-triggered Breaths - ANSWER: ✔✔•A/C or IMV breaths •Assisted if triggered by patient & < 12 bpm (partial support) •TI = 0.6 to 1 second •Trigger sensitivity •Inspiratory rise time for mandatory PC breaths •PS or ATC for spontaneous breaths Covidien PB 980 and PB 840 PC - SIMV mode is called? - ANSWER: ✔✔SIMV PC Drager Evita XL PC - SIMV mode is called? - ANSWER: ✔✔PCV+ Evita Infinity V500 PC - SIMV mode is called? - ANSWER: ✔✔PC SIMV PC SIMV + Hamilton G - 5 PC - SIMV mode is called? - ANSWER: ✔✔PC SIMV Maquet Servo-i and Servo-u PC - SIMV mode is called? - ANSWER: ✔✔SIMV PC Drager Evita XL //PC-CMV mode is called? - ANSWER: ✔✔PCV + assisted CMV with Autoflow Evita Infinity V500 //PC-CMV mode is called? - ANSWER: ✔✔PC A/C VC A/C with Autoflow Hamilton G - 5 //PC-CMV mode is called? - ANSWER: ✔✔PC CMV Adaptive pressure ventilation CMV Maquet Servo-i and Servo-u //PC-CMV mode is called? - ANSWER: ✔✔PC PRVC PC - IMV (types of breaths available) - ANSWER: ✔✔•Mandatory PC breaths and spontaneous breaths •PC breaths - ANSWER: ✔✔•Time- or patient triggered •Pressure limited •Time cycled PC-IMV - ANSWER: ✔✔Pressure controlled intermittent mandatory ventilation. PC-IMV SPONTANEOUS BREATHS ARE - ANSWER: ✔✔•Provided with or without pressure support •Maintains ventilatory muscle activity Ventilator induced lung injury - ANSWER: ✔✔1. Barotrauma 2. Volutrauma APRV Proprietary Names - ANSWER: ✔✔•BiLevel (Puritan Bennett/Covidien) •Bivent (Maquet) •BiPhasic (Avea/Carefusion) •PC+ (Drȧger) DuoPAP (Hamilton) APRV (airway pressure release ventilation) - ANSWER: ✔✔•Provides two levels of CPAP and allows spontaneous breathing at both levels when spontaneous effort is present APRV (airway pressure release ventilation) - ANSWER: ✔✔•Provides a set number of releases or drops from a high-pressure level to a low-pressure level allowing the lungs to deflate APRV (airway pressure release ventilation) - ANSWER: ✔✔•Each release is paired with a rise in pressure and is a mandatory breath APRV (airway pressure release ventilation) - ANSWER: ✔✔•Mandatory breaths are time-triggered, pressure-limited and time-cycled APRV (airway pressure release ventilation) - ANSWER: ✔✔•Spontaneous breaths are patient-triggered and patient-cycled APRV indications - ANSWER: ✔✔•The need to improve oxygenation and augment ventilation in those with ALI or low-compliance lung disease (ARDS) •Treat hypoxemia due to alveolar collapse •↑ Recruitment •Enhance gas diffusion •↓ Derecruitment •The need to unload inspiratory muscles and decrease WOB •Examples: ALI, airway disease such as COPD APRV without Spontaneous Breaths Upper CPAP level - ANSWER: ✔✔Upper CPAP level 37 cm H20 Inflation Lengthy, upper level time Oxygenation (↑PaO2) APRV without Spontaneous Breaths Lower CPAP level Lower CPAP level - ANSWER: ✔✔2 cm H20 Deflation Brief, lower level time Ventilation (↓PaCO2) Collateral Channels of Ventilation - ANSWER: ✔✔• Pores of Kohn •Seconds APRV pLow pressure = - ANSWER: ✔✔0-15 cmH20 •Low airway pressure setting •AKA "pressure release level" •The lower CPAP level •cm H2O APRV tLow time = - ANSWER: ✔✔•Duration of time at P low •AKA "release time" •Seconds Varying depending on patient needs. Usually 1 second •Determinants of alveolar ventilation (PaCO2) - ANSWER: ✔✔•P low •T low •Spontaneous breathing APRV •Factors heavily influencing oxygenation (PaO2) - ANSWER: ✔✔•P high •T high •FiO2 Alveolar derecruitment, atelectasis, and airway closure during the release phase is associated with? - ANSWER: ✔✔An excessively long T Low Initial APRV settings- Convert the plateau pressure of the conventional mode to P High and - ANSWER: ✔✔seek an exhaled V ̇E of 2 to 3 L/min, less than when on conventional ventilation Initial APRV Settings P high = - ANSWER: ✔✔20 - 35 cm H20 Initial APRV Settings- •P Low of zero produces minimal resistance to exhalation - ANSWER: ✔✔•Prevents impedance of expiratory gas flow during passive lung recoil Initial APRV Settings-T High = - ANSWER: ✔✔minimum of 4 seconds••Start RR at 8 - 12 bpm Initial APRV Settings- T Low between - ANSWER: ✔✔•0.5 to 0.9 second •Same FiO2 or no greater than 60% Initial APRV Settings- T-high + T-low = - ANSWER: ✔✔TCT (total cycle time) 4sec + 0.5sec = 4.5sec per breath now divide 60min by 4.5sec = RR (13 bpm) Adjusting APRV Settings(changes for weaning) •To fix poor oxygenation (low PaO2 and/or Sp02) - ANSWER: ✔✔•Increase P High by 2 - 3 cm H20 •What's the max P High? •Risk of barotrauma? •Increase T High •Decrease release rate OR decrease the T Low Adjusting APRV Settings(changes for weaning) •To fix poor ventilation - ANSWER: ✔✔•Lengthen (increase) T Low in 0.05 to 0.1 second increments •Consider permissive hypercapnea •Adjusting the RR has little impact on PaCO2