Mechanical Ventilation Final Exam with correct answers, Exams of Nursing

Download Mechanical Ventilation Final Exam with correct answers and more Exams Nursing in PDF only on Docsity! Mechanical Ventilation Final Exam with correct answers The primary variable that the ventilator manipulates to cause inspiration - ANSWER: ✔✔Control variable Control variables - ANSWER: ✔✔Volume Pressure Flow Time In what mode is controlling minute ventilation less stable? - ANSWER: ✔✔pressure controlled modes In what mode will you see higher mean airway pressures? - ANSWER: ✔✔pressure controlled modes Flow triggered, pressure- targeted, time-cycled - ANSWER: ✔✔Assisted breath—because flow initiates (patient), set pressure is reached and held until a set time is reached (ventilator). Time- triggered, volume-targeted, volume cycled - ANSWER: ✔✔Mandatory breath—because time initiates (ventilator), when set volume is reached inspiration ends (ventilator). Pressure- triggered, pressure targeted, time cycled - ANSWER: ✔✔Assisted breath—because pressure initiates (patient), set pressure is reached and held until a set time is reached (ventilator). Flow- triggered, pressure- triggered, flow cycled - ANSWER: ✔✔Assisted breath—this is a pressure- supported breath, which is a special form of assisted ventilation. The main advantage of _________ ventilation is that it guarantees a specific volume delivery and minute ventilation, regardless of changes in lung compliance and resistance or patient effort. - ANSWER: ✔✔volume During volume ventilation, your patient bronchospasms. What happens to PIP and the volume given to the pt? - ANSWER: ✔✔The peak inspiratory pressure rises anytime airway resistance increases, such as with bronchospasm. The amount of volume will remain constant, because it is the set variable. Your patients lung compliance worsens during volume ventilation, what will happen to peak inspiratory pressure and alveolar pressure? - ANSWER: ✔✔PIP will increase. Alveolar pressure will increase. When pressure is targeted as the control variable, _______ will vary with changing lung characteristics. - ANSWER: ✔✔volume When a patient's lung compliance worsens, during pressure targeted ventilation, volume delivery will ___________ (Increase or decrease?) - ANSWER: ✔✔decrease If your patients volume decreases during pressure targeted ventilation because of worsening lung compliance, you could expect alveolar _____________ (Hyperventilation or hypoventilation?) - ANSWER: ✔✔hypoventilation What 3 triggers may begin inspiration in the assist-control mode? - ANSWER: ✔✔Time Pressure Flow In the PC-CMV mode, the control variables are? - ANSWER: ✔✔time or patient trigger, pressure limit, time cycle. Controlled ventilation is appropriate for patients who are: - ANSWER: ✔✔obtunded because of drugs; sedated and paralyzed; or who have cerebral malfunction, a spinal cord or phrenic nerve injury, or motor nerve paralysis with no voluntary efforts. What happens when the ventilator is made totally insensitive to patient effort? - ANSWER: ✔✔The patient will be "locked out" and will be unable to trigger a breath. (CMV, IMV) constant pressure of 18 cmH2O is delievered over a period of one second. Following each inspiratory phase, the pressure returns to five cmH2O. The volumes are fluctuating. - ANSWER: ✔✔PC-CMV What does VC-SIMV stand for? - ANSWER: ✔✔Volume-Controlled Synchronized Intermittent Mandatory Ventilation During mechanical ventilation, one of the ports on your patient's ventilator circuit inadvertently opens. What effect would this have on PIP and VTe? - ANSWER: ✔✔PIP would decrease VTe would decrease A physician wants to ensure that a patient's PaCO2 remains at the person's normal level of 50mmHg. Would volume control ventilation or pressure control ventilation best meet this requirement? - ANSWER: ✔✔Volume-Control Ventilating pressure can become very high in patients with acute respiratory distress syndrome. To prevent excessive pressure, what independent variable would be most appropriate, volume or pressure? - ANSWER: ✔✔Pressure control ventilation should be used when the goal is to avoid high pressures. Mandatory Breath - ANSWER: ✔✔-Time Triggered -also known as controlled -vent controls VT or P Regarding PC-IRV: - ANSWER: ✔✔-MAP increases -PEEPi will increase -Ti is greater than Te During PC-CMV, the patient's Cs changes from 25 ml/cmH2O to 40 ml/cmH2O. As a result, which of the following is most likely to occur? - ANSWER: ✔✔VT will increase When using PRVC, pressure will not increase by more than - ANSWER: ✔✔3 cmH2O Which of the following 2 are necessary if placing a pt. on PC-IRV - ANSWER: ✔✔-sedative -paralytic Assisted Breath - ANSWER: ✔✔-characteristics of both mandatory and spontaneous ex.) patient triggers breath, ventilator controls VT or P Spontaneous Breath - ANSWER: ✔✔-Patient controls timing of breath and VT -volume delivered depends on patient demand, ability, lung characteristics Why would you choose VC versus PC? - ANSWER: ✔✔Maintain level of PaCO2 Advantage of Volume-Control - ANSWER: ✔✔Guaranteed V ̇e Disadvantage of Volume Control - ANSWER: ✔✔Pressure Varies Advantage of Pressure Control - ANSWER: ✔✔Control of pressure/reduce risk of overdistention Disadvantage of Pressure Control - ANSWER: ✔✔Variable volumes, lack of provider understanding modes How is PC-IRV different from PC-CMV? - ANSWER: ✔✔The I time is longer than the E time A pressure support breath is - ANSWER: ✔✔patient-triggered, pressure limited, and flow cycled With Pressure Support Ventilation (PSV) the patient establishes the - ANSWER: ✔✔rate, inspiratory flow, and Ti. With PRVC, pressure automatically adjusts: - ANSWER: ✔✔no more than 3 cmH2O each breath, and max pressure 5 cmH2O below HP Limit f stands for - ANSWER: ✔✔respiratory frequency, respiratory rate TCT calculation: - ANSWER: ✔✔60 seconds divided by RR In this mode, the ventilator delivers a preset minimum number of mandatory breaths. However, it also allows the patient to initiate spontaneous breaths in between the mandatory breaths - ANSWER: ✔✔Synchronized Intermittent Mandatory Ventilation True or False: Mrs. Smith is placed on PSV (Pressure Support Ventilation). If PS is increased, VT will likely increase. - ANSWER: ✔✔True Increasing MAP, increases - ANSWER: ✔✔oxygenation What will increased flow do to Ti? - ANSWER: ✔✔Decrease Ti What will increased flow do to PIP? - ANSWER: ✔✔Increase PIP What 2 things vary in pressure controlled modes? - ANSWER: ✔✔volume and flow What are the four type of triggers? - ANSWER: ✔✔patient, time, pressure and flow What is Continuous Mandatory Ventilation? - ANSWER: ✔✔A mode that is time-triggered, gives machine breaths, and is volume or pressure cycled In this mode, the ventilator delivers a time-triggered breath and allows the patient to breathe at their own tidal volume between mechanical breaths? - ANSWER: ✔✔SIMV In order for this mode to be used, the patient must be spontaneously breathing, have adequate lung function to maintain normal PaCO2, and not be at risk for hypoventilation? - ANSWER: ✔✔CPAP What is an absolute contraindication for initiating mechanical ventilation? - ANSWER: ✔✔An untreated tension pneumothorax Full ventilatory support is provided by which of the following modes? - ANSWER: ✔✔Pressure- Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) rate 12 with pressure support (PS) The ventilator mode that would be most appropriate to iatrogenically induce hyperventilation to manage a closed head injury patient with severely elevated intracranial pressure (ICP) is which of the following? - ANSWER: ✔✔Pressure-Controlled Continuous Mandatory Ventilation (PC-CMV) If flow or sensitivity is set incorrectly, which of the following is most likely to occur during the continuous mandatory ventilation (CMV) mode? - ANSWER: ✔✔Ventilator dysynchrony A breath that is patient triggered, pressure targeted, and time cycled is which of the following? - ANSWER: ✔✔Assisted breath A patient triggered, pressure limited, flow cycled breath describes which of the following? - ANSWER: ✔✔Pressure-support breath When a patient is to be switched from continuous mandatory ventilation (CMV) to synchronized intermittent mandatory ventilation (SIMV) to facilitate weaning from mechanical ventilation, which of the following could be used in addition to SIMV to assist this process? - ANSWER: ✔✔Pressure Support (PS) Every breath from the ventilator is time or patient triggered, pressure limited, and time cycled. This describes which of the following ventilator modes? - ANSWER: ✔✔Pressure-Controlled Continuous Mandatory Ventilation (PC-CMV) If lung compliance decreases while a patient is receiving mechanical ventilation with pressure-controlled continuous mandatory ventilation (PC-CMV) which of the following would occur? - ANSWER: ✔✔Tidal volume decreases The ventilator mode that delivers pressure breaths that are patient- or time-triggered, volume targeted, time cycled, and where the pressure is automatically adjusted to maintain delivery of the targeted volume is which of the following? - ANSWER: ✔✔Pressure Regulated Volume Control (PRVC) The ventilator mode where every breath is patient triggered, pressure targeted, flow cycled with a volume target is which of the following? - ANSWER: ✔✔Volume Support Ventilation (VSV) Mandatory Breath/Controlled - ANSWER: ✔✔ventilator controls timing of breath and VT or P Assisted Breath - ANSWER: ✔✔characteristics of both mandatory and spontaneous Spontaneous Breath - ANSWER: ✔✔patient controls: timing of breath and VT and cycling Goal of volume-targeted ventilation: - ANSWER: ✔✔maintain level of PaCO2 Advantage of Volume-Targeted/ Controlled MV - ANSWER: ✔✔guaranteed Ve Disadvantage of Volume-Targeted/Controlled MV - ANSWER: ✔✔-pressure increase with changes in lung characteristics -fixed flow setting on some vents Advantage of Pressure-Targeted/Control MV - ANSWER: ✔✔control of pressure - reduce risk of overdistention Disadvantage of Pressure-Targeted/Control MV - ANSWER: ✔✔-variable volumes -lack of provider understanding of mode With Continuous Mandatory Ventilation (CMV), *all* breaths are - ANSWER: ✔✔machine breaths -time-triggered -patient-triggered -or both Set rate for Partial Ventilatory support: - ANSWER: ✔✔<6 bpm Name the three partial support modes - ANSWER: ✔✔-Synchronized Intermittent Mandatory Ventilation (SIMV) -Pressure Support Ventilation (PS) -Volume Support (VS) Set rate for Full Ventilatory Support - ANSWER: ✔✔8 bpm or greater Settings for Volume-Targeted/Control - ANSWER: ✔✔VT, f, Ti or insp. flow, PEEP, FiO2, sensitivity, Alarms, and flow pattern if app. Settings for Pressure-Targeted/Control - ANSWER: ✔✔Pinsp, or PC above PEEP, f, Ti, PEEP, FiO2, sensitivity, Alarms Indications for Non-invasive(NIV) - ANSWER: ✔✔Acute or impending ventilatory failure Absolute contraindications to NIV - ANSWER: ✔✔-cardiac arrest -inability to protect airway If patient on NIV, when should we transition to invasive ventilation? - ANSWER: ✔✔minimal or no improvement after and hour S&S of Mild-Mod Hypoxemia - ANSWER: ✔✔-Pale -Restless -Lethargic S&S of Mild-Mod Hypercapnia - ANSWER: ✔✔-Red Skin -Dizzy -Diaphoretic Airway opening pressure aka - ANSWER: ✔✔-Airway Pressure (PCV) what is set, what will vary and what could cause a variation - ANSWER: ✔✔Pressure target is set by us, volume and flow waveforms vary other names for VCV - ANSWER: ✔✔-Volume-Targeted ventilation - Volume Ventilation What is set, what will vary and what would cause a variation (VCV) - ANSWER: ✔✔-Volume target is set -Pressure waveforms vary Which variable begins inspiration? - ANSWER: ✔✔Trigger Variable What are the two most common methods of patient-triggering? - ANSWER: ✔✔Pressure and Flow Normal settings for adult trigger/sensitivity - ANSWER: ✔✔-1 to -2 cmH2O 1 to 2 LPM Which variable ends inspiration? - ANSWER: ✔✔Cycling variable Volume Cycling - ANSWER: ✔✔inspiration ends when preset volume has been delivered. Flow Cycling - ANSWER: ✔✔Inspiration ends when inspiratory flow decreases to a % of PIF Pressure Cycling - ANSWER: ✔✔Inspiration ends when preset pressure is reached other names for Maximum Safety Pressure - ANSWER: ✔✔-High Pressure Limit -Upper Pressure Limit -High Pressure Alarm Where should you set the Maximum Safety Pressure (High Pressure Alarm)? - ANSWER: ✔✔10 cmH2O above PIP Besides obtaining a Pplat, what else can the inspiratory hold/pause be used for? - ANSWER: ✔✔Increase gas distribution to periphery What does the inspiratory hold do to Ti? - ANSWER: ✔✔Increases it What is the expiratory hold used for? - ANSWER: ✔✔To measure PEEPi and MIP/NIF When obtaining a NIF measurement, when the expiratory hold button need to be pressed? - ANSWER: ✔✔just before inspiration What is the limit variable and what happens when the limit is reached? - ANSWER: ✔✔maximum value a set variable can reach (i.e. P) Normal CL range for intubated males - ANSWER: ✔✔40-50 up to 100 ml/cmH2O Normal CL range for intubated females - ANSWER: ✔✔35-45 up to 100 ml/cmH20 How do you calculate Raw? - ANSWER: ✔✔(PIP-PPLAT)/FLOW*60 What would affect the accuracy of a PPLAT measurement? - ANSWER: ✔✔-difficult to obtain if tachypneic -high on vent -leaks Internal Pneumatic Circuit - ANSWER: ✔✔pathway for gas flowing from power source inside the vent External Pneumatic Circuit - ANSWER: ✔✔aka patient circuit -must have some basic components to provide positive pressure -cxs can vary according to vent requirements Diseases that decrease Static compliance - ANSWER: ✔✔-ARDS -Atelectasis -Kyphoscoliosis Disease that increases Static Compliance - ANSWER: ✔✔Emphysema Disease that decreases Dynamic Compliance - ANSWER: ✔✔Asthma What is PIP (base term) - ANSWER: ✔✔highest pressure recorded at the end of inspiration PIP is also the - ANSWER: ✔✔pressure required to overcome Raw & Cʟ Baseline Pressure - ANSWER: ✔✔pressure at which the breath begins & ends What does PEEP do - ANSWER: ✔✔prevents the pt. from exhaling to zero Pressure needed to overcome Raw - ANSWER: ✔✔Transairway Alveolar Pressure is also known as (2) - ANSWER: ✔✔Intrapulmonary Pressure or Plateau Pressure Alveolar Pressure - ANSWER: ✔✔if higher than <30, can cause injury and would need to investigate by measuring the breath delivered Things that can cause Airway Resistance (4) - ANSWER: ✔✔-bronchospasm (constriction) -secretions -obstruction -edema (swelling)