Workbook Chapt. 8&12

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University of Arkansas for Medical Sciences *

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NURSING RE

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Mechanical Engineering

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Feb 20, 2024

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Equipment and Techniques II Unit 2 Worksheet: Initial Patient Assessment & Methods to Improve Ventilation Chapter 8: Initial Patient Assessment 1. What does the increase in the difference between PIP and P plateau indicate? 2. What are the most common causes for increased airway resistance? 3. What is the significance of monitoring mean airway pressure? 4. The high pressure limit alarm is usually set about ___________________ cmH20 above the measured PIP, and when activated will ________________________________________ 5. List several causes that might activate a high pressure limit alarm. 6. The low pressure alarm is usually set at ____________ cmH20 below the measured PIP, and when activated usually indicates ______________________________________ 7. List possible causes for a decrease in static compliance (C S )

8. During pressure ventilation, if the set inspiratory pressure remains constant, what effect would a decrease in static compliance have on tidal volume? 9. The formula for static compliance is ______________________________________________ 10. C D decreases whenever C S __________________ or R AW _________________________ 11. Calculate the C S when the V T is 700ml, P plateau is 44 cmH20 and the end-expiratory pressure is +8 cmH20. 12. What effect would a leak have during pressure support ventilation? 13. During the ventilator check the respiratory therapist notices the patient making inspiratory efforts (patient is using accessory muscles) but the ventilator is not triggering. What could be causing the problem? What steps would you take to correct it? 14. A patient with ARDS is being maintained on PCV, with a set inspiratory pressure of 30 cmH20. According to the ventilator flow sheet, measured tidal volumes for the last 3 days have ranged between 400-450 ml. During the first ventilator-patient check of the day, the respiratory therapist notes that the measured tidal volume is now 550 ml. without any change in set parameters. What would cause the tidal volume to increase? 15. When the PIP is 43 cmH20 and the plateau pressure is 18 cmH20, how much pressure is required to overcome the resistance of the airways? 16. A 38 year old female patient was admitted through the ED 24 hours ago following a motor vehicle accident. She was intubated in the field due to respiratory arrest secondary to blunt chest trauma. The patient sustained four fractured ribs. The patient is currently on VC-CMV, (f)

= 15 b/m, VT = 440 ml, FiO2 = 80%, PEEP +8 cmH20. The following values were obtained on those settings: Time PIP (cmH 2 0) P plateau (cmH 2 0) Exhaled V T 0800 35 30 440 ml 1000 39 34 440 ml 1100 45 39 440 ml 1130 50 44 440 ml A. What is the PTA for each patient-ventilator system check? B. What is the source of the increase in PIP over the course of 3.5 hours? C. What are some of the most likely causes of this problem? D. How would you assess the patient to determine the appropriate treatment? 17. A 56 year old male patient with a history of COPD was admitted yesterday with a diagnosis of pneumonia. During the night he was intubated due to respiratory arrest. The patient is currently receiving VC-CMV, (f) – 12 b/m, VT -525 ml, FiO2 – 40%, PEEP +3cmH20. The following values were obtained on those ventilator settings: Time PIP cmH 2 0 P Plateau (cmH20) Exhaled V T 0630 36 23 525 ml 0835 39 22 523 ml 1030 41 23 525 ml 1230 46 19 524 ml A. What is the PTA for each patient-ventilator system check? B. What is the source of the increase in PIP over the course of 3.5 hours? C. What are some of the most likely causes of this problem? D. How would you assess the patient to determine the appropriate treatment?

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Chapter 12: Methods to Improve Ventilation 1. A 70 kg man with bilateral viral pneumonia is on SIMV. His set VT is 650 ml, SIMV rate of 12 b/min with no spontaneous breaths, 40% oxygen and +5 cmH20 PEEP. ABGs reveal pH = 7.48, PaCO2 = 30 mmHg, and PaO2 = 78 mmHg. Which of the following is appropriate? a. increase PEEP to 10 cmH20 b. increase FiO2 to 50% c. increase VT d. decrease frequency 2. A 95 kg male patient is on mechanical ventilation with the following settings and ABGs: SIMV Ph= 7.43 Vt = 650ml PaCO2 = 38 torr Rate = 8 bpm PaO2 = 43 torr FiO2 = 0.70 HCO3 = 23 mEq/L Which of the following changes would you recommend at this time? a. raise the Vt to 800 ml b. increase the rate to 12 bpm c. apply 5-7 cmH20 of PEEP d. decrease the rate to 6 bpm 3. A 70 kg patient on a volume ventilator in the assist-control mode with a Vt of 700ml, Rate of 10 b/m and an FiO2 of 0.50 has the following ABGs: PH = 7.58, PaCO2 = 21 torr, and PaO2 = 70 torr. The resident asks that you raise the patient's PaCO2. Which of the following actions would be most appropriate? a. decrease the set ventilator rate b. increase the inspiratory flow c. decrease the O2 concentration d. decrease the set tidal volume e. decrease mechanical dead space 4. A patient was placed on CMV with the following settings: VC-CMV, Vt = 550 mls, R = 14, FiO2 = 40%, PEEP +5, PF = 60 L/m. ABGs were drawn after 1 hour of mechanical ventilation. The patient had begun to trigger breaths and had a total (f) of 21 bpm. The ABGs revealed: P H = 7.48, PaCO 2 = 31, PaO 2 = 52, HCO 3 = 22, SaO 2 = 89%. How would you correct this problem? a. decrease the rate b. decrease the tidal volume c. increase the FiO 2 d. increase the PEEP e. change to SIMV mode

5. A doctor requests that you decrease the total minute ventilation of a patient receiving PSV. Which of the following changes would you consider? a. Add mechanical dead space. b. Decrease the rate. c. Increase the release frequency. d. Lower the pressure limit. 6. An 85 kg male (IBW) patient is being ventilated with VC-CMV, (f) – 12 b/m, VT = 450 ml. The patient’s ABG results reveal a PaCO2 – 55 mmHg. Which of the following changes should be made to the ventilator to reduce the patient’s PaCO2 to 40 mmHg? a. Increase the VT to 620 ml b. Decrease the VT to 400 ml c. Increase the rate to 18 b/m d. Decrease the rate to 10 b/m 7. A 100 kg (IBW) patient is receiving PCV at a set pressure of 20 cmH20 at a frequency of 12 b/m. The flow rate reaches zero before the beginning of exhalation. The exhaled volume is 550 ml, PaCO2 = 65 mmHg, pH = 7.29. The physician requests that the patient’s PaCO2 be decreased to a normal range of 40-45 mmHg. A. What would be the most effective means of reducing patient’s PaCO2? 8. A patient on VC-CMV has the frequency set at 10 b/m with a total respiratory rate of 20 b/m. The PaCO2 is 25 mmHg with a pH of 7.52. Will decreasing the set rate correct the respiratory alkalosis? Explain your answer. 9. Refering to the previous question (#8), what modes of ventilation may be more appropriate for this patient? Why? 10. When increasing tidal volume on a patient, it is important to maintain P plateau less than _____________ if at all possible. 11. List 8 clinical disorders that may result in a hypermetabolic state.

12. List 5 indications for endotracheal suctioning of the mechanically ventilated patient with artificial airways according to the AARC Clinical Practice Guidelines. 13. List the advantages and disadvantages of in-line suction catheters. 14. What are the high ventilator requirements that indicate the use of an inline suction catheter? 15. What are the consequences of instilling saline prior to performing endotracheal suctioning? 16. Placing an ARDS patient in a prone position is done for what reason? 17. List six potential problems associated with placing a patient in a prone position. 18. What effect does hyperventilation have on cerebral blood flow? 19. What technical problems are associated with the use of SVN using an external gas source? 20. Permissive Hypercapnia may be beneficial for a patient with which of the following? a. High Pplateau b. Intercranial lesion c. Pulmonary hypertension d. Head trauma

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