RC 255 EXAM 2 QUESTIONS 2024/2025 LATEST UPDATE WITH 100% VERIFIED ANSWERS ACCURATE, Exams of Health sciences

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RC 255 EXAM 2 QUESTIONS 2024/2025 LATEST UPDATE WITH 100% VERIFIED ANSWERS ACCURATE an increase in PIP may be due to a ________ in compliance or _________ in resistance -decrease in compliance -increase in resistance Transairway pressure (pta) -pressure to overcome resistance -Pta= PIP-Pplat Pplat should be kept below _____ to avoid lung injury 30cmH20 what does in increase in the difference between PIP & Pplat indicate? increase in Raw causes for increased Raw -secretions -tumors -clogged HME -kinked tube -biting on tube causes for decreased Cs -pulmonary edema -anything that affects chest wall -atelectasis -pneumonia -consolidation -pleural effusion -abdominal distention -pneumo/hemo during PC, if the set inspiratory pressure remains constant, what effect would a decreased Cs have on Vt? decrease Vt during VC, what effect would a decrease in Cd have on PIP and delivered Vt? -increase PIP -Vt would stay the same Cst Vt/Pplat-PEEP 70-100cmH20 Cdyn Vt/PIP-PEEP 40-70cmH20 Raw PIP-Pplat/flow (sec) 0.5-2.5ml/cmH20 4-8 w ETT what could an RT recommend if a pts Pplat is 38cmH20 on ABG? -decrease the Vt -up the rate -switch to pressure control -ultimately need ABG or CXR how to assess a pt with decreased Cs on the vent? -auscultation -palpation -percussion how to assess a pt with increased Raw on the vent? -suction -breath sounds -check if they're biting tube (insert bite block) -bronchodilator if bronchospasm calculate alveolar ventilation (Va) (Vt-Vdmech-Vanat) x rate what effect would an HME attached to a ETT have on alveolar ventilation decrease Valv (adds deadspace) respiratory alkalosis is characterized by pressure measured at the airway, averaged over entire vent cycle -how well alveoli are being recruited -parallels MAP -better oxygen diffusion how does increasing MPaw increase Pa02 in the presence of ventilation/perfusion abnormalities and/or diffusion deficits? recruits alveoli main goals of PEEP and CPAP PEEP- MV CPAP- spontaneous breathing improve oxygenation, recruit alveoli difference between physiological PEEP and therapeutic PEEP physiological PEEP-preserve pt normal FRC, natural therapeutic PEEP- added on, treats refractory hypoxemia optimal PEEP the most PEEP you can give to maximize oxygenation w/out overdistending lungs physiological parameters to monitor while determining optimal PEEP Pplat, breath sounds, ABG, P/F ratio, BP, Cs, Pa02 how can PPV benefit a pt with untreated CHF? move fluid out cardiopulmonary side effects of PEEP -decreased CO & BP -decreased preload -increased right ventricular afterload during VC ventilation, the PEEP level is set at 5cmH20 and the Ppeak is 42cmH20. After the PEEP is increased to 10cmH20 the Ppeak is now measured at 48cmH20. what caused the increase in Ppeak? -increase in PEEP, increased FRC what is the purpose of performing a slow or static pressure ventilation (PV) loop? recruits alveoli find lower & upper inflection pt how are inflation and deflation portions of the PV loop utilized? see where to set PEEP a pt in respiratory distress is intubated and on PCV with a PEEP of 5. Soon after, the pts CO decreases from 6l/min to 4.5 l/min. What can the therapist do to determine the cause of the decreased CO? PPV decreases CO point on the PV loop at which the lungs are overstretched the very tip "duck bill shape" may correlate with an increased PaC02 During PCV, the patient's lung compliance drops. How will this affect the delivered volume? decrease delivered Vt what happens to a pressure-volume loop when Cl decreases during PC-CMV? increase in PIP if you have a pt w/ hypoxemia and decreased Cl, what flow waveform would be most beneficial for gas distribution? descending ramp A 25-year-old man receiving mechanical ventilation is rotated from the supine position onto his right side. Immediately after this move, the high-pressure alarm on the ventilator activates. On auscultation, the respiratory therapist hears breath sounds over only the right lung. The centimeter marking of the endotracheal (ET) tube is 25 cm. What should the therapist do to correct this situation? -request CXR -deflate the cuff -pull out ETT till its 22cm at teeth A patient on mechanical ventilatory support is suctioned for large amounts of foul-smelling green sputum. The patient has a temperature of 38° C and a normal white blood cell count. Which of the following is the most likely cause of this problem? respiratory infection, temp is high, probably pseudomonas signs of respiratory distress in MV pt -TADC -retractions -paradoxical chest/abd movement -tachycardia/arrhythmias -hypotension What is the first step in managing a patient in severe distress who is receiving mechanical ventilation? How can one tell whether the problem originates with the ventilator or the patient? -manually ventilate -you can tell by assessing pt, ausculatation, airway leaks, and how hard/easy it is to bag steps to troubleshoot -assess situation -gather and analyze data -formulate solutions A 58-year-old man is intubated orally after cardiac arrest. The patient is admitted to the intensive care unit (ICU), and ventilatory support is provided using volume controlled-continuous mandatory ventilation (VC-CMV) in the assist/control (A/C) mode with 100% oxygen. The peak inspiratory pressure (PIP) has been increasing progressively over the past 4 hours. Auscultation of the patient's chest reveals an absence of breath sounds over the left lung and distant breath sounds over the right lung. The left hemothorax is dull to percussion, and the right chest is resonant. The trachea is deviated to the left. No chest radiographic evaluation is available. Briefly describe what is causing the problem and how can it be corrected. right mainstem intubation caused left lung collapse dull percussion, atelectasis) -tuben eeds to be repositioned, listen to breath sounds, stat CXR The low-pressure and low-volume alarms activate on a patient who is receiving ventilation. Auscultation over the trachea reveals a hiss during the entire mandatory breath cycle. What is the likely problem, and how can it be corrected? There is likely a leak in the cuff, check cuff pressure and inflate. -use MLT A patient is undergoing ventilation with bilevel positive airway pressure (biPAP) with a full face mask. Initial pressure readings were an inspiratory positive airway pressure (IPAP) of 12 cm H2O and an expiratory positive airway pressure (EPAP) of 3 cm H2O, with a measured VT of 0.55 to 0.6 L. The measured VT with the same pressures 3 hours later is 0.3 to 0.45 L. Which of the following could be the cause of the drop in VT? 1. There is an excessive mask leak. 2. Patient's lung compliance (CL) has decreased. 3. Patient's airway resistance (Raw) has increased. 4. Ascites is restricting the patient's inspiratory efforts. While monitoring a patient on mechanical ventilatory support, the respiratory therapist hears the high-pressure alarm and notes that breath sounds are absent over the right lung and diminished over the left lung. The percussion note is tympanic on the right and resonant on the left. The patient's -airway leaks -chest tube leaks causes of high pressure alarm -airway (coughing, secretions, biting, ETT position changes -increased Raw (edema, bronchospasm) -decreased cL (pleural effusion, pneumothorax) -changes in vent circuit contraindications of PEEP -tension pneumo -hyperextended lungs (emphysema, asthma) -hypovolemia -increased ICP VC/AC mode mandatory and assisted breaths PC/ AC mode mandatory and assisted breaths -decelerating flow pattern PSV assisted breaths flow cycled lower inflection point Minimum pressure required for alveolar recruitment -set PEEP upper inflection point - large numbers of alveoli are being overinflated -set PIP calculate alveolar volume (Valv) Vt-Vdmech-Vdanat adjusting vent settings for resp acidosis (blow off C02) increase Vt until out of range, then increase rate adjusting vent settings for respiratory aklalosis decrease rate, then Vt target Ve equation CaVa/Cd actual PaC02 x actual Ve/desired PaC02 calculate flow cycle % flow where insp ends/ peak flow higher flow cycle=shorter i-time pressure volume loop -counter-clockwise -higher flow=higher pTa/Ra (wider) -flattens with decreased cL, higher PIP flow-volume loop -clockwise -check response to bronchodilator (larger expiratory flow) -flow doesnt return to baseline (leak) -exhales more than inhaled (airtrapping) no return to baseline on flow-volume loop air-trapping metabolic acidosis is caused by pancreatitis renal failure aspirin diarrhea DKA lactic acid