Ch. 20

31問 • 1年前

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All of the following patients are intubated and receiving mechanical ventilation. The patient most likely to require slow liberation from mechanical ventilation is which of the following?

A patient with chest contusions from an accident

A patient is being weaned from invasive mechanical ventilation using VC-SIMV without pressure support. The respiratory therapist reviews the following data from the last few hours. What should the respiratory therapist recommend for this patient?

Add and titrate pressure support.

What ends inspiration in pressure support ventilation?

Flow

At what pressure is pressure support not high enough to contribute significantly to ventilatory support but is sufficient to overcome the work imposed by the ventilator system?

5 cm H2O

Which mode of ventilation delivers the exact amount of pressure required to overcome the resistive load imposed by the ET tube for the flow measured at the time?

Automatic tube compensation

The mode of ventilation that maintains a minimum VE by increasing or decreasing the amount of support (VT or respiratory rate) given to the patient is ________.

mandatory minute ventilation

The closed loop mode used for weaning from mechanical ventilation is which of the following?

Adaptive support ventilation

A postoperative patient, still under anesthesia, is being ventilated with VC-CMV with Automode. After 2 hours the patient is waking up and beginning to breathe spontaneously. The ventilator will respond by _________.

switching to the volume support mode.

The ACCP/SCCM/AARC task force recommends that a search for all possible causes that may be contributing to ventilator dependence be undertaken in patients who require mechanical ventilation for longer than ___ hours.

Assess the following data obtained from the spontaneous breathing trials of four patients. Which patient is most likely to be weaned successfully at this time?

Spontaneous rate = 15 breaths/min, VT = 650 mL, PaO2 = 91 mm Hg, FIO2 = 0.28

A 46-year-old male patient (IBW = 85 kg) who was injured in a motor vehicle accident has been receiving invasive mechanical ventilation for 24 hours. The patient is awake and alert and looks comfortable on these settings: VC- SIMV with pressure support of 5 cm H2O; set rate = 8 breaths/min; set VT = 500 mL; FIO2 = 0.4; PEEP = 5 cm H2O. A 10-minute spontaneous breathing trial (SBT) yields this information: f = 30 breaths/min, RSBI = 145, P0.1 = 10 cm H2O. What should the respiratory therapist suggest to the physician during patient rounds?

Continue with the current ventilator settings.

Calculate and determine the weanability of patients with this data: CD = 25 mL/cm H2O, PImax =-28cmH2O,PaO2 =93mmHg,PAO2 = 158 mm Hg, and f = 22 breaths/min.

19—weanable

Which parameter is used as the primary index of the drive to breathe?

Airway occlusion pressure

An SBT should not continue for longer than ____ minutes.

120

In which patient would continued use of an artificial airway be necessary?

A patient with upper airway burns and no peritubular leak

A recently extubated patient develops a partial upper airway obstruction, which causes stridor. What action can the respiratory therapist take to improve the patient’s condition?

Aerosolize 11.25 mg of racemic epinephrine.

A female intubated patient has been weaned from full ventilatory support to PSV 5 cm H2O, CPAP 5 cm H2O, and an FIO2 of 0.3. The patient is alert and oriented and doing well. The respiratory therapist performs a cuff leak test. The average peritubular leak is 70 mL. The respiratory therapist should recommend which of the following?

Pretreat the patient with steroids and/or racemic epinephrine before extubation.

A patient is extubated and placed on a cool, bland aerosol with 30% oxygen. Twenty minutes postextubation, the respiratory therapist is called to assess the patient, who has shortness of breath. The respiratory therapist observes intercostal retractions, accessory muscle use, and a respiratory rate of 38 breaths/min. Stridor can be heard without a stethoscope, and the SpO2 has dropped from 97% to 85%. The patient is given an aerosolized racemic epinephrine treatment and reassessed. Accessory muscle use continues, intercostal retractions decrease slightly, and stridor is heard on auscultation. The patient’s respiratory rate is 30 breaths/min, and the SpO2 is 88%. What should the respiratory therapist recommend?

Heliox therapy and steroid administration

If a patient who has failed an SBT still meets the criteria for discontinuation of ventilation, an SBT should be performed every _____ hours to determine weanability.

Sixty minutes after a patient is extubated, an arterial blood gas sample is drawn; the results are: pH=7.20,PaCO2 =60mmHg,PaO2 =55 mmHg,SaO =80%,HCO3- = 23mEq/L with a 2 L/min nasal cannula. The patient is SOB and complaining of chest pain. His blood pressure is 92/50 mm Hg. The most likely cause of this weaning failure is which of the following?

Acute left ventricular failure

How long does a tracheostomy site typically take to mature?

7 to 12 days

A patient who requires prolonged ventilatory support should not be considered permanently ventilator dependent until _____ month(s) has/have passed and all weaning attempts during that time have failed.

A patient being actively weaned from mechanical ventilation currently is receiving the following ventilatory support: pressure support = 15 cm H2O, spontaneous VT = 575 mL, spontaneous rate = 14 breaths/min, spontaneous VT = 500 mL, FIO2 = 35%, PEEP = 5 cm H2O. The arterial blood gas results are: pH =7.42,PaCO2 =38mmHg,PaO2=94mmHg, SaO2 = 98%, HCO3 -= 24 mEq/L. What should the respiratory therapist do next?

Reduce the PS to 10 cm H2O.

Which of the following would suggest that a patient is ready to be weaned from a ventilator

Rapid shallow breathing index of 75 breaths/min/L

Which of the following is defined as : The ratio of respiratory frequency to tidal volume

RSBI

Of the following which is a measurement of respiratory muscle strength

NIF

Sedatives can alter a patients RR & VT, thus affecting the assessment for ventilator discontinuation

True

A patient with amyotrophic lateral sclerosis has a tracheostomy tube in place. He has been unable to perform an SBT successfully and has been receiving mechanical ventilation for 4 months. An appropriate recommendation for this patient might be which of the following?

Transfer to a long-term care facility

A patient in the ICU who has successfully completed a 120-minutes SBT requires extubation. Which of the following tests or values would indicate the potential for airway edema after extubation?

cuff leak test

A female intubated patient has been weaned from full ventilatory support to PSV 5 cm H2O, CPAP 5 cm H2O, and an F1O2 of 0.3. The patient is alert and oriented and doing well. The respiratory therapist performs a cuff leak test. The average peritubular leak is 70 mL. The respiratory therapist should recommend which of the following?

Pretreat the patient with steroids V and/or racemic epinephrine before extubation

When weaning is unsuccessful for a patient who successfully performs an SBT, which of the following factors should be assessed? 1. Cardiac factors 2. Nutritional status and respiratory muscle strength 3. Acid-base status 4. Psychological factors

1, 2, 3, 4

ch. 2

Darya Rose · 83問 · 2年前

ch. 2