Ch. 13 - 14 | 暗記メーカー

Ch. 13 - 14

54問 • 1年前

問題一覧

During mechanical ventilation of a patient with COPD, the PaO2 = 58 mm Hg and the FIO2 = 0.5. If the desired PaO2 is 65 mm Hg, the FIO2 needs to be changed to which of the following?

0.56

During mechanical ventilation of a patient with CHF, thePaO2 =38mmHgandtheFIO2 =0.6. If the desired PaO2 is 60 mm Hg, the FIO2 needs to be changed to which of the following?

0.95

Thirty minutes after intubation and initiation of mechanical ventilation, a patient’s PaO2 = 55 mm Hg and the FIO2 = 0.5. To what should the FIO2 be set to obtain a PaO2 of 80 mm Hg?

0.75

Calculate the pulmonary shunt fraction using the following data: Pb = 757 mm Hg; hemoglobin (Hb) = 11g/dL; FIO2 = 0.5; PaO2 = 86 mm Hg; PaCO2 = 40 mm Hg; SaO2 = 91%; = 40 mm Hg; = 71%; respiratory exchange quotient (R) = 0.8.

19%

Calculate the pulmonary shunt fraction for a patient with the following data: Pb = 760 mm Hg; Hb = 10 g/dL; respiratory quotient = 0.8; FIO2 = 0.6; PaO2 = 100 mm Hg; SaO2 = 93%; PaCO2 = 45mmHg; =36mmHg; =70%.

26%

Calculate the pulmonary shunt fraction for a patient with the following data: CAO2 = 17 vols%; CaO2 = 16.5 vols %; = 11 vols%.

PEEP therapy is indicated for patients with which of the following?

PaO2 of 100 mm Hg while receiving an FIO2 of 0.8

Patients with which of the following clinical disorders may benefit from PEEP?

ARDS

How long after PEEP is increased should all ventilatory and available hemodynamic parameters be measured and calculated?

15 minutes

Assessing the outcome of PEEP at levels set above 15 to 20 cm H2O is best done using which of the following?

Pulmonary artery occlusion pressure

An absolute contraindication to PEEP is which of the following?

Untreated tension pneumothorax

The level of applied PEEP should be set at what point on the pressure-volume curve?

Above the upper inflection point of the deflation curve

What is the optimal PEEP level given the following information?

10 cm H2O

What is the optimal PEEP level given the following information?

8 cm H2O

The most appropriate PEEP level (optimum PEEP) for the patient whose information is in the table below is which of the following?

12 cm H2O

The level of PEEP that is most appropriate for a patient with the information shown below is which of the following?

10 cm H2O

A patient is being ventilated with a PEEP of 10 cm H2O and an FIO2 of 0.4. The arterial blood gas results show that the patient remains hypoxemic, and the respiratory therapist increases the PEEP to 18 cm H2O, maintaining the FIO2 at 0.4. The patient’s static compliance changes from 28 mL/cm H2O to 22 mL/cm H2O just after this change. The respiratory therapist should do which of the following?

Decrease PEEP to 15 cm H2O and measure static compliance.

A patient with ARDS has the slow pressure-volume loop shown below. Based on this loop, at what level should PEEP be set?

22 cm H2O

What is the Pflex on the following pressure-volume loop?

19 cm H2O

Regardless of the procedure used to establish an appropriate PEEP level, ventilating pressures should not be allowed to exceed which of the following?

Upper inflation point on the inspiratory limb (UIPi)

Despite the risk, it is still important to use PEEP, because it can prevent alveolar collapse during exhalation and reopening, even when a low VT is used. It now is theorized that it is important to use the pressure-volume loop to set PEEP ______.

above the upper inflection point detected during deflation of the lung

During a patient case study, increasing increments of PEEP showed no significant effects until 15 cm H2O was used, at which time the PaO2 improved markedly. This represents the point at which ________.

Alveolar recruitment probably occurred

In which ventilator mode should a patient receiving a sustained inflation technique be placed?

CPAP/spontaneous

To perform a slow-flow (quasi-static) technique for determining the appropriate PEEP level, the most appropriate ventilator flow setting is which of the following?

2 L/min

The highest pressure attained during the slow-flow (quasi-static) technique should be ______ cm H2O.

The point on a static pressure-volume curve (SPV) where the alveoli begin to open is referred to as which of the following?

Lower inflection point on the inflation limb

The “sigmoid” shape of the static pressure-volume lung recruitment maneuver indicates which of the following?

Lung units open at different times with different pressures

“Loose atelectasis,” or compression atelectasis, is most often associated with _______.

anesthesia

A recruitment maneuver (RM) is being performed on a patient receiving mechanical ventilation with PCV. During the maneuver the mode remains in PCV, rate = 10/min, I:E = 1:2, and PIP = 35 cm H2O. The following information is documented during the RM:

12 cm H2O

The patient with which of the following assessment findings meets the criteria for beginning weaning from PEEP?

PaO2 =95mmHg;FIO2 =0.3;Cs =30 mL/cm H2O; PEEP = 15 cm H2O

A pneumonia that was not incubating at the time of admission is one that develops a minimum of how many hours after admission?

48 hours

The type of organism that most often causes ventilator-acquired pneumonia is which of the following?

Bacteria

A patient was intubated in the emergency department just after arrival at the hospital from home. This patient develops VAP 36 hours after intubation. What type of pneumonia is this considered?

Non–hospital-acquired pneumonia

The mortality rate for VAP associated with prolonged hospital stays is which of the following?

25% to 50%

Sixty percent of all VAP infections are caused by which of the following?

Aerobic gram negative bacilli

The most common gram-positive bacterium that causes ventilator-associated pneumonia is which of the following?

Methicillin-resistant Staphylococcus aureus

Patients with chronic obstructive pulmonary disease (COPD) are at higher risk for infection with which of the following organisms? 1. Haemophilus influenzae 2. Pseudomonas aeruginosa 3. Moraxella catarrhalis 4. Staphylococcus aureus

1, 3

The incidence of ventilator-associated pneumonia for all intubated patients is _____.

8% to 28%

The mortality rate for VAP depends on which of the following? 1. Length of stay on the ventilator 2. Presence of underlying disease 3. Prior antimicrobial therapy 4. Presence of a heated humidifier

2, 3

Healthy individuals usually have which of the following bacteria in their upper airways?

Haemophilus sp.

Effective treatment of ventilator-associated pneumonia can be ensured by diagnosis based on findings from which of the following?

Bronchial alveolar lavage

Calculate the Clinical Pulmonary Infection Score (CPIS) for a patient with the following assessments: 56-year-old female, post motor vehicle accident, intubated and mechanically ventilated for 4 days. Static compliance is 42 cm H2O/L. Tracheobronchial suctioning reveals a moderate amount of yellow secretions; culture and sensitivity is pending. Breath sounds reveal bilateral lower lobe coarse rhonchi. Chest radiograph shows diffuse infiltrates. Partial pressure of oxygen in the arteries (PaO2) is 72 mm Hg on 40% supplemental oxygen. Patient has a temperature of 39.2°C, and white blood cell count (WBC) is 12,800L.

CPIS = 7

A patient with which of the following CPIS criteria should be placed on empiric antibiotic therapy pending the outcome of a bronchial alveolar lavage?

CPIS = 7

Critically ill patients receiving invasive mechanical ventilation have been found to have which of the following microorganisms not typically present in healthy individuals?

Gram-negative bacilli

Reasons for the shift in oropharyngeal flora in patients receiving invasive mechanical ventilation with endotracheal tubes include which of the following?

Decreased mucosal immunoglobulin A

Relying on clinical findings for the treatment of ventilator-associated pneumonia may do which of the following?

Create multidrug resistant organisms.

The initial empiric antibiotic used to treat suspected methicillin-resistant Staphylococcus aureus in a patient with late-onset VAP is which of the following?

Linezolid

The initial empiric antibiotic used to treat suspected methicillin-resistant Staphylococcus aureus in a patient with early-onset VAP is which of the following?

Levofloxacin

A 63-year-old male, post head trauma, is intubated and has been mechanically ventilated for 78 hours. The respiratory therapist notes the following during ICU rounds: partial pressure of oxygen in the arteries (PaO2) is 82 mm Hg on 60% supplemental oxygen with a positive end-expiratory pressure (PEEP) of 8 cm H2O; static compliance is averaging 38 to 41 cm H2O/L, breath sounds are diminished bilaterally. Bronchoalveolar lavage (BAL) results are pending, but MRSA is suspected. Chest radiograph shows bilateral, patchy infiltrates. Patient has a temperature of 38.8°C, and the most recent white blood cell (WBC) count is 11,300 L. The most appropriate recommendation for this patient is which of the following?

Combination therapy with two types of antipseudomonal agents and vancomycin

Which of the following is not a method to reduce the risk of VAP?

Nasally intubate whenever possible.

Which pathogen is commonly found in patients who had percutaneous tracheostomies?

Pseudomonas sp.

To avoid ventilator-associated pneumonia, how often should ventilator circuits be changed?

Not unless visibly dirty

The main strategy for the management of VAP focuses on which of the following?

Early diagnosis and treatment

A “ventilator bundle” may include which of the following? 1. Keeping the head of the bed at 30 degrees from the horizontal. 2. Changing the ventilator circuits every 48 hours. 3. Using heated humidifiers whenever possible. 4. Using noninvasive positive pressure ventilation (NPPV) whenever possible.

1, 4

ch. 2

Darya Rose · 83問 · 2年前

ch. 2