Exam 7: Final Considerations in Ventilator Setup

A chronic obstructive pulmonary disease (COPD)patient with an ideal body weight of 65 kg is brought to the emergency department.The patient is short of breath and using accessory muscles.Aerosolized bronchodilators are administered.The arterial blood gas reveals the following: pH 7.31,partial pressure of carbon dioxide (PₐCO₂)72 mm Hg,partial pressure of oxygen (PₐO₂)88 mm Hg,oxygen saturation (SₐO₂)90%,bicarbonate (HCO₃⁻)32 mEq/L on nasal cannula 2 L/min.The respiratory therapist should recommend which of the following at this time?

How much pressure and time is necessary during a lung recruitment maneuver?

A 70-year-old,61-inch-tall female patient was admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD).After 12 hours of oxygen therapy,bronchodilator therapy,and intravenous corticosteroids,the patient began to show signs of clinical deterioration.Her chest X-ray revealed an enlarged heart and bilateral infiltrates.Her arterial blood gas shows acute on chronic respiratory failure.It is decided that this patient requires intubation and mechanical ventilation.The most appropriate ventilator settings for this patient include which of the following?

Methods to minimize air trapping in mechanically ventilated patients include which of the following?

The mechanical ventilator event that is considered potentially life-threatening or a level two event is which of the following?

A 45-year-old,73-inch-tall,200 lb male patient is admitted to the emergency department with an exacerbation of myasthenia gravis.The respiratory therapist assesses the patient and finds the patient's maximum inspiratory pressure is 15 cm H₂O and his vital capacity is 1200 mL.It is decided that the patient requires ventilatory support.The most appropriate ventilator settings for this patient are which of the following?

Following intubation and placement on volume-controlled continuous mandatory ventilation (VC-CMV),a patient's average peak inspiratory pressure (PIP)is 26 cm H₂O following suctioning.The appropriate settings for the low- and high-pressure alarms are which of the following?

Identify the patient who could benefit from sigh breaths.

Following successful cardiac resuscitation,a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (FɪO₂)settings?

An 18-year-old,5'6",125 lb female patient was admitted to the hospital 2 days ago for spinal meningitis.She developed sepsis and suffered hypercapnic respiratory failure.The patient was intubated and placed on volume-controlled continuous mandatory ventilation (VC-CMV),respiratory frequency (f)12 breaths/min,tidal volume (Vᴛ)600 mL,positive end-expiratory pressure (PEEP)5 cm H₂O,fractional inspired oxygen (FɪO₂)0.40.Twenty-four hours later,the patient's oxygen requirements have dramatically increased and her lung compliance has dramatically dropped,while her chest X-ray showed development of bilateral fluffy infiltrates.The most appropriate actions to take include which of the following?

Essential capabilities of an adult intensive care unit (ICU)ventilator include all of the following except:

The respiratory therapist in the intensive care unit (ICU)responds to a patient's room because the ventilator is alarming.The most appropriate immediate action is which of the following?

Patients with acute severe asthma requiring mechanical ventilation are difficult to manage because of which of the following?

A 36-year-old female patient with a history of asthma is admitted to the ICU from the emergency department.Her respirations are 30,very labored,with accessory muscle use and bilateral inspiratory and expiratory wheezing.There is bilateral hyperresonance during chest percussion.A blood gas taken in the ICU after 1 hour of continuous aerosolized albuterol (15 mg)reveals: pH 7.38,partial pressure of carbon dioxide (PₐCO₂)42 mm Hg,partial pressure of oxygen (PₐO₂)53 mm Hg,oxygen saturation (SₐO₂)88%,bicarbonate (HCO₃⁻)25 mEq/L with nasal cannula 6 L/min.The patient is 5'5" and weighs 135 lb.The most appropriate action at this time is which of the following?

While initially ventilating a patient with acute respiratory distress syndrome (ARDS),the extrinsic positive end-expiratory pressure (PEEPᴇ)should be maintained using which of the following methods?

A patient is intubated due to an acute exacerbation of chronic obstructive pulmonary disease (COPD).The patient is now breathing with pressure support ventilation 5 cm H₂O and continuous positive airway pressure (CPAP)5 cm H₂O.The patient is unable to flow trigger every inspiration.Unintended positive end-expiratory pressure (auto-PEEP)is measured at 10 cm H₂O.The most appropriate action to take is which of the following?

A male patient who is 5'10" and weighs 190 lb arrives at the hospital having suffered a closed head injury in a motor vehicle accident.The patient is unconscious and a computer tomogram of the head reveals an intracranial bleed.The patient receives an intracranial pressure (ICP)monitor following neurosurgery.Initial ventilator settings should include which of the following?

Calculate the humidity deficit when a heat moisture exchanger (HME)provided 14 mg/L of water to the set tidal volume.

The goal of selecting a specific oxygen concentration is to try to achieve clinically acceptable arterial oxygen tensions within which of the following ranges?

A 72-year-old male patient (height 6'2",weight 95 kg)with a history of congestive heart failure (CHF)presents to the emergency department complaining of shortness of breath and inability to lie down to sleep.Physical assessment reveals a very anxious patient with a pulse of 140,respirations 32,and labored with diaphoresis.Breath sounds are decreased with bibasilar coarse crackles.The patient has a productive cough of pink frothy secretions.The patient is placed on a nonrebreather mask and the resulting arterial blood gases (ABG)show: pH 7.25,partial pressure of carbon dioxide (PₐCO₂)55 mm Hg,partial pressure of oxygen (PₐO₂)54 mm Hg,oxygen saturation (SₐO₂)86%,bicarbonate (HCO₃⁻)24 mEq/L.The most appropriate immediate action to take includes which of the following?