Exam 7: Final Considerations in Ventilator Setup

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?

All of the following are appropriate situations for the use of sigh or deep breaths except which?

What is the range for setting flow triggering?

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?

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

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

Identify the patient that could benefit from sigh breaths.

In which situation should the heat moisture exchanger (HME)be replaced with a heated humidification system?

During mechanical ventilation,a patient with a closed head injury develops the Cushing response.This may be immediately managed by using which of the following?

A male patient who is 5'10" and weighs 190 lbs 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?

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)shows: pH 7.25,partial pressure of carbon dioxide (P_aCO₂)55 mm Hg,partial pressure of oxygen (P_aO₂)54 mm Hg,oxygen saturation (S_aO₂)86%,bicarbonate (HCO₃^-)24 mEq/L.The most appropriate immediate action to take includes which of the following?

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 is to take is 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)42mm 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 lbs.The most appropriate action at this time is which of the following?

How much patient effort is needed to trigger a ventilator breath when there is 8 cm H₂O of unintended positive-end-expiratory pressure (auto-PEEP)and a pressure trigger setting of 2 cm H₂O?

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?

An 18-year-old,5'6" and 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 bpm,tidal volume (V_T)600 mL,positive-end-expiratory pressure (PEEP)5 cm H₂O,fractional inspired oxygen (F_IO₂)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?

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 (P_aCO₂)72 mm Hg,partial pressure of oxygen (PaO₂)88 mm Hg,oxygen saturation (S_aO₂)90%,bicarbonate (HCO₃^-)32 mEq/L on nasal cannula 2 L/min.The respiratory therapist should recommend which of the following at this time?

The statement that is true concerning the use of permissive hypercapnia in the management of patients with acute respiratory distress syndrome (ARDS)includes which of the following?

A patient set up on pressure support ventilation (PSV)has an average minute volume of 5.8 L.What should the low exhaled minute volume alarm be set at?