pilbeams ch 4

Question 1

Clinically ARF is defined as the

Answer 1

the inability to maintain Pa02, PaC02, and pH at acceptable levels. These are: a Pa02 lower than normal, a C02 >50 and a pH falling less than 7.25.

Question 2

Hypercapnic three types of disorders that can lead to pump failure

Answer 2

CNS disorders, Neuromuscular disorders, Disorders that increase the WOB.

Question 3

Tachycardia and tachypnea are early indicators

Answer 3

of hypoxia

Question 4

Elevation of PaC02 leads to

Answer 4

an increase in cerebral blood flow as a result of dilation of cerebral blood vessels

Question 5

Severe hypercapnia can lead to

Answer 5

C02 narcosis, cerebral depression, coma, & death

Question 6

Untreated hypoxemia, hypercapnia, and acidosis can lead to

Answer 6

cardiac dysrhythmias, vfib, and even cardiac arrest

Question 7

Central nervous system (CNS) disorders

Answer 7

Drugs
Tumors
Stroke
Head trauma
Cerebral hemorrhage
Increased intracranial pressure (ICP)

Question 8

Pathologic Conditions that Increase Risk

Answer 8

Neuromuscular disorders
Motor nerve damage
Faulty transmission of nerve impulses
Muscle dysfunction
CNS disorders
Drugs affecting neuromuscular function

Question 9

A 58 year old man is admitted to the ER from his home after a suspected stroke. Vital signs show RR 16bpm, normal temperature, and BP of 165/95. The patients pupils respond slowly and unequally to light. Breath sounds are diminished in the lung bases. A sound similar to snoring is heard during inspiration. The patient is unconscious and unresponsive to painful stimuli. What is the most appropriate course of action?

Answer 9

The patient should be intubated for airway protection and evaluated for cerebral reperfusion therapy

Question 10

A stat ABG evaluation is performed on a patient admitted through the ER department and reveals pH=7.15, PaC02=83, and Pa02=34, HC03=28, on room air. The patient was found unconscious in a nearby park. No other history is available at this time. What is the most appropriate course of action?

Answer 10

Possible drug overdose…narcan? Intubate and ventilate.

Question 11

A 68 year old woman with a history of myasthenia gravis has been in the hospital for about 12 days. She was admitted because he primary disease had worsened. The patient is unable to perform MIP and VC properly because she cannot seal her lips around the mouthpiece. Her attempts produced these values, MIP=-34cm.H20, VC=1.2L. What should we recommend at this time?

Answer 11

The numbers are adequate. Use a mouthseal. Continue to monitor MIP and VC every 8 hours. Request anticholinesterase challenge. Keep the patient NPO and have suction at bedside. Monitor SP02 and/or abg.

Question 12

Increased work of breath (WOB)

can be several factors

Answer 12

Severe chest trauma
Pneumothorax
Hemothorax
Respiratory center is 
Intact but the ability to 
Maintain the effort is 
compromised

Question 13

No single value for Pa02, PaC02, or pH indicates

Answer 13

a need for invasive ventilation

Question 14

Clinical judgement is essential, as is attention to the goals of therapy of mechanical ventilation

Answer 14

1. Support the pulmonary system so that it can maintain adequate levels of alveolar ventilation
2. Reduce the WOB until the cause of failure can be treated
3. Restore arterial and systemic acid-base balances to levels that are normal for the patient
4. Increase 02 delivery
5. Prevent complications associated with mechanical ventilation

Question 15

NIV for acute on chronic respiratory failure reduces

Answer 15

intubations, ventilator complications, shortens hospital stay, mortality

Question 16

Which of the following indicate the presence of respiratory problems that might require ventilatory support?
1 MIP of 17 cm H2O
2 VC of 2.1 L in a 70-kg man
3 PaCO2 of 81 mm Hg and pH of 7.19
4 PaO2 of 65 mm Hg on room air

Answer 16

1 and 3

1 MIP of 17 cm H2O
3 PaCO2 of 81 mm Hg and pH of 7.19

Question 17

Blood gas evaluation is performed for an unconscious patient brought to the emergency department. The results on room air are as follows: pH = 7.23, PaCO2 = 81 mm Hg, bicarbonate = 33 mEq/L, PaO2 = 43 mm Hg, and SaO2 = 71%. With no other data available, which of the following forms of therapy is indicated?
1 Oxygen with a nonrebreathing mask
2 Continuous positive airway pressure (CPAP) mask
3 Intermittent positive pressure breathing (IPPB) treatment with albuterol
4 Mechanical ventilatory support

Answer 17

4 Mechanical ventilatory support

Question 18

A 30-year-old woman is examined in the emergency department. She has paralysis of the lower extremities that is progressively worsening. After several hours, during which she was monitored frequently, her VC has decreased to 12 mL/kg and her MIP is –30 cm H2O. The results of blood gas evaluations are not yet available. What type of therapy is this patient most likely going to need?
1 Aerosolized bronchodilator administered with a metered-dose inhaler
2 Mechanical ventilatory support
3 Incentive spirometry to improve muscle strength
4 Narcotic-blocking agent

Answer 18

2 Mechanical ventilatory support

Question 19

A 28-year-old man with botulism poisoning is beginning to develop progressive paralysis. The respiratory therapist has been monitoring the patient’s MIP and VC every 2 hours. The most recent results show that the patient continues to deteriorate: MIP = −27 cm H2O, VC = 32 mL/kg. Which of the following could be appropriately recommended?
1 Gastric lavage
2 Oxygen therapy
3 Medication to reverse the paralysis
4 Mechanical ventilatory support

Answer 19

4 Mechanical ventilatory support

Question 20

Maximum inspiratory pressure (MIP)

Answer 20

normal range -100 to -50 cmH2O

critical may need mech vent -20 to 0 cmH2O

Question 21

Maximum expiratory pressure (MEP)

Answer 21

normal range 100 cmH2O

critical may need mech vent <40 cmH2O

Question 22

vital capacity (VC)

Answer 22

normal range 65-75 mL/kg

critical may need mech vent <10-15 mL/kg

Question 23

tidal volume (Vt)

Answer 23

normal range 5-8 mL/kg

critical may need mech vent <5 mL/kg

Question 24

RR (f)

Answer 24

normal range 12-20

critical may need mech vent >35

Question 25

forced expired volume in 1 sec (FEV1)

Answer 25

normal range 50-60 mL/kg

critical may need mech vent <10 mL/kg

Question 26

peak expiratory flow (PEF)

Answer 26

normal range 350-600 L/min

critical may need mech vent 75-100 L/min