VAP Flashcards
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;
Pneumonias that develop 48 hours after a patient is admitted or placed on a mechanical ventilator are hospital-acquired pneumonias.
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 development of pneumonia within 48 hours of admission and intubation is a result of an infection that was incubating at the time of admission.
The most common gram-positive bacterium that causes ventilator-associated pneumonia is which of the following?
Methicillin-resistant Staphylococcus aureus;
The predominant gram-positive bacterium that causes VAP is methicillin-resistant Staphylococcus aureus (MRSA). P. aeruginosa is a gram-negative bacterium.
The mortality rate for VAP depends on which of the following?
- Length of stay on the ventilator
- Presence of underlying disease
- Prior antimicrobial therapy
- Presence of a heated humidifier
2 and 3 only;
The overall attributable mortality rate for VAP depends on the infecting organism or organisms, the presence of underlying disease, and prior antimicrobial therapy.
Relying on clinical findings for the treatment of ventilator-associated pneumonia may do which of the following?
Create multidrug-resistant organisms.;
Relying on clinical findings alone can result in unnecessary use of broad-range antibiotics, which in turn can lead to the emergence of multidrug-resistant strains of microorganisms.
Thirty minutes following the insertion of a tracheostomy tube, the respiratory therapist palpates the skin around the site and notes a crackling sensation. The therapist should recommend which of the following?
removal of the tracheostomy tube and reintubation;
The crackling sensation, also called a popping sensation or sound, is most likely caused from subcutaneous emphysema. This is commonly caused from mal-positioning of the tracheostomy tube. Removal and repositioning is appropriate.
A respiratory therapist is having difficulty advancing a suction catheter down a fenestrated tracheostomy tube while the inner cannula is removed. The cannula appears to meet resistance within a few inches from insertion. The therapist should
twist the catheter while attempting to advance;
When suctioning somebody with a fenestrated tracheostomy tube, it must be remembered that the suction catheters can sometimes get stuck on the fenestration hole inside the tube. The best remedy for this is to twist the suction catheter until the end is clear of the hole.
Which of the following is the most important action to take for a 5-year-old patient with severe stridor as a result of acute epiglottitis?
perform intubation
A 62-year-old patient is brought to the emergency room (ER) from a local nursing care center where the patient has been in a vegetative state for 2 years. He routinely receives supplemental oxygen by trach collar and cool aerosol at 30%. He has a HR of 120 and an SpO2 of 83%. During a suction attempt, the therapist is unable to pass a suction catheter down the tracheostomy tube. What should the therapist do FIRST?
replace the airway;
The inability to pass a suction catheter down the tracheostomy tube is suggestive of an obstruction. In this kind of circumstance, the respiratory therapist should immediately remove the obstruction or remove the airway. The use of a suction catheter should be primarily used to clear the obstruction. In this case, the therapist is unable and therefore should act more aggressively to secure a patent airway by replacing the airway altogether.
Explain MLT in detail. Include all equipment you would need. (Minimal Leak Technique)
Cuff is inflated during positive pressure ventilation, untill no leak is heard. Then a small amount of air is released until a whisper of breath can be heard at end inspiration
Equipment needed stethoscope and pilot balloon syringe
Explain MOV technique in detail. What supplies would you need? (Minimal Occlusion Volume)
Cuff inflated during PPV until no leak is heard at end inspiration. Listen for leak at suprasternal notch and add air into pilot until no leak is heard
Equipment needed
syringe for inflating pilot balloon and stethoscope
Which pathogen is commonly found in patients who had percutaneous tracheostomies?
Pseudomonas sp
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 11,300mL. The most appropriate recommendation for this patient is which of the following?
Combination therapy with two types of antipseudomonal agents and vancomycin
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
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
