Question Answer
A control variable is the primary variable that the ventilator manipulates to cause inspiration. Name the three variables in the equation of motion that a ventilator can control. Pressure, Volume, and Flow (Egan, Chapter 42, page 969)
During mechanical ventilation, what is the variable that is measured and used to end inspiration? It is called the cycle variable. (Egan, Chapter 10, page 975)
True or False – PEEP is the application of pressure that improves oxygenation and helps to keep alveolar units open. True (Egan, Chapter 42, page 975)
What lung capacity does PEEP elevate? PEEP elevates a patient’s FRC. (Egan, Chapter 43, page 975)
During Intermittent Mandatory Ventilation: All breaths are spontaneous breaths. b.Breaths can be either spontaneous or mandatory.c. All breaths are mandatory B. During Intermittent Mandatory Ventilation breaths can be either spontaneous or mandatory. (Egan, Chapter 42, page 979)
Name 3 goals for Noninvasive Positive Pressure Ventilation? 1) Avoid intubation. 2) Decrease the incidence of ventilator-associated pneumonia. 3)improve gas exchange.(Egan, Chapter 45, page 1095)
When using CPAP to treat acute cardiogenic pulmonary edema, what water pressure and percent oxygen should be set? A) 10-20 cm H2O with 50% oxygen B) 5-10 cm H2O with 40% oxygen C) 8 -10 cm H2O with 100% oxygen c. 8-10 cm H2O with 100% oxygen(Egan, Chapter 45, page 1095)
True or False. COPD is the 4th leading cause of death in the United states. True (Egan, Chapter 41, pg 957)
Hypoxemic Respiratory Failure is most commonly caused by: A) V/Q mismatch. B) shunt. C) hypoventilation. D) all of the above. D. All of the above (Egan, Chapter 41, pg 962)
What are the main therapies to treat severe hypoxemia? Increased FIO2 and PEEP (Egan, Chapter 41, page 962)
What is the main goal of therapy when treating (acute ventilatory failure)hypercapnic respiratory failure? To bring the pH values back to normal. (Egan, Chapter 41, page 962)
What is the most important factor to consider when determining whether or not a patient needs ventilatory support? The clinical status of the patient. (Egan, Chapter 41, page 962)
During invasive ventilatory support on a patient with obstructive lung disease what tidal volumes, respiratory rates, and flow rates should you set to avoid dynamic hyperinflation? Lower tidal volumes(6 to 8 ml/kg), moderate respiratory rates, and high inspiratory flow rates(70 to 100 L/min.) are best to avoid dynamic hyperinflation. (Egan, Chapter 41, page 962)
When transporting a mechanically ventilated patient what device must you always bring with you? You must always have a manually powered bag-valve mask. (Egan, Chapter 42, pg 967)
What are the 2 different power sources for a ventilator? Either electrical energy or compressed gas. (Egan, Chapter 42, page 967)
What does the output control valve on a mechanical ventilator regulate? The output control valve regulates the flow of gas to the patient. (Egan, Chapter 42, page 967)
It is improtant for the RT to set an appropriare trigger level and flow rate for the patient in CMV ventilation. What could happen if the pressure sensitivity is set too high for the patient on CMV? The ventilator could autotrigger and cause hyperventilation, air-trapping, and patient anxiety.(Egan, chapter 42, page 989)
On a mechanical ventilator a ——— breath is a breath for which the machine sets the start time and/or the tidal volume. The machine triggers and/or cycles the breath. Mandatory breath.(Egan, Chapter 42, pg 976)
True or False: During Continuous mandatory ventilation all breaths are manadatory. True During CMV all breaths are mandatory. (Egan, Chapter 42, pg 976)
Most current evidence indicates that NPPV should be the standard of care for managing patients with what respiratory diseases? Patients with COPD exacerbation and acute cardiogenic pulmonary edema. (Egan, Chapter 45, pg 1111)
How is oral and nasal dryness corrected during NPPV? With a heated humidifier (about 30 degrees C) (Egan, Chapter 45, pg 1107)
What is the selection criteria for NPPV in the care of patients with acute respiratory failure? Two or more of the following should be present:*use of accessory muscles *Paradoxical breathing *respiratory rate > or equal to 25 breaths/min. *Dyspnea *PaC02 > 45 mm Hg with PH < 7.35 *Pa02/FIO2 ratio <200 (Egan, Chapter 45, pg 1111)
Before NPPV is considered for patients with restrictive thoracic disorders, what symptoms must be present? Nocturnal hypoventilation. (Egan Chapter 45, pg 1097)

 

Egan’s Chapter 41 Practice Questions:

 

1. About 2% to 3% of the blood supply is shunted via: The bronchial and thebesian veins that feed the lungs and heart; this is a normal anatomic shunt

2. Absence of breath sounds on one side of the chest may reveal: Collapse, infection, edema, or effusion as potential causes of the Q mismatch

3. Acute Hypercapnic Failure: pH decreases 0.08 for every 10 mm Hg increase in PaCO₂

4. Are PaCO₂ and alveolar ventilation directly or inversely related: Inversely

5. Auto PEEP: Pressure above atmospheric remaining in the alveoli at end exhalation due to air trapping AKA intrinsic PEEP

6. Barotrauma: Physical injury sustained as a result of exposure to ambient pressures above normal, most commonly secondary to positive pressure ventilation (e.g. pneumothorax, pneumo mediastinum)

7. Bilateral wheezing especially any young patients in respiratory distress often identifies: The bronchospasm of asthma

8. Breath sounds that are diminished bilaterally are common in: Emphysema

9. The causes of physiologic shunting: Atelectasis, Pulmonary edema, Pneumonia

10. Central muscle fatigue: An exertion induced, reversible decrease in central respiratory drive

11. A __________ chest radiograph is evident when alveoli are partially occluded: White

12. Chronic and acute hypercapnic respiratory failure can be differentiated by the severity of change in: pH

13. Chronic Hypercapnic Failure: pH decreases 0.03 of every 10 mm Hg in PaCO₂

14. Clinical Presentation of Diffusion Impairment: Signs and Symptoms are related to the specific disease, Interstitial lung disease may be the diagnosis of a dyspneic patient with a dry cough and fine basilar crackles, Digital clubbing, Joint abnormalities, Raynaud disease

15. Clinical presentation of Perfusion/Diffusion Impairment: Obvious signs of liver disease, Digital clubbing, Platypnea, Orthodoxia

 

16. Clinical Presentation of Shunt: Similar to V/Q mismatch, Bilateral of unilateral crackles

17. Contractile Muscle fatigue: A reversible impairment in the contractile response to a neural impulse in an overloaded muscle

18. Decreased Inspired Oxygen: Clinically uncommon, hypoxemia may develop when the inspired oxygen is less than body requirements

19. Diffusion: The movement of gas across the alveolar capillary membrane secondary to a pressure gradient

20. Diffusion impairment is commonly found in patients with what diseases: Patients with interstitial lung disease, Pulmonary fibrosis, Asbestosis, Sarcoidosis, The thickening and scarring of the interstitium undermine normal gas exchange, Emphysema, Pulmonary vascular abnormalities like anemia, pulmonary hypertension and pulmonary embolus

21. Does diffusion impairment become more pronounced at rest or during exercise: During exercise because it limits the time for gas exchange

22. Dynamic Hyperinflation: Increase in functional residual capacity (FRC) above the elastic equilibrium volume of the respiratory system; causes include increased flow resistance, short inspiratory time, and increased post inspiratory muscle activity

23. Fatigue: A condition in which there is loss of the capacity to develop force or velocity of a muscle resulting from muscle activity under load, which is reversible by rest

24. Guillain Barre Syndrome: Lower extremity weakness progressing to the respiratory muscles in one third of patients (Ascending)

25. High Frequency Ventilation: Ventilatory support provided at rates significantly higher than normal breathing frequencies

26. How does hypoventilation differ from other causes of Acute Hypoxemic Respiratory Failure: Manifesting with a normal alveolar to arterial PO₂ difference

27. Hypercapnic Respiratory Failure is also known as: Ventilatory Failure

28. Hypercapnic Respiratory Failure (Type 2): Inability to maintain normal removal of CO₂ from the tissues; may be indicated by PaCO₂ greater than 50 mm Hg in an otherwise healthy individual

29. Hypercapnic Respiratory Failure (type 2): An elevated PaCO₂, creating an uncompensated respiratory acidosis (Weather acute or acute on chronic)

30. Hypercapnic Respiratory Failure (type 2) is also known as: Pump failure or ventilatory failure

31. Hypercapnic (Type 2) Respiratory Failure: Describes “bellows failure” of the lungs resulting in elevated CO₂ levels

32. Hypoxemic Respiratory Failure (Type 1): Inability to maintain normal oxygenation in the arterial blood

33. Hypoxemic (Type 1) Respiratory Failure: Occurs when the primary problem is inadequate oxygen delivery

34. Maximum Expiratory Pressure (MEP): Measurement of the output of the expiratory muscles against a maximum stimulus, measured in cm H₂O positive pressure

35. Maximum Inspiratory Pressure (MIP): Measure of the output of the inspiratory muscles against a maximum stimulus, measured in cm H₂O negative pressure

36. Maximum Voluntary Ventilation (MVV): Maximum volume of air in L/min that a subject can breathe during a 12 to 15 second period. It is a very patient dependent test.

37. MIP of _________ cm H₂O or less (more negative) usually indicates adequate respiratory muscle strength to continue spontaneous breathing: -30

38. Muscle Fatigue: Condition involving loss of the capacity to develop force or velocity of a muscle resulting from muscle activity overload, which is reversible by rest.

39. Noninvasive Ventilation (NIV): Mechanical ventilation without endotracheal intubation of tracheotomy, usually via a form fitting mask

40. Pathologic anatomic shunt occurs as a result of: Right to left blood flow through cardiac openings (artial or ventricular septal defects) or in pulmonary arteriovenous malformations

41. Pathologic V/Q mismatch occurs when: Disease disrupts the balance, and hypoxemia results

42. Perfusion/Diffusion Impairment: Right to left intra cardiac shunt combines with dilated pulmonary capillaries resulting in impaired gas exchange

43. Perfusion/Diffusion Impairment: A rare cause of hypoxemia found in individuals with liver disease complicated by hepatopulmonary syndrome

44. Physiologic shunt leads to hypoxemia when: Alveoli collapse or are filled with fluid or exudate

45. Positive End Expiratory Pressure (PEEP): Application and maintenance of pressure above atmospheric at the airway throughout the expiratory phase of positive pressure mechanical ventilation

46. Pressure Control Ventilation: Mode of ventilatory support in which mandatory support breaths are delivered to the patient at a set inspiratory pressure

47. Pulmonary Hypertension may manifest with signs of: Right sided heart failure such as edema, jugular venous distention, and a louder pulmonary component of the second heart sound

48. Radiographically, V/Q mismatch can manifest as a _____________ radiograph, with large or hyper inflated lungs as in the case of obstructive disease: black

49. Respiratory Alternans: Alternating between use of the diaphragm for short periods and use of the accessory muscles to breathe; indicative of end stage respiratory muscle fatigue

50. Respiratory Failure: Inability to maintain either the normal delivery of oxygen to the tissues or the normal removal of carbon dioxide from the tissues and often results from an imbalance between respiratory workload and ventilatory strength of endurance

51 .Respiratory Failure is defined as (#’s): Arterial partial pressure of oxygen (PaO₂) less than 60 mm Hg, or Alveolar partial pressure of carbon dioxide (PaCO₂) greater than 50 mm Hg

52. Respiratory muscle weakness: The decreased capacity of a rested muscle to generate force and decreased endurance

53. Respiratory muscle weakness occurs most commonly in patients with: Neuromuscular disease, COPD, Kyphoscoliosis, Obesity

54. Severe hypoxemia can lead to: Significant central nervous system dysfunction, ranging from irritability to confusion to coma

55. Shunting can be diagnosed by: Using 100% oxygen breathing techniques, Contrast enhanced echocardiography, Macro aggregated albumin scanning, Pulmonary angiography

56. Shunt is differentiated from V/Q mismatch by: The lack of increase in PO₂ as FiO₂ is increased

57. Shunt usually manifests with a _________ chest x ray: white

58. Tension Time Index: Product of contractile force (ratio of diaphragmatic pressure to maximum diaphragmatic pressure) and contractile duration (ratio of inspiratory time to total breathing cycle time) used to indicate a level of contraction associated with fatigue

59. Transmission muscle fatigue: An exertion induced, reversible impairment in the transmission of neural impulses

60. True/False: A shunt does not respond to supplemental oxygen: TRUE, because the gas exchange unit (the alveolus) is not open

61. True/False: V/Q mismatch does not respond to supplemental oxygen: FALSE, V/Q mismatch responds to supplemental oxygen

62. Upper airway disease or fluid filled airways may also result in: Wheezing

63. Venous Admixture: A decrease in mixed venous oxygen increase the gradient by which oxygen needs to be stepped up as it passes through the lungs

64. V/Q mismatch usually manifests with a ______ chest x ray: black

65. What are the causes of V/Q mismatch: Obstructive Lung diseases, Bronchospasm, Mucous Plugging, Inflammation, Premature airway closure that signal asthmatic or emphysematous exacerbations, Infection, Heart Failure, Inhalation injury may lead to partially collapsed or fluid filled alveoli

66. What are the most commonly used tests to assess respiratory muscle strength at the bedside:, Maximum inspiratory pressure (MIP), Maximum expiratory pressure (MEP), Forced Vital Capacity, Maximum voluntary ventilation (MVV)

67. What are the primary causes of hypoxemia: Ventilation/Perfusion mismatch, Shunt, Alveolar hypoventilation, Diffusion impairment, Perfusion/diffusion impairment, Decreased inspired oxygen, Venous admixture

68. What are the three main causes of Hypoxemic Respiratory Failure: Hypoventilation, V/Q mismatch, Shunt

 

69. What can be used to over come Perfusion/Diffusion Impairment: Significant supplemental oxygen the gas transfer reduction

70. What causes hypercapnic respiratory failure do to a decreased ventilatory drive: Drug overdose or sedation, Bilateral carotid endarterectomy with incidental resection of the carotid bodies, Brainstem lesions, Disease of the CNS such as multiple sclerosis or Parkinsons, Hypothyroidism, Morbid obesity (obesity hypoventilation), Sleep apnea, Metabolic Alkalosis, Malnutrition, Sleep deprivation, Metabolic encephalopathy, Elevated ICP

71. What disease are associated with Hypercapnic respiratory failure: COPD, Asthma, Upper airway obstruction, Obesity hypoventilation, Pneumothroax, Severe burns, Chest wall disorders (khyphoscoliosis), Ankylosing spondylitis

72. What diseases cause muscle weakness/fatigue: Guillain Barre Syndrome, Myasthenia gravis, COPD, Kyphoscoliosis, Obesity

73. What is a Shunt: An extreme version of V/Q mismatch in which there is no ventilation to match perfusion

74. What is the clinical presentation of a patient with V/Q mismatch: Hypoxemia commonly manifests with dyspnea, tachycardia, and tachypnea, use of accessory muscles, nasal flaring, lower extremity edema, peripheral or central cyanosis

75. What is the clinical presentation of decreased inspired oxygen: The signs are symptoms of hypoxemia may be present, with the cause clearly related to the patient environment

such as altitude

76. What is the most common cause of hypoxemia: Ventilation/Perfusion Mismatch

77. What is the most common cause of lox mixed venous oxygen, owing to increased peripheral extraction of oxygen: Congestive heart failure with low cardiac output

78. What is the most common situation for decreased inspired oxygen: High altitude

79. What is the term for Respiratory Failure due to inadequate ventilation: Hypercapnic (Type 2) Respiratory Failure

80. What is the treatment for decreased inspired oxygen: Supplemental oxygen

81. Wheezing in one lung may identify: Endobronchial lesion

82. When does fatigue occur: Work of breathing, Hypoxemia

decreased inspiratory muscle efficiency, Poor nutrition, Inability of a muscle to extract energy from supplied substrates

83. Work of Breathing: Amount of force needed to move a given volume into the lung with a relaxed chest wall. 1.alveolar hypoventilation occurs: in an essentially normal lung when CO2 displaces O2

84. auto-PEEP: pressure above atmospheric remaining in the alveoli at end-exhalation due to air trapping

85. barotrauma: physical injury sustained as a result of exposure to ambient pressures above normal, most commonly secondary to positive pressure ventilation

86. Causes of Hypoxemia: ventilation/perfusion mismatch, shunt, alveolar hypoventilation, diffusion impairment, perfusion/diffusion impairment, decreased inspired O2, venous admixture

87. dynamic hyperinflation: increase in functional residual capacity (FRC) above the elastic equilibrium volume of the respiratory system, causes include increased flow resistance, short inspiratory time and increased post inspiratory muscle activity (low rates, high flows, and moderate volumes avoid this harmful outcome).

87. high-frequency ventilation: ventilatory support provided at rates significantly higher than normal breathing frequencies

88. Hypercapnic respiratory failure is also know as ventilatory failure,this results from: neurologic disease, decreased ventilatory drive, increased work of breathing

89. hypercapnic respiratory failure-type II: ventilatory failure; inability to maintain normal removal of CO2 from the tissues; may be indicated by PaCO2 greater thank 50mmHg in an otherwise healthy individual (CO2 is too high).

90. hypoxemic respiratory failure – type I: inability to maintain normal oxygenation in the arterial blood (oxygen is too low).

91. in what disease states have NIV been shown to be beneficial in the acute setting: Acute exacerbation of COPD, Carcinogenic edema

92. maximum expiratory pressure MEP: measure of the output of the EXPIRATORY muscles against at a maximum stimulus, measured in cm H2O POSTIVE pressure

93. maximum inspiratory pressure MIP: measure of the output of INSPIRATORY muscles against a maximum stimulus, measured in cm H2O NEGATIVE pressure

94. maximum voluntary ventilation MVV: maximum volume of air in L/min that a subject can breathe during a 12 to 15 second period. It is a very patient-dependent test.

95. muscle fatigue: condition involving loss of the capacity to develop force of velocity of a muscle resulting from muscle activity overload, which is reversible at rest

96. noninvasive ventilation NIV: positive pressure ventilation without endotracheal intubation of tracheotomy, usually via form fitting nasal face mask

97. positive end-pertest expiratory pressure PEEP: application and maintenance of pressure above atmospheric at the airway throughout the expiratory phased of positive pressure mechanical ventilation

98. pressure control ventilation: mode of ventilation support in which mandatory support breaths are delivered to the patient at a set inspiratory pressure

99. respiratory alternans: alternating between use of the diaphragm for short periods and use of the accessory muscles to breathe, indicative of end-stage respiratory muscle fatigue

100. shunt: occurs when there is no ventilation at all,

an example is pneumonia or ARDS

DOES NOT respond to O2 therapy

101. tension-time index: product of contractile force(ratio of diaphragmatic pressure to maximum diaphragmatic pressure), and contractile duration (ratio of inspiratory time to total breathing cycle time)used to indicate a level of contraction associated with fatigue

102. T/F Acute respiratory failure is identified by PaO2 less than 60mmHg or PaCO2 greater than 50mmHg,: True, or both in otherwise healthy individuals at sea level

103. venous admixture is a: low O2 level int he blood returning to the vena cava/lungs

example: CHF with low cardiac output or low hemoglobin; treatment needs more cardiac output/more hemoglobin to deliver O2

104. ventilation/perfusion mismatch: usually the result of poorly ventilated areas that sill get blood flow, an example is bronchospams. Treatment: O2 therapy

105. What are the main therapies used for severe hypoxemia: increased FiO2; PEEP

106. What are the most common reasons for Hypoxemic Respiratory Failure ?: V/Q mismatch, shunt, hypoventilation

107. what is a typical ABG result for a patient in acute respiratory failure due to V/Q mismatch or shunt: pH-7.45, PaCO2-33mmHg, PaO2-40mmHg

108. what is the goal of therapy in hypercapnic respiratory failure: to normalize the pH

109. what is the most common cause of respiratory muscle fatigue: excessive work of breathing

110. What is the most important factor determining the need for ventilatory support?: the clinical status for the patient

111. What will chronic respiratory failure manifest from?: hypercapina, evidence of compensatory metabolic alkalosis, polycythemia reflecting chronic hypoxemia

112. work of breathing: amount of force needed to move a given volume into the lung with a relaxed chest wall; mathematically, work is the integral of pressure times volume (the physiologic cost of increased dead space and resistance).