Quiz review

Question 1

An ICU pt has been intubated and on a vent for 7 days, pt is expected to have a prolonged ventilator support (more than 30 days). Which of the following would be the recommended method of continuing airway control

a. repeat oral intubation with smaller ETT

b. Switch to nasal intubation

c. Tracheotomy w/trach tube insertion

d. laryngectomy

Answer 1

C. Tracheotomy w/trach tub insertion

Question 2

If a pt is to be intubated via RSI, how long should you preoxygenate?

Answer 2

3-5 minutes

Question 3

During RSI, if pt is sufficiently pre-oxygenated and then vent is discontinued, how long does it take for the SpO2 to decrease to 90?

Answer 3

8 minutes

Question 4

How often should the dressing be changed on a patient who has had a tracheostomy for more than 1 week

Answer 4

Once daily and PRN

Question 5

What airway device would most be most appropriately used on a semi conscious adult pt who is obstructing?

Answer 5

Nasopharyngeal airway

Question 6

What affect will raising PPV on a mech. ventilated Pt have?

Answer 6

Increase FRC

Question 7

How do you calculate dynamic inspiratory time (Ti)?

Answer 7

1. Vt/flow (lps)

• Remember to convert to seconds.

2. Ti = [TCT/ I + E ratio]

Question 8

Regarding a pressure control breath, when equilibrium is occuring, what can you expect?

Answer 8

Plateau pressure to be the same as peak peak pressure

Question 9

Is a time triggered breath mandatory or assisted?

Answer 9

mandatory

Question 10

What happens to mean airway pressure when a inspiratory pause is added?

Answer 10

Mean airway pressure increases

Question 11

A Pt requiring NIV for management of COPD exacerbation requires what?

Answer 11

BiPap settings to allow for alleviation of resp. effort.

• Greater delta pressure/pressure support = greater tidal volumes

Question 12

which pathology would benefit from CPAP?

Answer 12

Cardio pulmonary edema

Question 13

what physiological effect does EPAP provide?

Answer 13

Increases FRC (oxygenation)

Question 14

What is the purpose of a continuous controlled leak in non-invasive ventilation

Answer 14

Allow exhaled gas to escape

Question 15

During NIV, adding an appropriate IPAP has what affect?

Answer 15

Reduces resp. muscle fatigue

Question 16

On NIV, If EPAP improves EPAP what does IPAP do?

Answer 16

Reduces WOB by reducing resp. muscle fatigue.

Explanation:

• IPAP helps to increase the tidal volume by providing a higher pressure during inspiration.
• This helps to overcome any resistance in the airways and deliver a greater volume of air to the lungs.
• IPAP can also help to reduce the work of breathing by assisting the patient with inhalation.

Question 17

An air bubble in the arterial line may produce what effect?

Answer 17

Pressure waveform having reduced amplitude

Question 18

When the inflated balloon tipped PA catheter wedges in a small pulmonary artery, the BP measured through the distal lumen is approximately the same as what?

Answer 18

left atrial pressure

note proximal would be a measure of the PAP

Question 19

Besides placement/location, to obtain an accurate wedge pressure reading, what condition must be met?

Answer 19

There must be uninterrupted blood flow between the catheter tip and the left heart

Question 20

what are indications for open endotracheal (ETT) suctioning?

Answer 20

Visible secretions in the ETT

Question 21

During CPR after an advanced airway is in place, how many breaths should be given?

Answer 21

one breath every 6 seconds (10 breaths in one min)

Question 22

What is postural drainage?

Answer 22

Technique that involves laying/ sitting in certain positions to drain secretions from your airways using gravity.

Question 23

Postural drainage is most appropriate for what condition?

Answer 23

Patient with an ineffective cough

Question 24

If I:E is getting bigger, what does that mean about the ratio?

Answer 24

It is getting closer to 1:1

Question 25

what size of particles would most likely be deposited into the lower parenchyma/alveolar region?

Answer 25

0.8 - 0.3 microns

Question 26

what inspiratory flow should all turbuhalers, diskus, handihalvers have?

Answer 26

30 - 60 lpm

Question 27

A pt with a FEV1 below normal (less than 0.7 of predicted) would likely have what pathology?

Answer 27

obstructive

Question 28

what pulmonary function test requires the pt to inhale carbon monoxide (CO)

Answer 28

DLCO

Question 29

When a thoracic drainage unit is being tested, why would a underwater seal be bubbling continuously when the chest tube is clamped?

Answer 29

The thoracic drainage system has a leak.

Question 30

Nasopharyngeal airways are contraindicated by what factor?

Answer 30

Coagulation disorders

Question 31

what is esophageal intubation?

Answer 31

Incorrect intubation placement

Question 32

How can you rule out esophageal intubation?

Answer 32

Expired CO2 with a capnograph (confirms ventilation)

Question 33

What is a common complication that occurs while intubating?

Answer 33

Esophageal intubation

Question 34

If the patient is cleared for extubation, what should be done before the tube itself is removed?

Answer 34

Preoxygenate

Question 35

A patient with long term ventilator requirements would benefit and serve as an indicator of?

Answer 35

Tracheostomy

Question 36

For a patient with a cuffed tracheostomy tube, before a speaking valve can be applied what needs to be done?

Answer 36

Deflate the cuff

Question 37

What is a primary physiological effect of PEEP?

Answer 37

Increases FRC

Question 38

what is the most common complication post extubation

Answer 38

Air obstruction aka **STRIDOR**

Question 39

What do the following mean 1. Positive leak test 2. Negative leak test

Answer 39

1. A positive cuff leak test means that there is a significant difference in the patient's ability to breathe with the cuff inflated versus deflated. This suggests that the ETT is obstructing the patient's airway and there is a risk of developing post-extubation stridor or airway edema 2. Negative cuff leak test means that there is no significant difference in the patient's ability to breathe with the cuff inflated versus deflated. This suggests that there is a low risk of developing post-extubation stridor or airway edema, and the patient may be a candidate for extubation.

Question 40

What is the most important consideration for extubation?

Answer 40

If the pt can protect their own airway. - aka has cough/gag reflex

Question 41

Passive ventilator circuits are also known as

Answer 41

non-heated vent circuits

Question 42

How often should passive ventilator circuits be changed?

Answer 42

The circuits should be changed whenever they become visibly soiled or contaminated, or if there is a suspected or confirmed infection. - In critically ill patients or those with copious secretions, the circuits may need to be changed more frequently, such as every 24-48 hours. - In patients who are less critically ill or have minimal secretions, the circuits may be changed less frequently, such as every 3-7 days.

Question 43

How will minute ventilation be by PC-CMV adaptative (PRVC)

Answer 43

PRVC will maintain a set min volume (it will adjust pressures to meet volume requirements)

Question 44

In pc-imv how would a decrease in endotracheal tube size (ETT) effect Ti dynamic (Ti)

Answer 44

- A smaller ETT will increase the resistance in the airway and require a higher inspiratory pressure to deliver the same tidal volume, resulting in a **longer Ti dynamic**. - The vent will need to maintain the inspiratory flow rate for a longer time to reach the set tidal volume.