Contemporary Topics Chapter 10 + 11 Quiz

The data has been collected from a sedated, paralyzed patient whose ventilator is in A/C mode. Vt: 600 ml RR: 15 FiO2: 0.45 PH: 7.50 PaCo2: 30 paO2: 98 To increase the paco2 to 40 mmhg the ventilator rate should be adjusted to what rate?

11

The information below has been obtained from a patient on an aerosol mask at 40% O2. PH:7.42 PaCO2: 36 paO2: 122 HCO3: 26 Barometric pressure: 747 What is the patients P(a-a)O2?

113 mmHg

Co2 is approx. ______ of inspired air

0.003%

What do you record on an ABG sample that is drawn?

- Fio2 - Vt - RR - mode of vetilation - PEEP level - mechanical dead space - patients temperature

Common criteria for initiating mechanical ventilation

- VC less than 10-15 (normal 65-75) - p(A-a)o2 greater than 450 with 100% (normal 25-65) - dead space greater than 60% -unable to maintain a MIP of Atleast -20 (normal -50 to -100) -PEP of less than 40 (normal is 100) - RR greater than 35 - P/F ratio less than or equal to 300 (ALI) or less than 200 (ARDS)

If a patient is using a 50% to 60% oxygen mask and they still have hypoxemia you would:

-Initiate CPAP or add PEEP -if patient is on ventilator and on 50-60% then add more O2

Indications for mechanical ventilation

-apnea - acute ventilatory failure - impending acute ventilatory failure -oxygenation

Following information is obtained from a vented patient: PIP: 42 Pplat: 27 Vt: 500 ml PEEP: 6 What is the static compliance?

24

Normal P-50:

27 mmHg;Conditions: 37 ºC, PCO2 40 mmHg, pH 7.40 It is the most sensitive indicator of a curve shift by factors other than pH, T°, and PCO2.

Normal P(A-a)O2 gradient

4-12 mmhg

If a patient has a fever, how does it affect ABG

A fever shifts the HbO2 curve to the right, indicating that hemoglobin more readily releases O2 to the tissues but does not pick up the O2 easily. This may affect the PaO2 value but not usually to a specific degree

ABG results: PH: 7.38 PaCO2: 61 PaO2: 62 HCO3: 33 BE: +9 What is the acid base status , ventilatory status, metabolic status, and oxygenation status?

Acid base: Normal PH Ventilatory status: increased paco2 hypoventilation resulting in decreased PH Metabolic status: elevated HCO3, compensation for initial acidosis Oxygenation status: moderate hypoxemia

A patient with a 2LPM nasal cannula has the following ABG results: PH: 7.51 PaCO2: 27 PaO2: 62 HCO3: 23 These results indicate which of the following conditions?

Acute respiratory alkalosis

Right shift of dissociation curve indicates

Affinity of hb for O2 has decreased, or hb will release O2 to the tissues more readily

If there is a left shift in the dissociation curve indicates

Affinity of hb for o2 has increased or hb will not release o2 to the tissues readily

A patient being MV in AC mode at a rate of 12 Is triggering the ventilator at a rate of 34/min. The patient is anxious and agitated and has the following ABG: PH: 7.55 PaCO2: 25 PaO2: 96 HCO3: 25 BE: +1 What medication should the RT recommend at this time?

Albuterol (proventil)

What do the results of an Allen's test mean?

An Allen's year is done before a radial arterial puncture to determine collateral blood flow to the hand. It is essential to determine whether ulnar blood flow is present in case the radial artery spasms or clots

Patients not able to achieve an MIP of Atleast -20 cannot generate:

An adequate cough to maintain secretion clearance

Blood gas analysis monitors the following physiologic variables

Arterial oxygenation: pao2 Alveolar ventilation: paco2 Acid-base status: PH Tissue oxygenation: PvO2

What is the Bohr effect?

As the RBC travels to the tissue, it releases the oxygen because elevated CO2 levels, which are present around tissues, decrease the affinity of hb for O2

The s-shapes curve of the HbO2 dissociation curve indicates that

At paO2 levels of less than 60 mmhg, small increases in PaO2 result in fairly large increases in SaO2

Static compliance will decrease as a result of what?

Atelectasis

Mechanical ventilation can lead to which of the following complications?

Barotrauma

The RT has received an order to obtain an ABG sample from a patient, but an Allen's test indicates collateral circulation is not present in the right wrist. At this time, the therapist would:

Check collateral circulation in the left wrist

Paco2 DECREASES when _____ decreases or _____ increases

Dead space decreases RR or Vt increases

The PaO2 is the portion of oxygen that is:

Dissolved in plasma For every 1 mmHg of PaO2, there is 0.003 mL of dissolved O2

3 ways CO2 is transported in the blood

Dissolved in plasma Bound to hb As HCO3

The RT reviewing ABGS obtained earlier in the day from a patient on a 35% air-entrainment mask. The ABG values are: PH: 7.43 PaCO2:29 PaO2: 70 HCO3: 18 What is the correct interpretation of this blood gas?

Fully compensated respiratory alkalosis with mild hypoxemia

Most effective way in preventing cross contamination of patients is

Hand washing

Which of the following conditions shifts the HbO2 dissociation curve to the right?

Hypercapnia

Factors that shift the curve to the right include:

Hypercapnia Acidosis Hyperthermia Increased DPG

Factors that shift the dissociation curves LEFT include:

Hypocapnia Alkalosis Hypothermia Decreased DPG HbCO

The following data are collected on a 70 kg (154 lb) female receiving mechanical ventilation in volume control: Mode: SIMV Vent rate: 12 Total rate: 24 Vt: 500ml Fio2: 0.35 Pressure support: 7 PEEP: 5 PH: 7.48 PaCO2: 30 PaO2: 62 HCO3: 23 BE: -2 What appropriate ventilator changes are appropriate at this time?

Increase the FiO2 to 0.45

A 34 year old patient with CHF is in the ICU receiving noninvasive positive pressure ventilation by mask. The settings and ABG results are below: IPAP: EPAP: RR: PH: 7.29 PaCo2: 51 PaO2: 63 HCO3: 23 BE: -1 Which of the following should be recommended to improve the patients ventilatory status?

Increase the IPAP to 18 CmH2O

What does air bubbles in the syring cause?

Increased PaO2 as high as 150 torr and decreased paCo2 levels

A patient receiving volume controlled ventilation in assist-control mode, and the I:E ratio alarm is sounding. Which control adjustment would correct this problem?

Increased flow rate

The following data has been collected from a patient receiving volume control ventilation in the AC mode Vt: 500 ml RR: 10 FiO2: 0.50 PEEP: 5 PH: 7.44 PaCO2: 42 PaO2: 58 Based on this information, the RT should recommend which ventilator changes?

Initiate CPAP at 4 cmH2O and an Fio2 of 50%

Paco2 increases when ______ decreases or _____ increases.

Minute ventilation decreases Dead space increases

What is the half as effect?

Oxygen combines with the hb, the release of CO2 is enhanced

Which of the following ABG measurements determines how well the patients lungs are being ventilated?

PaCO2

What is POC analyzer?

Portable ABG analyzer that allows blood gas testing to be done at or near the patients bedside

Which of the following blood gas measurements determines the level of tissue oxygenation?

PvO2

A pt on a MV has the following ABGS: PH: 7.27 Paco2: 28 Pao2: 88 HCO3: 27 Based on this data the RT should recommend which of the following?

Repeat the blood gas evaluation since the results in I ate a lab error

HbO2 dissociation curve

Shows the relationship between PO2 and sao2 and the affinity that hb has for O2 at various saturation levels

The following blood gases are obtained on a severe cyanosis COPD patient on a 2 LPM nasal cannula: PH: 7.51 PaCO2: 29 PaO2: 155 HCO3: 34 What accounts for these ABG values?

There is air in the blood sample

The following ABGS have been recorded for a patient on a 35% air entrainment mask: PH: 7.51 PaCO2: 42 PaO2: 79 HCO3: 33 What is the correct interpretation for this blood gas?

Uncompensated metabolic alkalosis