207 Unit 4

Calculate the cerebral perfusion pressure when the mean arterial blood pressure is 120 mm Hg and the ICP is 14 mm Hg.

106 mm Hg

Dark pattern, air

radiolucent

PPV may improve left ventricular dysfunction because of ?

the decrease in afterload

A stroke volume of 100cc and a heart rate of 38 bpm produces a cardiac output with is a trained athlete

true

Four different tissue densities are air, fat, water, and bone

true

It is thought that patients with TBI would benefit from hyperventilation?

true

Overdistended alveoli can impede venous return?

true

Normovolemic patients experience decreases in cardiac output above what level of PEEP?

15 cm H2O

Which of the following is the range for the time a pulmonary artery catheter should be inflated?

15-30 seconds Correct

On a chest radiograph, the tip of the endotracheal tube for an adult patient should be

2 cm above the carina

A patient with a mitral valve stenosis is most likely to have which of the following pulmonary artery occlusion pressure (PAOP) values?

20mmhg

ETT placement should be

5-7 cm above the carina in the sniffing position

Urinary output is severely reduced when the renal arterial pressure decreases below what level?

75 mm Hg

Which of the following patient conditions is least likely to experience hemodynamic changes with high alveolar pressures during mechanical ventilation?

ARDS

A patient in the ICU has a chest X-ray that shows bilateral infiltrates and has the following hemodynamic measurements: central venous pressure (CVP) 3 mm Hg, pulmonary artery pressure (PAP) 21/10 mm Hg, and pulmonary artery occlusion pressure (PAOP) 8 mm Hg- These findings are consistent with which of the following?

Acute respiratory distress syndrome

Which of the following is not used to determine cardiac output

Blood pressure

You place a patient on PPV and you notice their CO decreased within a few beats. Why?

the intrathoracic veins are compressed

A patient is believed to have a pleural effusion, Which of the following radiographic techniques would be most useful in making a confirmation?

CT.

Which measurement most accurately reflects preload?

CVP

What do the following PCWP numbers indicate?

CVP of 15mmHG → Fluid overload, right heart failure, PCWP of 20 → Left heart failure, pulmonary edema, Increase in PAP → pulmonary hypercapnia

A patient has dyspnea and tachycardia following thoracentesis to treat a pleural effusion-Evaluation of this patient should include?

CXR

Absolute confirmation of placement of a central venous pressure catheter is done with which of the following?

CXR

Which of the following can cause an elevated right arterial pressure?

Cardiac tamponade

A patient in the ICU has a chest X-ray that shows bilateral infiltrates and has the following hemodynamic measurements: central venous pressure (CVP) 5 mm Hg, pulmonary artery pressure (PAP) 24/13 mm Hg, and pulmonary artery occlusion pressure (PAOP) 21 mm Hg- These findings are consistent with which of the following?

Cardiogenic pulmonary edema

.Which of the following measurements can be used to estimate right ventricular preload?

Central venous pressure

Which of the following is the hemodynamic measurement that is indicative of a patient with right heart failure?

Central venous pressure (CVP) = 16 mm Hg

.A patient with a history of hypertension presents in the ED with headache, slurred speech, and left-sided weakness- What diagnostic imaging procedure would the respiratory therapist recommend to further evaluate this patient according to the ACLS guidelines?

Computed tomography (CT).

A patient with a history of pulmonary pathology and cancer presents with a suspicious mediastinal mass on the chest x-ray- What diagnostic imaging procedure would be useful in gathering further information about the mass?

Computed tomography (CT).

An intubated patient with no known history of congestive heart failure is in the ICU- The patient is comatose and currently receiving mechanical ventilation via volume-controlled continuous mandatory ventilation (VC-CMV), set rate 12 breaths/min, set tidal volume (VT) 400 mL, positive end-expiratory pressure (PEEP) 18 cm H2O, fractional inspired oxygen (FIO2) 35, and the patient is not assisting- Hemodynamic measurements show the following- central venous pressure (CVP) 5 mm Hg, pulmonary artery pressure (PAP) 33/20 mm Hg, and pulmonary artery occlusion pressure (PAOP) 16 mm Hg- Arterial blood gas (ABG) results are: pH 7 43, arterial partial pressure of carbon dioxide (PaCO2) 38 mm Hg, arterial partial pressure of oxygen (PaO2) 90 mm Hg, The physician asks for recommendations to improve this patient's hemodynamics- The most appropriate recommendation for this patient is which of the following?

Decrease the PEEP incrementally and recheck hemodynamic measurements.

The sign of worsening backward heart failure that requires intervention is

Development of leg edema

Ventricular contractility can be estimated by which of the following?

Ejection fraction

CVP measures what?

Fluid levels

Positive pressure ventilation increases splanchnic resistance, decreases splanchnic venous outflow, and may contribute to gastric mucosal ischemia, which can contribute to which of the following?1

Gastric ulcers

ARDS may present with what on the xray?

Ground glass diffuse bilateral opacity

Select the 4 main factors that influence th3e output of the right and left ventricle:

Heart Rate, Preload, Contractility, Afterload

Which of the following is the most likely cause of uneven ventilation?

High inspiratory flow rates

.Which of the following disorders can cause an increase in systemic vascular resistance?

Hypervolemia

My Hoyt, 72, is admitted with bilateral pneumonia. He has CAD. His BP si 110/90, HR 120, CO 4lpm and stroke volume 4lpm. What is the best approach to increase his cardiac output?

Increase fluid

Which of the following will cause an increase in systemic vascular resistance?

Increase left ventricular afterload

An otherwise healthy 19-year-old male is currently intubated and being mechanically ventilated after a motorcycle accident in which he sustained a closed head injury and multiple rib fractures- Before the patient is taken to the operating room for cranial surgery, the respiratory therapist notices that he has jugular vein distention- The most likely cause of this problem is which of the following?

Increased intracranial pressure

High tidal volumes and/or high levels of PEEP can cause which of the following?

Increased right ventricular afterload

Malnutrition during mechanical ventilation can cause which of the following?

Increased spontaneous ventilation

What specific type of chest radiograph may be useful in evaluating pleural effusion?

Lateral decubitus position.

A respiratory care practitioner is treating a child with respiratory distress in the emergency department, Which type of diagnostic imaging procedure may be useful for differentiating between epiglottitis and croup in children?

Lateral neck x-ray.

PCWP is a measurement of what?

Left heart

.The harmful cardiovascular effects of PPV are influenced most by which of the following pressures?

Mean airway pressure

Which of the following condition must exist to cause the interventricular septum to move to the left during positive pressure ventilation?

Mean airway pressure >15 cm H2O

You place a patient on PPV and later you notice that the urine output decreases. You should look at what to determine if PPV caused this

Mean arterial pressure would be decreased

Which of the following IV solutions could be considered treatment for hypovolemia?

Normal saline

A patient with CHF will have an increased what?

PCWP

What resistance must the right ventricle overcome to pump blood into the lungs?

PVR

Which of the following describes the filling pressure of the ventricle at the end of ventricular diastole?

Preload

Advancing a pulmonary artery catheter into a smaller artery may cause which of the following complications?

Pulmonary infarction

Pulmonary vascular resistance Systemic Vascular resistance

Pulmonary vascular resistance → measures the afterload of the right ventricle, Systemic Vascular resistance → measures the afterload of left ventricle

The respiratory therapist is checking a patient-ventilator system in the medical intensive care unit when the high-pressure alarm begins to sound. Breath sounds are absent on the left with good tube placement. Blood pressure is 80/50 mm Hg. SpO2 is 86% and falling. The heart rate is 160 beats/min. There is a hyperresonant percussion note on the left upper chest. The patient has lost consciousness. What action should the respiratory therapist take at this time?

Recommend immediate needle decompression of the cheST

Positive pressure ventilation has which of the following effects on the kidneys?

Redistributes blood flow in the kidneys

While attempting to draw blood from an indwelling arterial catheter, the respiratory therapist notices a dampened waveform and has difficulty withdrawing blood for sampling- What should the respiratory therapist's immediate action be?

Remove the catheter.

Which measurement is typically used to indicate right ventricular preload?

Right ventricular end-diastolic pressure (RVEDP)

During spontaneous breathing, the fall in intrapleural pressure that draws air into the lungs during inspiration also draws blood into the major thoracic vessels- This phenomenon increases which of the following?

Right ventricular preload

A low CVP value is indicative of which of the following?

Shock, dehydration, hemorrhage

Which of the following is an indication of left ventricular afterload?

Systemic vascular resistance

During the inspiratory phase of spontaneous breathing, what happens to the pulmonary artery (PA) waveform?

The PA waveform trend decreases.

when heart rate increase to greater than 200 bpm there is a decrease in cardiac output because diastolic filling time decreases

true

The medical record of an intubated patient indicates that the morning chest film shows opacification of the lower right lung field with elevated right diaphragm and a shift of the trachea to the right-These findings suggest?

right-sided atelectasis

An increase in pulmonary artery pressure is concerning for what?

The lungs

A MAP below 60 indicates what?

compromised circulation to vital organs, poor tissue perfusion

A pneumothorax would appear on a chest radiograph as a.

dark area without lung marking

Spread throughout

diffuse

Opaque

fluid/solid

Extra pulmonary air

hyperlucency

As the myocardium hypertrophies and heart failure develops, what happens to the value of the ejection fraction?

it gradually decreases

What would you see on a chest xray with a PCWP > 18mmHG?

The onset of pulmonary vascular congestion

The CNS effects of PPV are

loss of control, loss of autonomy, inability to communicate

The mode that causes the greatest reduction in cardiac output during ventilation is which of the following?

VC-CMV with PEEP

what typically causes retrograde flow in the heart?

Valve dysfunction

.What is the most determining factor for preload?

Venous return

Way to minimize the negative effects of PPV

adequate fluid balance, Low MAP and PEEP, Using vasopressors

Infiltrate

any ill defined radiodensity

Radiodense/opacity

white pattern, solid or fluid