Workbook Ch 10 Mech Part 2

Front 1

Name 7 conditions that cause hypermetabolic states & 5 conditions that cause hypometabolic states

Back 1

HM: pancratitis, hyperthyroidism, pregnancy, stimulants, hyperthermia, seizures 7 burns.
Hmet: starvation hypothyroidism, anesthesia, sedation & hypothermia

Front 2

What is the RQ range for a healthy adult consuming a typical American diet?

Back 2

0.8-0.85

Front 3

The RQ for feedings of large amounts of glucos is 1.0 & for prolonged starvation is ___.

Back 3

0.7

Front 4

When CO2 is production is increases, the respiratory quotient ____.

Back 4

increases

Front 5

If a mechanically ventilated pt is only being given IV glucose, the pt's RQ will be close to 1, meaning that the patient's CO2 production is elevated. With a limited ventilatory reserve, a patient being weaned will most likely not be able to handle the increased CO2 load. this type of failure to wean can be avoided by switching the diet to one that has ____.

Back 5

a higher fat to carbohydrate ratio

Front 6

The devices used to measure airway pressures int he current generation of adult and neonatal vents are ____ transducers.

Back 6

electromechanical

Front 7

The most common airway pressure measurements are ___.

Back 7

Peak Inspiratory Pressure, Static Pressure & Plateau Pressure

Front 8

On newer ventilators, static pressure is obtained by adding an ____ or plateau for 1-2 seconds to allow pressure equilibrium to occur across the airway.

Back 8

inspiratory hold

Front 9

Factors that influence plateau pressure include: Vt, Lung & Thoracic Compliance, Circuit Elastance & the _____.

Back 9

total measured PEEP

Front 10

Vortex ultrasonic flowmeters, variable orifice pneumotachometers, & turbine flowmeters are used during mechanical ventilation to measure ___.

Back 10

flow

Front 11

A ____ pneumotachometer can be used to detect bi-directional flow.

Back 11

variable orifice

Front 12

Increases in peak inspiratory pressure (PIP) may be caused by: bronchospasm, increased mucus, mucus plugging, _____ & water in the ventilator tubing.

Back 12

clogged HME

Front 13

What is the formula for calculating mean airway pressure?

Back 13

Paw=
[1/2(PIP-PEEP)(Ti/TCT)]+PEEP

Front 14

Calculate Paw for the following clincal data: PIP 30cmH2O, PEEP 5cmH2O, set respiratory rate 12 breaths/min & Ti of 1sec.

Back 14

Paw=
{1/2(PIP-PEEP)(Ti/TCT)}+PEEP
{1/2(30-5)(1/5)}+5
{1/2(25)(1/5)}+5
=7.5cmH2O

Front 15

Calculate static compliance for the following clincal data: Pplat 28cmH2O, PEEP 10cmH2O, Vt 400mL & Ct 2mL/cmH2O.

Back 15

Cstat=
Vt-[(Pplat-PEEP)*Ct]/(Pplat-PEEP)
400-[(28-10)*2]/(28-10)
400-[36]/18
364/18
=20.2 cmH2O

Front 16

Calculate airway resistance for the following clinical data; PIP 35cmH2O, Pplat 25cmH2O & flow rate 50L/min.

Back 16

first, change L/mn to L/sec
50/mn*1mn/60sec=aprox .83L/sc
Raw=
(PIP-Pplat)/Flow rate(L/sec)
(35-25)/.83
10/.83
=12cmH2O

Front 17

Work to overcome the normal elastic & resistive forces plus the work to overcome a disease process affecting normal workloads in the lung & thorax is known as ____.

Back 17

Intrinsic work

Front 18

Five factors that increase the extrinsic WOB are the ET tube, machine sensitivity, ___ humidifying device & the pt circuit.

Back 18

demand valve systems

Front 19

What is the mathmatical formula for the WOB?

Back 19

WOB=
(PIP-.5xPplat)/ 100xVt

Front 20

An increase in airway resistance, such as happens during bronchospasm, makes it more difficult for a pt to ____. This increases the work a pt must do to breathe (WOB).

Back 20

inhale & exhale

Front 21

A decrease in Cstat implies that the Pplat has increased. Increases in Pplat occur when more pressure is needed to overcome elastance. The pt's WOB must increase to accommodate this change. (Note that increases in Pplat result in a higher PIP as well.) Mathmatically, this increases the numerator of the WOB formula, thereby, _____.

Back 21

increasing the calculated WOB.

Front 22

Pulmonary Interstitial fibrosis, ___, hyper inflation, consolidation, RDS, & pulmonary vascular congestion are all pathological conditions that are associated with decreases in lung compliance.

Back 22

pleural effusion

Front 23

___ is associated with reductions in both Cstat & Cdyn.

Back 23

CHF

Front 24

Increases is airway resistance may be caused by: retention of secretions, peribronchiolar edema, bronchoconstriction & ___.

Back 24

dynamic compression of the airways

Front 25

The TRANSDIAPHRAGMATIC PRESSURE is a measure of the forcefulness of diaphragmatic contractions obtained by simultaneously measuring the ___ during the respiratory cycle. The electronic difference between these 2 pressures is the transdiaphragmatic pressure.

Back 25

gastric (Pga) & esophageal (Pes) pressures

Front 26

The ____ is a graph of the transdiaphragmatic pressure plotted over time.

Back 26

pressure-time product

Front 27

___ is the pressure measured by occluding the airway during the first 100ms of a pt's spontaneous inspiration. It may be a useful indes of ventilatory drive & may be used as a predictor of weaning sucess.

Back 27

Occlusion pressure

Front 28

COHB & MetHb are unable to carry oxygen but are actually part of a fractional hemoglobin saturation. pulse oximetry values include the functional hemoglobin. This causes SpO2 values to appear normal when dysfuctional hemoglobins are elevated. Therefore, when dysfuctional hemoglobins are suspected, blood should be drawn for analysis in a ___.

Back 28

CO oximeter

Front 29

When trying to use a finger probe for pulse oximetry, the RT finds that pulse rate & ECG monitor are not consistant & there is no SPO2 reading. One reason is that the finger sensor may be misaligned by inserting the pt's finger too far into the probe. Another cause could be ____. RT should do a capillary refill test, try another finger or warm the finger by rubbing it for 20-30 seconds.

Back 29

hypoperfusion to the site

Front 30

During cardiac arrest, blood flow is not occurring. Therefore, CO2 is not being returned to the pulmonary system to be eliminated during exhalation. When a colorimetric detector is used, this situation would produce a reading of ___ end-tidal CO2. During decreased cardiac output, blood flow to the lungs is decreased, which produces a low end-tidal CO2 reading.

Back 30

less than .5%

Front 31

A pulse oximeter is generally considered accurate for O2 saturations greater than which of the following? (.65,.70,.75,.80)

Back 31

.80

Front 32

A RT encounters a pt whose pulse oximetry reading is 73%. The most appropriate action is to __.

Back 32

confirm the value with arterial blood CO-oximeter analysis.

Front 33

The response time of a pulse oximeter is most directly affected by ____.

Back 33

the location of the sensor or the probe

Front 34

The oxyhemoglobin concentration divided by the concentration of hemoglobin capable of carrying oxygen determines ___.

Back 34

Functional hemoglobin

Front 35

On rounds, a RT encounters a pt who is receiving supplemental O2 & whose SpOo2 is constantly displaying 85%. The RT notes that the pt is also receiving dapsone. the most appropriate action to take is.....

Back 35

confirm with CO-oximeter.

Front 36

The partial pressure of end-tidal CO2 is read at what point on a capnograph?

Back 36

During phase 3

Front 37

The arterial to maximum expiratory PCO2 gradient will be greatest for a pt with ___.

Back 37

Pulmonary Embolism

Front 38

The most reliable method for ruling out esophageal intubation is ___.

Back 38

the presence of CO2 in the pt's exhaled gas

Front 39

Most likely, cardiac arrest will cause a colorimetric CO2 detector to display ___.

Back 39

less than 1% CO2 per NBRC(textbook says .5)

Front 40

A RT is called to the bedside of a pt who is being transcutaneously monitored for PO2 & PCO2. The signal is drifting & will not stabilixe during calibration. To fix this the RT should clean the electrode & Change the sensor membrane (remember to ____).

Back 40

add a drop of electrolyte solution to the electrode surface

Front 41

A difficult to wean pt with COPD has a RQ of 0.98. The most likely cause of this pt's inability to be weaned is ___.

Back 41

excessive carbohydrates are overloading the pt's ventilatory reserve

Front 42

The tracing of a slow-speed capnograph is not returning to zero every exhalation. The most likely cause of this finding is ___.

Back 42

that CO2 is being re-breathed

Front 43

A RT monitoring a pt receiving mechanical ventilatory support finds that over the past 2 hrs the pt's PIP IS INCREASING but the STATIC PRESSURE IS STABLE. This could be caused by ___.

Back 43

retained secretions

Front 44

Intrinsic WOB will be increased by which of the following? (bronchospasm, ET tube, machine sensitivity or HME)

Back 44

bronchospasm