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mechanical ventilation - exam 1 questions with answers
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Reasons for Mechanical Ventilation - ANSWER: - Acute Respiratory Failure - Ventilatory Failure - not moving adequately but perfusing - Oxygenation Failure - moving air but perfusing inadequate - Combined Ventilatory and Oxygenation Failure Acute Respiratory Failure - ANSWER: - Classified as...

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  • June 23, 2024
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  • 2023/2024
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mechanical ventilation - exam 1
questions with answers

Reasons for Mechanical Ventilation - ANSWER: ✔✔- Acute Respiratory Failure

- Ventilatory Failure - not moving adequately but perfusing

- Oxygenation Failure - moving air but perfusing inadequate

- Combined Ventilatory and Oxygenation Failure



Acute Respiratory Failure - ANSWER: ✔✔- Classified as blood gas abnormality

- PaO2 less than 60 mm Hg (however, less than 80 is hypoxemia)

- PCo2 greater than 45 mm Hg with acidosis.

- Sa02 less than 90%. (pulse oximetry)

- Can be caused by ventilatory failure, oxygenation failure or a combination of both.

- Whatever the cause, the patient is hypoxemic.



Ventilatory Failure - ANSWER: ✔✔- Can result from inadequate chest wall movement not allowing
enough air movement into and out of the lungs, which causes carbon dioxide to be retained.

- Muscle weakness that occurs with some neuromuscular diseases such as Myasthenia Gravis, ALS, brain
stem dysfunction can cause inadequate ventilation.

- Table 32-2

- Shallow resp, agonal resp, probs with brain



Oxygenation Failure - ANSWER: ✔✔- Oxygenation failure results when air moves in and out the lungs
without difficulty, but does not oxygenate the blood sufficiently.

- Poor diffusion of oxygen at the alveolar level.

- Air that is low in oxygen

- Abnormal hemoglobin that fails to bind oxygen.

- Table 32-3

,Combined Ventilatory and Oxygenation Failure - ANSWER: ✔✔- Hypoventilation and poor gas diffusion
with or without poor lung perfusion.

- Examples are ARDS and combined heart failure and lung disease.

- With ards, surfactant is washed away and pt will have slower breaths and lungs fdont' move adequately
and lungs become stiff and as alveoli are affected , we don't have good oxygenation



Clinical Manifestations (ASSESSMENT) - ANSWER: ✔✔- Dyspnea - difficulty breathing

- Orthopnea - can't breathe while laying down. characterized by number of pillows it takes for pt to lay
on to breath properly

- Hypercarbia - too much CO2

Pallor - turning pale or grayish (later sign)

- Cyanosis - turning blue or purple (later sign)

Restlessness - will happen with hypoxemia (early sign)

- Confusion

- Labored breathing

- Agonal respirations- An abnormal pattern of breathing characterized by gasping, labored breaths that
are not effective. Not moving air

--- Can be the result of brain injury, respiratory failure, cardiac arrest



Diagnostics - ANSWER: ✔✔- Pulse Oximetry - measured on finger, earlobe, nose, forehead (SaO2 95% -
100%)

- ABGs - most reliable way to tell about gas echange and oxygenation

- End-Tidal Carbon Dioxide Monitoring - amount of CO2 that is exhaled (normal value is 35-45). When pt
is being intubated is the most definitive way to show proper placement without x-ray

- CXR - can visualize lungs and see if pt is properly intubated, if needed



Pulse Oximetry (cannot replace abgs) - ANSWER: ✔✔- Noninvasive measurement of oxygen saturation
(SpO2).

- Measures the percentage of oxygen bound to hemoglobin (normal 97%)

- Can be used for continuous monitoring or spot check.

, - Can reduce the need for frequent sampling of arterial blood

- Can it completely replace ABGs?



When is Pulse Ox Not Accurate?? - ANSWER: ✔✔- Vasoconstriction meds - epinephrine, dopamine

- Elevated carboxyhemoglobin (smokers)

- Shock - decreased perfusion and compensatory mechanisms cause vasoconstrictions

- Severe anemia - not enough circulation hemoglobin

- Arrested - blood is shunted from periphery to heart to sustain bp

Anything causing decreased perfusion

- Thick acrylic nails



End-Tidal Carbon Dioxide - ANSWER: ✔✔- Measures the level of CO2 at the end of exhalation by
changing colors

- Measured via

--- Endotracheal tube

--- Nasal or oral airway



Nursing Diagnoses related to mechanical ventilation - ANSWER: ✔✔- Impaired Gas Exchange - look at
abgs

- Ineffective Breathing Pattern - look at resp rate (12-20 (or 28 for resp failure), depth, and effort [should
be full even and unlabored with chest movement symmetrical]

- Ineffective Airway Clearance - abnormal breath sounds (crackles, wheezing, coarse, moist non-
productive cough, et tube that keeps getting clogged with secretions)

- Impaired Spontaneous Ventilation - apnea, agonal breathing, decreased rate of 10 or 8

- For unsuccessful weaning - dysfunctional ventilatory weaning process



Goals/Objectives - ANSWER: ✔✔- ABG's return within normal value - don't say normal value say a PaO2
greater than or equal to 80, pH between 7.35 and 7.45, and PaCO2 between 35 and 45

- Resp 12-28, full, even, and unlabored

- O2 sat >/ 92% (lower may be acceptable depending on the pt and doctor's order)

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