The high-pressure alarm activates on a patient receiving ...

[xroflmao]

The high-pressure alarm activates on a patient receiving mechanical ventilatory support. The pa-tient is tachycardic and tachypnic with absent breath sounds on the right side. Which of the fol-lowing condition(s) could be the cause?
 
  1. Pneumothorax
  2. Pulmonary edema
  3. Disconnection from the ventilator
  4. Increased airway resistance
  a. 1 only
  b. 4 only
  c. 1, 2, and 3 only
  d. 1 and 4 only

Question 2

The respiratory therapist is performing a patient-ventilator system check on a patient who was in a motor vehicle accident 2 days earlier. The therapist gathers the following information from the flow sheet:
 
  Day/Time 1/25:1720 1/26:0830 1/26:1840 1/27:0650
  Mode VC-CMV VC-CMV VC-CMV VC-CMV
  PIP (cm H2O) 21 28 32 41
  Pplateau (cm H2O) 18 25 29 38
  Which condition most likely has produced the changes reflected in these data?
  a. Bronchospasm
  b. Abdominal distention
  c. Secretion retention
  d. Mucosal edema

[Jody Vaughn]

Answer to Question 1

ANS: A
Pneumothorax is another possible problem that must be detected during positive pressure ventila-tion (PPV) and treated quickly. Pneumothorax can be recognized as increased WOB if a patient is conscious. For example, the patient may demonstrate nasal flaring, use of accessory muscles, uneven chest wall movement, and absence of breath sounds on the affected side. Auscultation and percussion of the chest, cardiovascular assessment, and ventilating pressure evaluations usu-ally can distinguish a pneumothorax from other problems.

Answer to Question 2

ANS: B
The difference between the PIP and Pplateau is consistent throughout the documentation (3 cm H2O). The Pplateau has increased over the course of the 36 hours, from 18 to 38 cm H2O. This in-dicates a decrease in static lung compliance. Causes of this condition include ARDS, pneumonia, pneumothorax, pleural effusions, abdominal distention, and ascites. Bronchospasm, secretion re-tention, and mucosal edema would increase the transairway pressure (PIP  Pplateau).