A patient is receiving full ventilatory support with volume ...

[Ebrown]

A patient is receiving full ventilatory support with volume ventilation. At 0700 the respiratory therapist observes the pressure-, volume-, and flow-time scalars shown in A below.
 
  Six hours later the respiratory therapist observes the scalars shown in B. The most appropriate action to take is which of the following?
 
  a. Increase the positive end-expiratory pres-sure (PEEP) level.
  b. Check the circuit for a leak.
  c. Administer a bronchodilator.
  d. Switch to pressure ventilation.

Question 2

During pressure-controlled continuous mandatory ventilation (PC-CMV) the respiratory therapist observes the pressure-time scalar shown below. The most appropriate action to take is which of the following?
 
  a. Adjust the inspiratory time.
  b. Increase the flow rate setting.
  c. Adjust the inspiratory rise time control.
  d. Increase the peak inspiratory pressure set-ting.

[gabrielle_lawrence]

Answer to Question 1

ANS: C
All three scalars show signs of increased airway resistance. The pressure-time scalar shows an in-crease in peak inspiratory pressure (PIP). The volume-time scalar shows that it is taking longer for the patient to exhale all the volume. The flow-time scalar shows that the expiratory flow is very slow and takes a long time to rise to the zero baseline.

Answer to Question 2

ANS: C
The pressure-time scalar shows a pressure spike at the beginning of the pressure curve before the pressure adjusts to the set value. Adjusting the inspiratory rise time control will slow the rate at which pressure and flow exit the ventilator. This will reduce or eliminate the pressure spike.