The therapist is to manually calculate expiratory airway ...

[chads108]

The therapist is to manually calculate expiratory airway resistance on a patient receiving mechanical ventilation. What should the therapist do to ensure valid measurements? I. Set the ventilator to deliver a descending ramp flow pattern II. Initiate an expiratory hold maneuver at the end of expiration. III. Ensure that the patient receives a mandatory breath. IV. Institute an inspiratory pause maneuver at the end of inspiration.
 
  A. I, II only
  B. III, IV only
  C. I, II, III only
  D. II, III, IV only

Question 2

A patient receiving mechanical ventilation is about to receive medication delivered via an MDI. Where should the therapist place the spacer, and when should the MDI be actuated?
 
  A. Place the spacer anywhere along the inspiratory limb, and actuate the MDI at the end of inspiration.
  B. Place the spacer in the inspiratory side of the ventilator circuit at the Y, and actuate the MDI at end-exhalation.
  C. Place the spacer near the elbow connector, and actuate the MDI anytime during the ventilatory cycle.
  D. Place the spacer along the inspiratory limb about 50 cm from the elbow connector, and actuate the MDI during inspiration.

[dmurph1496]

Answer to Question 1

ANS: B
A. Incorrect response: See explanation B.
B. Correct response: The ventilator must be set to deliver a square wave inspiratory flow pattern. Any other flow pattern will provide invalid data. If the patient contributes any inspiratory or expiratory effort, the measurement is invalid. The delivered breath must be a mandatory breath.
An expiratory pause is used to measure auto-PEEP, not expiratory airway resistance. An inspiratory pause is initiated at the end of inspiration to obtain peak pressure and plateau pressure readings. Therefore, the pressure generated to overcome airway resistance (driving pressure) can be determined.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.

Answer to Question 2

ANS: B
A. Incorrect response: See explanation B.
B. Correct response: When an MDI is used to deliver medication to a mechanically ventilated patient, the spacer should be attached to the Y in the inspiratory side of the circuit. The MDI can be actuated at end-exhalation so that the drug plume is inspired during the next inspiration. The MDI can also be actuated in synchrony with inspiration.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.

[chads108]

Thank you

[dmurph1496]

No problemo