The respiratory therapist is assessing a mechanically ventilated ...

[rosent76]

The respiratory therapist is assessing a mechanically ventilated patient for whom the high pressure alarm is active and the flow-volume loop shows the following:
 
  The action that could alleviate this problem is which of the following?
  a. Place a bite block into the patient's mouth.
  b. Perform a recruitment maneuver and in-crease PEEP.
  c. Administer a fast-acting bronchodilator and suction the ET tube.
  d. Insert a 14-gauge needle into the second intercostal space, midclavicular line, and right side.

Question 2

Which of the following can activate an apnea alarm?
 
  a. Secretions
  b. Auto-PEEP
  c. Loss of PEEP
  d. Active inhalation

[yuyiding]

Answer to Question 1

ANS: C
The flow-volume loop shows increased expiratory resistance; this plus activation of the high pressure alarm indicates increased airway resistance. Increased airway resistance can be caused by bronchospasm, which can be alleviated by a bronchodilator and suctioning. Although a patient biting the tubing would cause a high pressure alarm, no or very little volume would enter the pa-tient, and the flow-volume loop would not be as large. The flow-volume loop is not indicative of low compliance, which would necessitate a recruitment maneuver and increased PEEP. The ex-piratory flow would not be scooped out if low compliance were a problem. Because the signs indicate increased airway resistance, needle decompression is not appropriate.

Answer to Question 2

ANS: B
In a spontaneous mode, the presence of auto-PEEP can cause the patient difficulty in triggering the ventilator. As a result, the patient's efforts can go undetected, and the ventilator misinterprets this as apnea.

[rosent76]

Excellent

[mcarey591]

TYSM