Mechanical Ventilation Management Flashcards

A patient on SIMV is fighting the ventilator with rapid shallow breaths. Arterial blood gas shows respiratory alkalosis. What is the most appropriate first action?

Answer: Assess for pain, anxiety, and ventilator dyssynchrony

Patient distress and dyssynchrony should be evaluated for treatable causes like pain or anxiety before escalating sedation or paralysis.

What is the primary physiologic benefit of applying PEEP?

Answer: Recruiting collapsed alveoli to improve oxygenation

PEEP keeps alveoli open at end-expiration, increasing functional residual capacity and improving oxygenation.

During a spontaneous breathing trial, which finding suggests the patient is failing and should be returned to full support?

Answer: Rapid shallow breathing index (RSBI) above 105

An RSBI (respiratory rate divided by tidal volume in liters) above 105 predicts weaning failure.

A pressure-support ventilation mode requires which patient capability?

Answer: An intact spontaneous respiratory drive

Pressure support augments each spontaneous breath, so the patient must be triggering breaths.

A ventilated patient's high-pressure alarm sounds repeatedly. After ruling out kinks, what should the nurse assess next?

Answer: Need for suctioning due to secretions

Secretions are a common cause of high-pressure alarms; suctioning may relieve the obstruction.

Which arterial blood gas pattern is most consistent with acute respiratory acidosis from hypoventilation?

Answer: pH 7.28, PaCO2 58, HCO3 24

Low pH with elevated PaCO2 and normal bicarbonate indicates acute (uncompensated) respiratory acidosis.

A low-pressure or low-exhaled-volume alarm on the ventilator most commonly indicates what?

Answer: A disconnection or leak in the circuit

Low-pressure and low-volume alarms typically signal a leak or disconnection in the circuit or around the cuff.