• NRNP 6566 Week 7 knowledge check

• NRNP 6566 Week 7 knowledge check • Question 1 A patient with respiratory failure has hemodynamic monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 10 cm H2O. Which information indicates that a change in the ventilator settings may be required? a. The arterial line shows a blood pressure of 90/46. b. The pulmonary artery pressure (PAP) is decreased. c. The cardiac monitor shows a heart rate of 58 beats/min. d. The pulmonary artery wedge pressure (PAWP) is increased. Correct Answer: The hypotension indicates that the high intrathoracic pressure caused by the PEEP may be de-creasing venous return and cardiac output (CO). Decreasing the PEEP should decrease the intrathoracic pressure and improving venous return and cardiac output. The APRN is monitoring a newly intubated patient. He appears to be very anxious and “fighting” the ventilator. What would be the most appropriate action? Correct Answer: Remove the patient from the ventilator and bag him with 100% FIO2. If the patient improves, then the problem is with the ventilator. Respiratory professional should check the ventilator function. If the patient does not improve, the problem is with the patient. If death appears imminent, airway obstruction pneumothorax, and dislodged endotracheal tube must be considered as the cause. If death is not imminent, close examination of the patient and chest X-ray should be completed. The need for additional sedation should be considered as well. A 59 year old man was admitted to the ICU for a COPD exacerbation. He was intubated earlier in the day. Initially after being intubated his static pressure was 23 cm H2o and peak pressure 47 cm H20. The APRN is notified that currently his peak pressure has risen to 62 cm H20 and the static pressure is 42 cm H20. His heart rate has increased from 88 to 112beats / minute and his blood pressure has decreased from 112/88 to 92/ 72. He has decreased breath sounds on the left side. Where do you think the problem lies with this particular patient? Correct Answer: This patient has had increases in both the peak and static pressures suggestion this patient has a new “compliance” problem. A patient with COPD who develops unilateral decreased breath sounds, tachycardia, and hypotension while on mechanical ventilation should be suspected that he has developed a tension pneumothorax.