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Question 1

Hypoxaemia

Answer 1

Lack of o2 rich blood results in less efficient anaerobic metabolism and compromised cellular function

Question 2

Signs of hypoxia

Answer 2

Confusion, headaches, reduced consciousness, tachyarrhthymias, chest pain
Initial responses: increased RR and depth of breathing
Raised HR and vasoconstriction

Question 3

Inflammation and oedema

Answer 3

Pulmonary oedema: occurs from inadequate left ventricular function, limited lymphatic drainage in distal lung areas
Inflammatory processes: inhalation injury, aspiration or resp infections, sepsis, trauma,

Pulmonary oedema: shunts blood past alveoli, results in left ventricular failure increased preload and after load

Question 4

LMA

Answer 4

Rapidly easily inserted
Variety of sizes
More efficient than face mask
Avoids need of laryngoscopes and full intubation
Types: supreme, iGel, Unique, fastrack iLMA

Question 5

Endoctracheal intubation

Answer 5

Patients has reduced LOC
Respiratory failure that requires additional o2 therapy, positive pressure ventilatory support and active remove of sputum

Question 6

Cricoid pressure

Answer 6

Technique to stop aspiration during intubation
BURP
Occluded oesophagus

Question 7

Tracheal intubation advantages and limitation

Answer 7

Ad: allows ventilation up to 100%, isolates airway preventing aspiration, allows suctioning, alternative route for drug administration

Lim: training and experiences essential, potential to worsen cervical cord or head injury, damage to airway

Question 8

Nursing priorities for intubate patient

Answer 8

Ensure tube is secure
Monitor RR, depth , effort, sats, ABG
Prevent accidental extubation 
Monitoring
Medication 
Mouth care
Suctioning
Positioning
Communication

Question 9

Tracheostomy

Answer 9

Surgical opening in anterior wall of the trachea to facilitate ventilation
Surgical or percutaneous
Indication: upper airway obstruction, oedema, tumour, burns, neuromuscular disorders
Types of tubes: cuffed, uncuffed, fenestrated

Question 10

Changing inner cannula of tracheostomy and wound care

Answer 10

Check every 4hrs if copious secretions
Remove and clean using sterile water
Aseptic technique
Use protective, absorbent, non adhesive dressing around stoma to keep it dry

Question 11

Communication

Answer 11

Speaking tubes
Speaking valves - passymuir
Info and reassurance
Details to patient and fam

Question 12

Negative pressure ventilation

Answer 12

Iron lungs
Non invasive ventilation first used in Bostons children hospital 1928
Pump draws out air and creates a suction pressure

Question 13

Positive pressure ventilation

Answer 13

First used in Massachusetts General hospital 1955
Allows air to flow into airway until the ventilator breath is terminated
Exhalation occurs due to elastic recoil of lungs

Question 14

Non invasive ventilation/ non invasive positive pressure ventilation

Answer 14

Provides adjunct between simple oxygen delivery systems and ETT
Reduces day in hospital without reducing quality of care
Reduces trauma do infection risks associated with intubation

Question 15

CPAP - continuous positive airway pressure

Answer 15

Splints airway open
Increased pressure within airway
Gas exchange is maintained
Decreases work of breathing
Clinical applications: acute pulmonary oedema, COPD, anaesthesia, weaning from mechanical ventilation

Question 16

BiPAP bilevel positive airway pressure NIV

Answer 16

Cycles between two levels of pressure and provides continuous positive airway pressure (IPAP and EPAP)
Rest respiratory muscles
Increases o2 delivery
Reduces WOB

Question 17

Patient selection criteria for NIPPV and COAP

Answer 17

Spontaneously breathing
Ability to protect and maintain airway
Ability to clear secretion
Co-operate
Tolerate mask
Not retain co2
Contraindications: facial surgery or trauma, base skull fractures, pneumothorax, upper airway obstruction, decreased conscious level, high risk of aspiration or vomiting.

Question 18

CPAP vs intubation

Answer 18

CPAP: NIV, easily discontinued, adjusted, doesn’t require sedation, comfortable

Intubation: invasive, potential for infection, requires high skill level, requires sedation, traumatic

Question 19

Commencing CPAP BiPAP clinical obs

Answer 19

Explain procedure, prescription
15 min obs the first hour then hourly, temperature every 4 hours
Abdominal distension (may require NG tube insertion ie swallowing a lot of gas can cause aspiration)
Have planned breaks
Diets and fluid
Pressure area care

Question 20

Common complication with CPAP and BiPAP

Answer 20

Pressure sores, gastric distension, reduced CO therefore drop in BP, hyperventilation, fluid retention

Question 21

Mechanical ventilation

Answer 21

Critically ill patients who have persistent respiratory insufficiency and don’t respond to other interventions

Can’t protect airway
Inadequate breathing pattern
Inability to sustain adequate oxygenation
Hypercarbia

Question 22

Mechanical ventilators

Answer 22

Invasive can be short term or long term

Enable synchrony to patients own respiratory efforts

Question 23

Basic ventilation

Answer 23

Delivers gas to lungs using positive a certain rate

Volume and pressure settings

Question 24

High frequency ventilation

Answer 24

Lungs that are extremely inflamed, can be made worse if lungs are constantly inflating and deflating hence given fats breaths that endure lungs don’t have to work, 900 bpm,

Question 25

Nitric oxide

Answer 25

Smooth muscle relaxant working on pulmonary arteries, causes vasodilation so shunting does not occur

Question 26

Prone positioning:

Answer 26

Air goes up and they get good gas exchange

Question 27

Extracorporeal membrane oxygenation

Answer 27

Blood removed from the body via a lump system and oxygenated via an external membrane

Question 28

Future ventilation strategy

Answer 28

Liquid ventilation: breathe an oxygen rich liquid (per fluorocarbon) rather than breathing air, less stress on lungs

Question 29

Weaning from ventilation

Answer 29

Patients have increased WOB and reduced muscle strength
Assess patient
Increase strength and stamina
Extubation when ready

Question 30

Nursing care of ventilated patient

Answer 30

ABCDE
Regular monitoring
Position patient: 45 degrees to reduce VAP, prevent secretion build up, pressure area care
Mouth and eye care
Wound dressings and drains
Nutrition and hydration
Medication and drugs
Infection control
Investigations
Other therapies / inotropes
Transfer

Question 31

Common acute and critical respiratory states

Answer 31

Respiratory failures 
Acute lung injury
Asthma
 Pneumothorax
PE
Infection/pneumonia