Respiratory

Question 1

What patient groups is NIV not indicated for?

Answer 1

Asthma
Type 1 resp failure
Pulmonary oedema
Metabolic acidosis
Multi-organ failure

Question 2

What are the absolute contraindications for NIV?

Answer 2

Severe facial deformity
Facial burns/trauma
Fixed upper airway obstruction
Facial or upper airway surgery/trauma
Undrained acute pneumothorax

Question 3

What are the relative contraindications for NIV?

Answer 3

pH < 7.15
Haemodynamic instability
GCS < 8
Cognitive impairment
Vomiting
Small bowel obstruction or marked abdominal distension

Question 4

What must be done before starting a patient on NIV?

Answer 4

A chest X-ray

Question 5

How can you help a patient to better tolerate NIV?

Answer 5

Appropriate sized mask
Ensure all masks have an exhalation port and anti-asphyxiation valve
Use patients dentures
Hold mask in front of face first
Regular breaks

Question 6

What should you routinely assess for a patient on NIV?

Answer 6

Vital signs with continuous pulse oximetry
Chest wall movement
Accessory muscle activity
Patient comfort

Question 7

What are the red flags and signs of deterioration for a patient on NIV?

Answer 7

Worsening or static ABGs despite NIV
Persistent RR > 30/min
New onset confusion, agitation or restlessness
Drop in GCS
Increased respiratory effort
Worsening tachycardia
Hypotension
Exhaustion
Increased oxygen requirement

Question 8

What is CPAP?

Answer 8

Continuous positive airway pressure
Uses one setting to keep the airway open

Question 9

What is BiPAP?

Answer 9

Bilevel positive airway pressure - delivery of O2 positive pressure
Uses 2 settings - one for inhalation and one for exhalation

Question 10

What is the technique used for assisted ventilation?

Answer 10

BVM - 2 person technique

Question 11

What is the benefit for BVM - 2 person technique?

Answer 11

It ensured a seal is applied properly

Question 12

How do you do a BVM - 2 person technique?

Answer 12

Person 1 - holds mask to seal properly
Person 2 - delivers breath

Question 13

What are the important things to remember when using a ventilator?

Answer 13

Ensure it is charged at all times
ICU dr or ODP will set it up

Question 14

What nursing care is required for a ventilated patient?

Answer 14

1:1 care - ICU Dr present
Ensure correct placement - confirmed by auscultation, CO2 reading, CXR
Assess teeth level of tube placement
Mouthcare
Turning and positioning
NG tube
Catheter
Admission under ACCU

Question 15

What does the IPAP on BiPAP do?

Answer 15

Provides ventilation
Higher than EPAP

Question 16

What does EPAP on BiPAP do?

Answer 16

Allows removal of exhaled gas
Recruits under ventilated or collapsed lung for gas exchange

Question 17

What patient groups use CPAP?

Answer 17

T1RF
Pulmonary oedema

Question 18

What type of patients use NIV?

Answer 18

T2RF (low O2, high CO2)