What does BPM stand for in respiratory monitoring?
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Breath Per Minute.
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What does BPM stand for in respiratory monitoring?
Breath Per Minute.
What type of mask may be preferred over a nasal mask?
A mouth mask.
What does leak monitoring provide?
Quantitative assessment of patient/mask leak.
What is important to do before starting Non-Invasive Ventilation (NIV)?
Spend time explaining, reassuring, and trialing different setups for patient tolerance.
What aspect of non-invasive ventilation will be covered in the lecture?
The theory and practice in using non-invasive ventilation.
What is the timed inspiration duration provided?
2.0 seconds.
What is 'Rise Time' in BiPAP settings?
The time from EPAP to IPAP.
What does the total respiratory rate include?
Spontaneous and machine breaths.
Why is close ongoing monitoring critical for patients on NIV therapy?
To evaluate for potential decline in status.
What changes should clinicians watch for in patients receiving NIV?
Changes in mental status, respiratory rate, accessory muscle use, tidal volumes, ventilator synchrony, and comfort.
Why is continuous monitoring important after initiating CPAP and BiPAP?
To determine optimal settings.
What is BiPAP used for in nursing interventions?
BiPAP is a support device for patients requiring non-invasive ventilation.
What is one goal of adjusting IPAP?
To improve ventilation.
How does BiPAP therapy affect work at expiration?
It requires less work at expiration.
What effect does increasing IPAP have on tidal volume?
It increases tidal volume.
Which type of organ failure is a contraindication for NIV?
Nonrespiratory organ failure.
What does pressure monitoring demonstrate?
Pressure regulation.
What is the second form of Non-Invasive Ventilation (NIV)?
Bi-Level Positive Airway Pressure (BiPAP).
How can nurses help patients who feel claustrophobic while using NIV?
Allow the patient opportunities to remove the mask.
What is essential to treat anxiety in patients with respiratory failure?
Adequate respiratory support.
Where should a patient receiving NIV be nursed?
In a highly visible area.
What vital signs should be monitored in patients with NIV?
Hemodynamic changes, blood pressure, and cardiac filling pressures.
What are the two pressure settings in BIPAP?
Inspiratory Positive Airway Pressure (IPAP) and Expiratory Positive Airway Pressure (EPAP).
What does CPAP stand for?
Continuous Positive Airway Pressure.
Why is it important to ensure there is no gas leak in NIV?
To maintain positive pressure.
What modes can non-invasive positive pressure ventilation operate in?
Pressure-cycled or volume-cycled modes.
How does EPAP relate to PEEP?
EPAP is equal to PEEP.
How should a nurse support a patient during NIV mask attachment?
Continue to offer support and reassurance until the patient can tolerate the secured mask.
What intervention can be done for gastric distension in NIV patients?
Insert a nasogastric tube on free drainage.
What acid-base imbalance can occur due to COPD exacerbation?
Respiratory acidosis.
What does S/T stand for in the context of ventilation?
Spontaneous/Timed.
What will you understand regarding non-invasive ventilation by the end of the lecture?
The indications of non-invasive ventilation.
What does an increase in respiratory rate indicate?
It is an early sign of fatigue.
What does IPAP stand for in BiPAP therapy?
Inspiratory Positive Airway Pressure.
What can sedating patients in respiratory failure lead to?
NIV failure, necessitating intubation.
What are the two levels of pressure delivered in BiPAP therapy?
Inspiration pressure (IPAP) and expiration pressure (EPAP).
What is the relationship between NIV and patient monitoring?
The use of NIV is highly dependent on patient monitoring and nursing support.
What type of support does non-invasive positive pressure ventilation provide?
Close to full mechanical ventilatory support.
What is the primary purpose of BiPAP?
To augment tidal volume (VT).
What is the role of a β-agonist inhaler in NIV support?
It helps decrease airway resistance.
What are signs of failure of NIV therapy?
Mental status changes, hemodynamic instability, worsening gas exchange, worsening tachypnea, dyspnea, or asynchrony with mechanical breaths.
Can the BIPAP machine cycle between IPAP and EPAP at set intervals?
Yes, it may be time cycled.
Which patient group is indicated for NIV due to pulmonary infiltrates?
Immunocompromised hosts.
What is the range of rise times for BiPAP settings?
From 100ms to 600ms.
What agreement should be reached with the patient regarding NIV?
Agreement on the escalation and/or discontinuation of treatment.
What should O2 saturations be for patients on NIV?
Greater than 94%.
What gastrointestinal condition poses a risk for aspiration and is a contraindication for NIV?
Severe upper GI bleeding.
What should be done if the patient's respiratory status worsens after NIV?
The patient should be closely observed.
What does EPAP stand for?
Expiratory Positive Airway Pressure.
Why might a mouth mask be preferred for some patients?
Due to increased airway resistance of the nasal passages and likelihood of positive pressure loss through the mouth.
What nursing intervention can help alleviate a patient's anxiety about NIV?
Provide reassurance and education about the BiPAP machine.
What emotional response is commonly associated with respiratory failure?
Appropriate anxiety.
How can a nurse help a patient overcome initial anxiety about NIV?
By providing reassurance and explaining the process.
What should be done when there is doubt about a patient's potential deterioration on NIV?
Obtain an ABG and do not rely solely on SaO2 levels.
Why should clinicians not be misled by a seemingly normal SaO2 in NIV patients?
Because desaturation is often a late sign of patient changes.
What is the primary purpose of non-invasive ventilation (NIV)?
To support respiratory function without the requirement for intubation.
What does EPAP stand for?
Expiratory Positive Airway Pressure.
How are pressure levels in BIPAP adjusted?
According to patient response.
What is a common method to assess responsiveness in patients suspected to be unrousable?
Supraorbital pressure.
What does the Ti/Ttot parameter evaluate?
Respiratory muscle endurance.
What is a significant advantage of NIV compared to intubation?
The patient is free from the discomfort of an artificial airway.
What should be minimized to prevent positive pressure loss in NIV?
Air leak.
What happens to alveolar CO2 pressure during COPD exacerbation?
It increases (PACO2).
What is a primary contraindication to Non-Invasive Ventilation (NIV)?
Instability or inability to maintain an airway.
What type of disease affects the nerves controlling voluntary muscles and may require NIV?
Neuromuscular disease.
What stage of COPD may indicate the use of NIV?
End-stage COPD.
What mode is typically used in BiPAP settings?
BiPAP (S/T – Spontaneous/Time, Pressure Control).
Which sleep disorder is an indication for NIV?
Obstructive sleep apnea.
What is a common emotional response of patients receiving NIV, particularly in this case scenario?
Anxiety about the BiPAP machine.
What is the example rate given for BPM?
10 BPM.
What is the timed rate interval mentioned?
6.0 second intervals.
What role does patient education play in managing anxiety related to NIV?
It helps the patient understand the purpose and function of the BiPAP machine.
What type of dressing is effective in preventing skin breakdown?
Hydrocolloid dressing.
Why are hydrocolloid dressings used in NIV care?
They provide a moist environment and protect the skin from friction and pressure.
What is tachypnea in the context of COPD exacerbation?
Rapid breathing that can worsen breath-stacking.
What are some clinical interventions that may accompany BiPAP use?
β-agonist inhaler, IV steroids, IV loop diuretics.
What should be checked to prevent pressure damage or skin breakdown in NIV patients?
The fitting of the mask and straps.
What activities can a patient perform while on NIV?
The patient can eat and speak.
What is key to maintaining comfort in NIV patients?
Monitoring and adjusting the mask to attain a good seal and fit.
What does expiratory flow limitation lead to in COPD patients?
Accumulation of CO2 in alveolar air.
In which condition is NIV indicated due to poor outcomes associated with intubation?
Acute respiratory failure.
How can adjustments in rise time affect BiPAP therapy?
They can improve patient comfort and tolerability.
What is a common indicator that respiratory failure is resolving after initiating BiPAP?
Visible decrease in work of breathing.
What improvements are observed when a patient is responding well to BiPAP?
Improved mental status, respiratory acidosis, and/or oxygenation.
What is the first form of Non-Invasive Ventilation (NIV)?
Continuous Positive Airway Pressure (CPAP).
Why is BPM an important indicator?
It indicates work of breathing (WOB).
What is the first form of Non-Invasive Ventilation (NIV)?
Continuous Positive Airway Pressure (CPAP).
What can be used to reduce noise for patients on high-flow gas during NIV?
Consider use of earplugs.
What does BiPAP stand for?
Bi-level Positive Airway Pressure.
What should be adjusted to increase patient comfort during NIV?
Pressure settings and possibly the mask.
Why should benzodiazepines be avoided in patients with acute respiratory failure on NIV?
Benzodiazepines can cause respiratory depression, which may worsen the patient's condition.
What is the first nursing intervention when setting up NIV for a patient?
Provide patient explanation.
What is the purpose of Positive End-Expiratory Pressure (PEEP)?
To maintain pressure in the lungs above atmospheric pressure at the end of expiration.
What is the purpose of decreasing CO2 in BiPAP therapy?
To improve ventilation.
What is tidal volume (VT) associated with?
A decrease in PaCO2, work of breathing (WOB), and improved oxygenation.
What is a safer alternative to benzodiazepines for patient comfort in NIV?
Non-sedative anxiolytics or supportive measures.
What should be observed in ABG within 1 hour if NIV is effective?
Improvement in gas exchange.
How does EPAP improve oxygenation?
By stabilizing the upper airway and reducing work associated with Auto-PEEP.
What should be supported for patients having difficulty eating or drinking?
Fluid and nutrition delivery by alternative routes.
What is the effect of EPAP on intrinsic PEEP?
EPAP can match intrinsic PEEP, making the initiation of inhalation easier and decreasing the work of breathing.
What psychological experience should be created for the patient during NIV?
A sense of being there or a sense of presence.
How soon should a successful outcome of NIV be evident?
Within 4 hours.
How should EPAP be adjusted to avoid intolerance?
EPAP should be increased slowly, in increments of 2 cm H2O.
What is the nature of NIV in relation to respiratory difficulty?
NIV is supportive, and the cause of respiratory difficulty should be managed and treated.
What are the two main types of non-invasive ventilation?
Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP).
What respiratory rate indicates a need for NIV in COPD exacerbation?
A respiratory rate of ≥ 25 breaths/min.
What does 'Time Insp.' refer to in BiPAP settings?
Inspiratory Time.
What discomfort might patients experience with nasal masks?
Increased airway resistance and positive pressure loss through the mouth.
What should be monitored continuously after initiating CPAP and BiPAP?
Cardiac and pulse oximetry monitoring.
What vital signs should be monitored alongside CPAP and BiPAP?
Vital signs and ABGs.
What is the second form of Non-Invasive Ventilation (NIV)?
Bi-Level Positive Airway Pressure (BiPAP).
How is Pressure Support (PS) calculated?
PS = IPAP minus EPAP.
What should be assessed to determine if a patient is suitable for NIV treatment?
The patient's level of consciousness and ability to respond.
What effect can raised intra-thoracic pressure have on hemodynamics?
It may decrease blood pressure and cardiac filling pressures.
What condition must a patient meet to be eligible for NIV?
The patient must be spontaneously breathing and have a level of consciousness to comply with the treatment.
What type of respiratory failure tends to respond well to Non-Invasive Ventilation (NIV)?
Hypercapnic respiratory failure.
What is the result of each breath leading to larger lung volumes in COPD patients?
Increased residual volume and air trapping.
What condition has shown improved outcomes with NIV during acute exacerbations?
Acute COPD exacerbations.
What does a Ti/Ttot value of less than 30 indicate?
Improvement, allowing for a decrease in IPAP.
What is the purpose of CPAP in relation to functional residual capacity (FRC)?
To increase or maintain FRC.
What should be monitored in patients with NIV?
Gas flow, PEEP valve, O2 levels, tidal volume, minute ventilation, and O2 saturations.
What should be established before starting Non-Invasive Ventilation (NIV)?
A clear management plan and document the settings.
What does a rise time setting of 1 represent?
The fastest rise time.
What does a rise time setting of 5 represent?
The slowest rise time.
What is the relationship between nursing care and the success of NIV?
Evidence shows that successful outcomes are dependent on nursing care.
What is crucial to monitor in a barely arousable patient on NIV?
Worsening hypoventilation.
What is the typical inspiratory time (Ti) in BiPAP settings?
1/3 of the breath cycle.
What must be ensured before initiating NIV for COPD exacerbation?
There must be no contraindications.
What is a nursing intervention for patients with feelings of claustrophobia during NIV?
Offer a supportive presence.
Why is it important to address a patient's anxiety when using NIV?
To improve patient comfort and compliance with the treatment.
What is a recommended method for preventing skin breakdown in NIV patients?
Using hydrocolloid dressing.
What will be discussed about nursing care in relation to non-invasive ventilation?
The management of the patient with non-invasive ventilation.
What should be ensured for the patient during NIV?
That the call bell is within easy reach.
What must be done simultaneously while using BiPAP?
Attempts must be made to decrease airway resistance and improve compliance.
What is the significance of a patient opening their eyes transiently in the context of NIV?
It indicates some level of responsiveness, which may make NIV treatment safer.
What is a potential risk of using benzodiazepines in NIV patients?
Increased risk of airway obstruction and reduced respiratory drive.
What should a nurse do after explaining the NIV setup to the patient?
Set up the machine and/or attach the correct accessories.
How can the bridge of the nose, ears, and chin be protected from pressure damage?
By using hydrocolloid dressing.
What type of mask is used for delivering non-invasive ventilation?
A tight-fitting mask.
What effect does EPAP have on functional residual capacity (FRC)?
It increases FRC.
What are some interfaces through which NIV can be delivered?
Tight-fitting face mask, mouth, nasal cannula, nasal mask, or helmet.
What benefits are associated with an increased functional residual capacity (FRC)?
Improved work of breathing, improved oxygenation, and improved lung compliance.
What does hemodynamic instability suggest in a patient on NIV?
It is a sign of potential NIV failure.
What should be monitored to assess the effectiveness of BiPAP?
Resolution of respiratory acidosis and improvement in oxygenation.
What factors may contribute to a patient's condition improving while on BiPAP?
Diuresis or steroids.
What is non-invasive ventilation (NIV)?
A method of providing ventilatory support without the need for intubation.
What does 'T' indicate in BiPAP settings?
Machine triggered; time cycled.
What neurological condition can prevent the use of NIV?
Severe encephalopathy or inability to protect airway.
What signs may indicate NIV failure?
Increased respiratory distress, decreased oxygen saturation, and altered mental status.
What does BIPAP stand for?
Bi-level Positive Airway Pressure.
What is a key benefit of using hydrocolloid dressings for NIV patients?
They help maintain skin integrity and prevent breakdown.
What phenomenon occurs when a patient does not have enough time to exhale during COPD exacerbation?
Breath-stacking.
What does CPAP maintain throughout inspiration and expiration?
Positive pressure, equivalent to positive end expiratory pressure (PEEP).
How can benzodiazepines affect a patient's ability to use NIV?
They may impair the patient's ability to cooperate with NIV, leading to ineffective treatment.
How is the pressure level in CPAP set?
It is set and adjusted according to patient response.
What should be checked if a patient experiences drying of the eyes?
The mask fitting for leaks.
When should NIV be used in relation to advanced airway placement?
Use NIV in select patients to avoid placement of an advanced airway, but it should not be used to delay imminent intubation.
What does worsening tachypnea indicate in the context of NIV?
It may be a sign of NIV failure.
What is a potential cause of a patient's somnolence that may improve with BiPAP?
CO2 narcosis.
How quickly can one anticipate improvement in a patient with CO2 narcosis on BiPAP?
15 to 30 minutes.
What should be prepared if a patient's condition does not improve on BiPAP?
Equipment for ETT intubation.
What should be done if a patient appears improved after NIV?
Close clinical observation for 30 minutes and obtain an arterial blood gas (ABG).
What indicates that BiPAP should be continued?
If the ABG is improved or stable, with resolved or stable respiratory acidosis and/or PaO2 > 8 kPa.
What are the criteria for NIV positive pressure ventilation for exacerbation of COPD according to the American Association of Respiratory Care?
Must meet two or more of the following: respiratory distress with moderate to severe dyspnea, arterial pH < 7.35 with PaCO2 > 6 KPA, or respiratory rate ≥ 25 breaths/min.
What is an important aspect of nursing care for NIV patients?
Monitoring for patient comfort and ensuring proper mask fit.
What is ramp time in BiPAP settings?
The amount of time taken to achieve the preset IPAP pressure, gradually changing over 10-30 minutes.
What is a potential outcome for patients who fail Non-Invasive Ventilation (NIV)?
They may require endotracheal intubation and mechanical ventilation.
How is the respiratory rate (RR) typically determined in BIPAP?
By the patient’s spontaneous rate.
How awake does a patient need to be for NIV treatment to be considered safe?
The patient should be able to respond to stimuli and maintain an adequate airway.
What are the modes that BiPAP may consist of?
Time-cycled, machine-triggered breaths, spontaneous, or a combination.
What is important to consider when choosing a mask for NIV?
Choose the correct size of mask using a sizing guide.
What should be done before fixing the straps of the NIV mask?
Allow the patient to try the mask without fixing the straps.
What is the adequate tidal volume for patients on NIV?
Greater than 6 ml/kg.
What is the adequate minute ventilation for patients on NIV?
Greater than 5 L/min.
What is one of the indications for NIV in post-operative care?
Post-operative respiratory failure.
What are the two dangers posed to an unarousable patient on BiPAP?
Emesis and completion of hypoventilation (respiratory arrest).
When might NIV be considered safe for a barely arousable patient?
If the patient is not experiencing emesis.
What are some contraindications to non-invasive ventilation?
Facial trauma, severe respiratory distress requiring intubation, and inability to protect the airway.
What is the significance of a PaCO2 level greater than 6 KPA in COPD patients?
It indicates a need for NIV if accompanied by an arterial pH < 7.35.
What does Vt refer to in BiPAP settings?
Target tidal volume.
What condition involves hemodynamic instability as a contraindication for NIV?
Cardiac or respiratory arrest, or unstable cardiac rhythm.
How does EPAP affect fluid in the alveolar space?
EPAP can redistribute fluid in the alveolar space and improve oxygenation.
What is a potential downside of high EPAP levels?
A high EPAP is uncomfortable for patients.
What does 'S' represent in BiPAP settings?
Patient triggered; patient cycled.
What airway condition is a contraindication for NIV?
Upper airway obstruction.
What is key to successful Non-Invasive Ventilation?
Developing the patient’s trust and confidence.
What parameters should be monitored in patients receiving NIV?
Respiratory rate, oxygen saturation, and patient comfort levels.
What is a key consideration in clinical judgment for NIV treatment safety?
Assessing the patient's overall condition and response to therapy.
What facial conditions can contraindicate the use of NIV?
Facial surgery, trauma, or deformity.
How should patients be involved in the decision to trial off BiPAP?
Patients should be asked if they feel ready.
What should be solicited from patients regarding EPAP?
Feedback regarding comfort must be solicited.
What level of arterial pH indicates a need for NIV in COPD exacerbation?
Arterial pH < 7.35.
What is rise time in BiPAP settings?
The time for the pressure to rise from EPAP to IPAP.
What are the primary indications for using non-invasive ventilation?
Conditions like COPD exacerbations, acute pulmonary edema, and respiratory failure.
What is IPAP in BiPAP settings?
Inspiratory Positive Airway Pressure.
What are common problems patients may face with NIV?
Skin breakdown, discomfort from the mask, and air leaks.
How can patient comfort be enhanced during NIV?
By ensuring proper mask fit and providing psychological support.
