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BiPAP/CPAP Questions

Terms in this set (41)

CPAP stands for?
Continuous positive airway pressure
What type of mask can you use to administer CPAP?
Nasal Mask
Full Face Mask
Nasal Pillow
Do you set a respiratory rate in this mode?
No
What if the patient starts exhibiting hypoventilation? What adjustments would you make?
Switch the patient to BiPAP.
CPAP provides pressure during the entire OR inspiratory phase of the spontaneous breath.
Entire
The total amount of work of breathing the patient is experiencing while wearing CPAP is the result of... patient effort OR machine assistance?
Patient effort
CPAP is indicated for what type of sleep apnea?
Obstructive Sleep Apnea (OSA)
Can you place a nasal trumpet in a patient while wearing CPAP? What about BiPAP?
You can place a nasal trumpet with CPAP/BiPAP
Can you place an oral airway in a patient while wearing CPAP? What about BiPAP?
No; the patient has to be unconscious for this airway.
Provide some clinical examples of contraindications to using CPAP.
Claustrophobia
Apnea
Neuromuscular diseases
Facial trauma
Unable to protect airway
Hypoventilation syndrome
If the patient is experiencing respiratory failure should you use CPAP?
No
BiPAP stands for?
Bilevel positive airway pressure
What does IPAP stand for? What's a starting pressure for IPAP?
Inspiratory positive airway pressure

Starting pressure: 10-12 cm H2O
What does EPAP stand for? What's a starting pressure for EPAP?
Expiratory positive airway pressure

Starting pressure: 5 cm H2O
IPAP and EPAP are recorded in what units?
cm H2O
If you want to increase the ventilation, you would increase the IPAP or EPAP?
IPAP
If you want to increase the oxygenation, you would increase the IPAP, or EPAP?
EPAP
Mechanical breaths are provided by IPAP or EPAP?
IPAP
If I increased IPAP and EPAP in the same amount, would this change the tidal volume?
No; they need to be different to increase tidal volume.
What does NPPV stand for?
Noninvasive positive pressure ventilation
Which type of mask is more likely to develop a significant leak during NPPV?
Nasal prongs/nasal mask
Which type of mask should you use if the patient exhibits SOB with an increase in RR?
Full face mask
Helmet

(must cover nose and mouth)
What are some possible complications when wearing a full-face mask?
Pressure sores
Aspiration
Claustrophobia can lead to agitation
How do you determine the correct mask size?
Measure from bridge of the nose to the center of the chin.

(some packages have measuring holes)
How can you determine if the patient is tolerating the NPPV settings?
Improvement in vitals
Decreased WOB
Relaxed patient
ABG improvement
What if the patient develops redness around the mask site/nose/forehead area, what should you do?
Document the redness and let everyone know (nurse, charge therapist, physician)

Change to a different type of mask if necessary.
How often should you check on a patient while they are wearing CPAP or BiPAP?
Every four hours minimum, but feel free to check as frequently as you want.
What is a possible consequence while wearing a nasal mask or pillows?
Increased risk of leakage.

Can use a chin strap to decrease this.
What's the purpose of the ramp feature on a BiPAP/CPAP machine?
This setting gradually increases the setting on the machine to the desired pressures you want over a course of time.

Hopefully, the patient is asleep by the time the desired pressure is reached.
What's the purpose of C-flex?
Relieves the pressure upon exhalation.

Improves patient tolerance.
What if the patient is experiencing nasal dryness while wearing CPAP or BiPAP, what can you do to help?
Add humidification, use saline spray or lubricant in the nose.
Should dentures be removed prior to initiation of CPAP or BiPAP?
Yes
What should be documented during a routine BiPAP check?
Date + Time
Settings (ex. 14/5, 0.40, set rate 12, total rate 14)
Vital signs
Breath sounds
Exhaled tidal volume
Skin integrity and any adjustments made
Leak
What should be documented during a routine CPAP check?
Date + Time
Settings (5 cmH2O)
Vital signs
Breath sounds
Skin integrity and any adjustments made
Will you be able to document a delivered tidal volume on CPAP?
No
I have a patient wearing BiPAP on the following settings: 0.5, 10/5, Set Rate 10. Total Rate of 10. After placement of the BiPAP I wait 30 minutes to obtain the ABG. Results are: 7.30, 65, 85, 28.

a. Please classify this ABG including oxygenation status.

b. What changes, if any need to be made?
a. Partially compensated respiratory acidosis with normal oxygenation.

b. We are not ventilating. You should change the IPAP or the rate because the total rate is the same as the set rate. You can also lower the FiO2 because you are properly oxygenating.

CHANGES: 12/5, 0.40, set rate 12
You placed a patient on BiPAP at midnight with the following settings: 0.7, 10/5, Set Rate 10, Total rate of 10. The RN calls you at 0300 and states she can't wake up Mr. Zerkle. The RN has not medicated the patient.

a. What are your initial thoughts regarding this patient?
b. What should be ordered?
c. You get an ABG... 7.29, 75, 60, 34
d. Classify this ABG including oxygenation status.
e. What type of patient is Mr. Zerkle?
f. What have you done wrong regarding Mr. Zerkle's settings?
g. What's the next step?
a. The patient's ventilatory drive has been wiped out. His blood sugar could also be extremely low (this happens during the night).

b. An ABG should be ordered.

c. Partially compensated respiratory acidosis with mild hypoxemia.

d. Mr. Zerkle is a COPDer.

e. His oxygen is way too high and his drive to breathe has been wiped.

f. Take him off the machine, this should wake him up.
You have a patient wearing BiPAP with the following settings: 0.40, 8/4, Set Rate of 10, Total rate of 16. You obtain an ABG per Dr. Eltaki request: 7.29, 60, 48, 30.

a. Please classify this ABG including oxygenation status.
b. Do BiPAP settings need adjusting? If so, what values need changing?
a. Partially compensated respiratory acidosis with moderate hypoxemia.

b. We are not ventilating or oxygenating. Change the IPAP to 12, change the EPAP to 7. No need to change the rate because they are already breathing above that. The FiO2 can be adjusted from 0.40 to 0.60.
You have a patient wearing BiPAP with the following settings: 0.75, 20/10, set rate of 16, Total rate of 16. You obtain an ABG and call Dr. Antiporda with the following results: 7.55, 28, 150, 22.

a. Please classify this ABG including oxygenation status.
b. Do BiPAP settings need adjusting? If so, what values need changing?
a. Uncompensated respiratory alkalosis with hyperoxemia.

b. This patient is over-ventilated and over-oxygenated. The oxygen can be turned down from 0.75 to 0.40. The IPAP/EPAP can be turned down to 10/5. Rate can be lowered to a set rate of 12.
Let's say your patient's PaCO2 is gradually increasing while wearing BiPAP, would you change the IPAP or EPAP setting? Would you go increase or decrease this setting?
Increase the IPAP.
Should you hear snoring while your patient is wearing CPAP or BiPAP? If you said no, what parameter would you adjust to eliminate the snoring?
No

You should change the EPAP.
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