Respiratory Therapy: EPAP and NIV Overview

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Questions and Answers

What is a significant characteristic of severe anxiety in the context of pancreatitis?

Moderate hypovolemia

Edematous or interstitial changes

Gallstone complications

Necrotizing damage (correct)

Which of the following is a common cause of esophageal varices?

Diabetes mellitus

Chronic kidney disease

Liver cirrhosis (correct)

Pancreatitis

Which symptom is indicative of potential gastrointestinal bleeding in a patient with liver disease?

Tachycardia (correct)

Hyperactivity

Jaundice

Increased appetite

During assessment of a patient with suspected esophageal varices, which sign is least likely to be observed?

Spasmodic cough Signup and view all the answers

What diagnostic test is recommended specifically for gallstone pancreatitis?

ERCP Signup and view all the answers

What is the purpose of inserting an Oropharyngeal airway (OPA) during tube placement?

To maintain airway patency and prevent biting the tube Signup and view all the answers

How should the tube be anchored to prevent obstruction of the external jugular veins?

It should be secured around the neck without constricting it. Signup and view all the answers

Where should the tube be anchored in relation to the mouth?

At the corner of the mouth to provide a secure seal Signup and view all the answers

What should be observed in the tracheal tube to confirm proper tube placement?

Presence of moisture condensation with exhalation Signup and view all the answers

What indicates that the tube may be in the esophagus rather than the trachea?

Absence of CO2 response from the detector Signup and view all the answers

Which condition results from over-distension of the alveoli during mechanical ventilation?

Volutrauma Signup and view all the answers

What should be done to ensure the tape adheres properly during tube securing?

Dry the patient’s face and apply tincture of benzoin Signup and view all the answers

What is a consequence of changes in pressure during mechanical ventilation?

Barotrauma to the lungs Signup and view all the answers

What is the primary purpose of CPAP?

To provide continuous airway pressure for patients with OSA Signup and view all the answers

Which method is NOT suitable for the delivery of NIV?

For unstable and critically ill patients Signup and view all the answers

What must be maintained to ensure CPAP functions effectively?

A tight seal between the mask and the patient's skin Signup and view all the answers

Which condition is characterized by episodes of apnea lasting at least 10 seconds while asleep?

Obstructive sleep apnea Signup and view all the answers

Which of the following is a contraindication for the use of NIV?

Hypoventilation Signup and view all the answers

In which scenario would CPAP be most commonly used?

Long-term management of sleep apnea at home Signup and view all the answers

What should be adjusted in NIV based on the patient’s status?

The ventilatory and oxygenation settings Signup and view all the answers

What is a key requirement for the delivery of CPAP?

The patient must be breathing spontaneously Signup and view all the answers

What is the significance of a blood sugar level greater than 600 mg/dL?

Suggests severe hyperglycemia Signup and view all the answers

Which of the following is a common trigger for Diabetic Ketoacidosis (DKA)?

Physical stress such as infection Signup and view all the answers

What is the initial management step for a patient presenting with DKA?

Aggressive intravenous rehydration Signup and view all the answers

What is the appropriate action when blood sugar levels fall below 250 mg/dL during DKA treatment?

Change to a dextrose-containing solution Signup and view all the answers

Which of the following is NOT a common characteristic of DKA?

Hypoglycemia Signup and view all the answers

What dietary recommendation is crucial for managing diabetes?

Adhere to a regular meal schedule including snacks Signup and view all the answers

For which type of diabetes are oral hypoglycemic agents primarily prescribed?

Type 2 Diabetes Mellitus Signup and view all the answers

What can lead to Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC) in non-diabetics?

Improper hydration during tube feedings Signup and view all the answers

What is the primary goal in managing a patient with acute gastrointestinal bleeding?

Maintain blood volume and prevent recurrence Signup and view all the answers

Which sign indicates potential intraabdominal bleeding and is characterized by bluish discoloration around the umbilicus?

Cullen’s sign Signup and view all the answers

For a patient with a non-variceal upper GI bleed, what would be an appropriate diagnostic test?

Upper endoscopy Signup and view all the answers

What is a nursing intervention to prevent hypoxemia in a patient with acute pancreatitis?

Oxygen supplementation Signup and view all the answers

Which of the following is a sign of potential hypovolemia in a patient?

Hypotension Signup and view all the answers

Which nursing consideration is essential when caring for a patient with acute pancreatitis?

Provide comfort and safety Signup and view all the answers

What blood component would be prioritized for a patient experiencing acute upper GI bleeding?

RBCs, Platelets, FFP Signup and view all the answers

What is a common cause of acute pancreatitis?

Gallstones Signup and view all the answers

What is the typical PaO2 range considered normal in adults?

80-100 mmHg Signup and view all the answers

What vital sign change might indicate effective resuscitation in a patient with hypotension?

Increased blood pressure Signup and view all the answers

Which symptom is NOT typically associated with severe tissue perfusion issues?

Increased skin turgor Signup and view all the answers

What is included in the management of a patient with an acute gastrointestinal bleed regarding pharmacological intervention?

Proton pump inhibitors Signup and view all the answers

Which intervention is crucial for maintaining airway patency in a patient requiring intubation?

Securing the airway with a cuffed tube Signup and view all the answers

What does a stable hemoglobin level indicate in a patient recovering from acute gastrointestinal bleeding?

Effective recurrent bleeding control Signup and view all the answers

Study Notes

Expiratory Positive Airway Pressure (EPAP)

EPAP is airway pressure above 0cm H2O during the expiratory phase of breathing.
EPAP is used in NIV for patients experiencing acute respiratory impairment.
A tight seal must be maintained between the mask or prongs and the patient’s skin for EPAP to work effectively.
Supplemental oxygen is required if it is ordered for the patient.

Non-invasive Ventilation (NIV)

Primary treatment for OSA, a sleep disorder characterized by partial or complete airway obstruction
2 main forms are CPAP (Continuous Positive Airway Pressure) and NIVPP (Non-Invasive Positive Pressure Ventilation) – NIVPP uses a ventilator that cycles between inspiratory and expiratory phases.
Used in the inpatient setting for patients who are experiencing acute respiratory impairment and, continuously as part of in-home care for patients with respiratory impairment.
Also used at home for patients who have OSA.
NIV is NOT for UNSTABLE and CRITICALLY ILL patients.

Indications For NIV

Severe dyspnea
Congestive heart failure
Obstructive Sleep Apnea (OSA)
Pulmonary edema
Acute respiratory failure
COPD

Obstructive Sleep Apnea (OSA)

A condition where the patient has 5 episodes of apnea that last at least 10 seconds each within one-hour time period while asleep.

Contraindications for NIV

Apnea
Hypoventilation

Tracheal Tube Confirmation

**Re-confirm the tube mark at the front teeth. **
Insert an OPA (Oropharyngeal Airway)
Dry the patient’s face and apply tincture of benzoin
**Carry the tape right around the patient’s neck when anchoring the tube. **
Anchor the tube at the corner of the mouth, not in the midline.
Look for MOISTURE CONDENSATION on the inside of the tracheal tube with exhalation

Secondary Confirmation

End-Tidal CO2 detector device - The device reacts with a color change to exhaled CO2 from the lungs. Absence of CO2 response from the detector generally means that the tube is in the esophagus.

Complications of Mechanical Ventilation

Barotrauma - Injury to the lungs or other air-filled spaces caused by changes in pressure, often due to mechanical ventilation
Volutrauma – Lung injury resulting from over-distension of alveoli due to excessive tidal volumes during mechanical ventilation

Nursing Considerations for Mechanical Ventilation

Maintain urinary and bowel elimination
Maintain eye, mouth, and skin cleanliness and integrity
Maintain mobility/ musculoskeletal function
Provide psychological support
Monitor for:
- PaO2 80-100mmHg
- Effective breathing patterns
- Hemodynamic stability
- Increased/stable hemoglobin
- Adequate tissue perfusion
- UO >30cc/hr

Acute Gastrointestinal Bleeding

Peptic ulcer disease, etc.
Assess
History of liver disease, alcohol use.
Checking for signs of bleeding, such as tachycardia, hypotension.
Determine location, nature, and resolution of the bleeding.
Endoscopy, PPI, surgical consult
Prevention of recurrent bleeding
- Gastric acid suppression
- Minimize precipitating factors

Nursing Considerations for Acute GI Bleed

Maintain breathing patterns
Provide comfort and safety
Lessen anxiety
Prevention of complications

Acute Pancreatitis

Caused by gallstones or excessive alcohol consumption.
Pathophysiology: Autodigestion
Mild: Edematous/interstitial
Moderately Severe: Hypovolemia, pain, organ failure.
Severe: Necrotizing.
Gallstone pancreatitis: Perform ERCP

Nursing Considerations for Acute Pancreatitis

Oxygen supplementation
Pain management
Fluid resuscitation
Prevent and treat infection
Prevent complications
Surgery

Esophageal Varices

Swollen veins in the lower esophagus
Occurs due to increased pressure in the portal vein
Often resulting from liver cirrhosis.
Can rupture and cause severe bleeding

Nursing Considerations for Esophageal Varices

Assess history of liver disease, alcohol use, and previous variceal bleeding.
Check for signs of liver disease
Check for signs of bleeding, such as melena, hematemesis.

Diabetic Ketoacidosis (DKA)

Acute complication of DM.
Results from severe insulin deficiency.
Has a sudden onset.

Etiology of DKA

Typically caused by undiagnosed diabetes or the inadequacy of the prescribed therapy.

Clinical Manifestations of DKA

Blood sugar levels greater than 300 mg/dL
Serum pH less than 7.35
Elevated ketone levels
Sweet, fruity breath

Hyperosmolar Hyperglycemic Nonketotic State (HHNS)

Severe hyperglycemia; usually greater than 600 mg/dL
pH less than 7.4
Ketones – negative
Profound dehydration
Altered level of consciousness

Interprofessional Care for DKA

Aggressive intravenous rehydration with normal saline or Lactated Ringers
Lowering of the blood sugar with a short-acting insulin, such as regular insulin given through continuous intravenous infusion.
When blood sugar levels fall below 250 mg/dL, the IV solution should be changed to a dextrose-containing solution, e.g., 0.9% NaCl/5% dextrose.

Management of DM

Diet - Regular meal schedule including snacks
Exercise - recommendation 3 times a week
Insulin - for Type 1 DM
Oral Hypoglycemic Agents (OHA) - for Type 2 DM

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Description

This quiz covers the essential aspects of Expiratory Positive Airway Pressure (EPAP) and Non-Invasive Ventilation (NIV). Learn about the applications, techniques, and patient requirements for effective respiratory support in both acute and chronic scenarios. Test your understanding of these critical components in respiratory therapy.