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?

    <p>Spasmodic cough</p> Signup and view all the answers

    What diagnostic test is recommended specifically for gallstone pancreatitis?

    <p>ERCP</p> Signup and view all the answers

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

    <p>To maintain airway patency and prevent biting the tube</p> Signup and view all the answers

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

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

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

    <p>At the corner of the mouth to provide a secure seal</p> Signup and view all the answers

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

    <p>Presence of moisture condensation with exhalation</p> Signup and view all the answers

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

    <p>Absence of CO2 response from the detector</p> Signup and view all the answers

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

    <p>Volutrauma</p> Signup and view all the answers

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

    <p>Dry the patient’s face and apply tincture of benzoin</p> Signup and view all the answers

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

    <p>Barotrauma to the lungs</p> Signup and view all the answers

    What is the primary purpose of CPAP?

    <p>To provide continuous airway pressure for patients with OSA</p> Signup and view all the answers

    Which method is NOT suitable for the delivery of NIV?

    <p>For unstable and critically ill patients</p> Signup and view all the answers

    What must be maintained to ensure CPAP functions effectively?

    <p>A tight seal between the mask and the patient's skin</p> Signup and view all the answers

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

    <p>Obstructive sleep apnea</p> Signup and view all the answers

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

    <p>Hypoventilation</p> Signup and view all the answers

    In which scenario would CPAP be most commonly used?

    <p>Long-term management of sleep apnea at home</p> Signup and view all the answers

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

    <p>The ventilatory and oxygenation settings</p> Signup and view all the answers

    What is a key requirement for the delivery of CPAP?

    <p>The patient must be breathing spontaneously</p> Signup and view all the answers

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

    <p>Suggests severe hyperglycemia</p> Signup and view all the answers

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

    <p>Physical stress such as infection</p> Signup and view all the answers

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

    <p>Aggressive intravenous rehydration</p> Signup and view all the answers

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

    <p>Change to a dextrose-containing solution</p> Signup and view all the answers

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

    <p>Hypoglycemia</p> Signup and view all the answers

    What dietary recommendation is crucial for managing diabetes?

    <p>Adhere to a regular meal schedule including snacks</p> Signup and view all the answers

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

    <p>Type 2 Diabetes Mellitus</p> Signup and view all the answers

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

    <p>Improper hydration during tube feedings</p> Signup and view all the answers

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

    <p>Maintain blood volume and prevent recurrence</p> Signup and view all the answers

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

    <p>Cullen’s sign</p> Signup and view all the answers

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

    <p>Upper endoscopy</p> Signup and view all the answers

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

    <p>Oxygen supplementation</p> Signup and view all the answers

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

    <p>Hypotension</p> Signup and view all the answers

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

    <p>Provide comfort and safety</p> Signup and view all the answers

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

    <p>RBCs, Platelets, FFP</p> Signup and view all the answers

    What is a common cause of acute pancreatitis?

    <p>Gallstones</p> Signup and view all the answers

    What is the typical PaO2 range considered normal in adults?

    <p>80-100 mmHg</p> Signup and view all the answers

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

    <p>Increased blood pressure</p> Signup and view all the answers

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

    <p>Increased skin turgor</p> Signup and view all the answers

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

    <p>Proton pump inhibitors</p> Signup and view all the answers

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

    <p>Securing the airway with a cuffed tube</p> Signup and view all the answers

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

    <p>Effective recurrent bleeding control</p> 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.

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