A patient is admitted with a diagnosis of COPD and the health ...

[ereecah]

A patient is admitted with a diagnosis of COPD and the health care provider orders BiPAP. Which action by the nurse is appropriate?
 
  a. Set the initial BiPAP settings at 4 to 8 cm H2O for inspiration and expiration.
  b. Draw arterial blood gas (ABG) levels after the first hour.
  c. Make sure the mask does not have quick-release straps.
  d. Set the initial BiPAP settings at 4 to 10 cm H2O for inspiration and at 10 to 15 cm H2O for expiration.

Question 2

The nurse is teaching a patient about continuous subcutaneous infusion with an insulin pump. What should the nurse include in the teaching plan?
 
  a. Rotate the site every 1 to 2 days.
  b. Place a gauze dressing over the insertion site.
  c. Select an insertion site in the abdomen away from the waistline.
  d. Pull the skin laterally before inserting the needle.

[okolip]

Answer to Question 1

B
When BiPAP is initiated, especially in patients with underlying COPD, it is important to obtain ABG levels after the first hour and then per agency policy (usually every 2 to 6 hours) during the first day because these patients may retain carbon dioxide. BiPAP initial settings are 10 to 15 cm H2O for inspiratory pressure and 4 to 10 cm H2O for expiratory pressure. It is imperative that the mask have quick-release straps. In the case of an emergency (e.g., vomiting, respiratory arrest), quick-release straps allow the mask to be removed quickly. This system also allows the patient to remove the mask quickly as needed.

Answer to Question 2

C
Insulin is absorbed most consistently in the abdomen, so a site should be chosen in the abdomen away from the waistline. The site is changed every 2 to 7 days unless erythema or leaking occurs. An occlusive transparent dressing is used over the site. The skin should be gently pinched or lifted up to ensure that the needle will enter subcutaneous tissue.