A patient with acute respiratory failure requires NIV. The ...

[biggirl4568]

A patient with acute respiratory failure requires NIV. The patient is very dyspneic. Which of the following patient interfaces is most appropriate?
 
  a. Nasal mask
  b. Mini mask
  c. Nasal pillows
  d. Oronasal mask

Question 2

A 75-year-old, 5-foot, 7-inch female patient with an exacerbation of COPD is placed on the fol-lowing NIV settings: IPAP = 8 cm H2O, EPAP = 4 cm H2O, rate = 12 breaths/min, FIO2 = 0.3.
 
  The resulting VT is 255 mL. An arterial blood gas sample is drawn 1 hour later, and the results are: pH = 7.33, PaCO2 = 70 mm Hg, PaO2 = 58 mm Hg, HCO3 = 35 mEq/L. What action should the respiratory therapist take at this time?
  a. Increase the rate to 14 breaths/min.
  b. Increase the IPAP to 10 cm H2O.
  c. Intubate and mechanically ventilate the patient.
  d. Increase the IPAP to 10 cm H2O and the EPAP to 6 cm H2O.

[bblaney]

Answer to Question 1

ANS: D
The oronasal mask is used for patients with ARF, because acutely dyspneic patients tend to breathe more through the mouth as dyspnea increases.

Answer to Question 2

ANS: B
NIV was initiated at the appropriate settings for this patient; however, the arterial blood gas val-ues show that the patient still has hypercapnia in addition to her chronic ventilatory failure. The current settings are yielding a VT of 4 mL/kg. The IPAP needs to be increased to maintain the exhaled VT at 5-7 mL/kg. This will decrease the PaCO2 to an acceptable DIF for this patient.