Author Question: A home care patient using NIV complains that when she puts on the NIV mask at night and turns on the ... (Read 93 times)

haleyc112 · **on:** Jul 16, 2018

A home care patient using NIV complains that when she puts on the NIV mask at night and turns on the machine, at first the gas feels like it is punching her in the face. The patient is noncompliant with the NIV because of this.

What action should the respiratory therapist take?
a. Decrease the IPAP.
b. Increase the EPAP.
c. Decrease the flow trigger.
d. Set the ramp and delay time.

Question 2

A 75-year-old man with a long history of COPD is brought to the emergency department with shortness of breath.

He has a persistent, productive cough with green purulent sputum, cyanosis of the lips and ex-tremities, and is uncooperative. His arterial blood gas values on 2 L/min by nasal cannula are: pH = 7.25; PaCO2 = 90 mm Hg; PaO2 = 38 mm Hg; SaO2 = 59; HCO3 = 38 mEq/L. The most ap-propriate action at this time is which of the following?
a. IPPB
b. Mask CPAP
c. NIV via full face mask
d. Invasive mechanical ventilation

ttt030911 · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: D
The PTV allows for adjustment of the ramp and delay time to enhance patient comfort. Ramp allows positive pressure to increase gradually over a set interval or delay time.

Answer to Question 2

ANS: D
This patient meets the blood gas criteria for moderate to severe respiratory failure and therefore needs ventilatory support, as evidenced by the pH <7.35 and the PaCO2 >45 mm Hg; the PaO2/FIO2 is estimated at 38/0.28 = 136. This patient is at risk for failure of NIV because he is uncooperative (probably due to hypoxia) and has excessive secretions, as evidenced by his per-sistent productive cough.