Exam 19: Basic Concepts of Noninvasive Positive-Pressure Ventilation

The primary goal of NIV in the acute care setting is to do which of the following?

A patient with central sleep apnea uses a nasal mask with NIV at night.The patient complains of nasal congestion.What action should the respiratory therapist take?

A 61-year-old female was admitted last night with shortness of breath.She currently is alert and oriented but very anxious.Her latest arterial blood gas values,on a nasal cannula at 3 L/min,show: pH = 7.39; PₐCO₂ = 41 mm Hg; PₐO₂ = 40 mm Hg; SₐO₂ = 74%; HCO₃⁻ = 24 mEq/L.Breath sounds are decreased throughout with fine late crackles on inspiration.The current chest X-ray shows an enlarged heart with bilateral vascular congestion.The most appropriate therapy for this patient is _________.

One of the physiological goals of NIV in acute respiratory failure is to improve gas exchange by ______________.

A 68-year-old,5-foot,10-inch male patient with acute-on-chronic respiratory failure due to COPD has been placed on NIV with these settings: IPAP = 8 cm H₂O,EPAP = 4 cm H₂O,FɪO₂ = 0.28.The patient's measured exhaled volume is 350 mL with a spontaneous respiratory rate of 24 breaths/min.The resulting arterial blood gas values are: pH = 7.27,PₐCO₂ = 77 mm Hg,PₐO₂ = 64 mm Hg,SₐO₂ = 88%,HCO₃⁻ = 36 mEq/L.What action should the respiratory therapist take at this time?

A patient who was diagnosed 1 year ago with amyotrophic lateral sclerosis is being seen in his primary care physician's office.The patient is complaining of fatigue and inability to concentrate at work.The patient's FVC is 45% of predicted,the PₐCO₂ is 47 mm Hg,and the MIP is 54 cm H₂O.Which of the following should be considered for this patient?

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 extremities,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 appropriate action at this time is which of the following?