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.
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.
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