BiPAP and Prepare Transfer – COPD Nursing Care in ER

by Rhonda Lawes, PhD, RN

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    00:01 Now, what about the Venturi mask? What's the next step as a nurse if you know if that Venturi mask, if we titrated up, still not enough to maintain the target oxygen saturation.

    00:12 What might the health care provider consider as the next step.

    00:16 We've gone from nasal cannula to Venturi mask.

    00:21 Now in the Venturi mask, she needs to be able to breathe on her own.

    00:25 So she's breathing on her own and it's still not enough.

    00:29 What we need to do is think about what the next step is.

    00:32 So pause it, based on your knowledge of oxygen delivery methods, see what you think could be the next step.

    00:38 I'll give you a clue. It's not the ventilator.

    00:45 Okay, did you get it? This one would be considering a BiPAP.

    00:50 Now, why is a BiPAP beneficial for a COPD patient? See if you can recall from our oxygen delivery videos if you know the answer to this one.

    01:03 Let me give you a really complete list of what the benefits are for BiPAP particularly for Mrs. Taylor because she has COPD.

    01:11 See, BiPAP can deliver a higher pressure when the patient inhales and then a lower one when Mrs. Taylor's trying to breathe out.

    01:18 That's really helpful so she doesn't work as hard.

    01:21 She's already working hard enough.

    01:23 Now, I wanna emphasize we're not at the point where we need to go to BiPAP.

    01:27 This is just thinking ahead and what would likely be the next step if the Venturi mask doesn't work.

    01:34 Cuz see people with COPD end up with this 'air trapping' in their lungs, right? That's why they keep getting the bigger, bigger lung tissue, they have this damage the lung tissue from the disease so they need a longer time to exhale.

    01:47 So I wouldn't wanna do anything that makes it harder for her to exhale that's why a BiPAP is really good with the lower pressure.

    01:56 Now, the lower pressure's on exhale but the BiPAP delivers, reduces the amount of work it takes for Mrs. Taylor to breathe out.

    02:04 Because of the COPD, we know she has air trapping so the BiPAP with lower pressures will reduce the amount of work she'd have to do if we just had a CPAP machine on this, like a hair dryer on your face.

    02:17 Now, BiPAP is a non-invasive, it's a positive pressure oxygen delivery method by mask.

    02:24 So it's non-invasive, meaning if she was intubated, the physician would put the tube in the oral cavity down into the trachea, that's called invasive.

    02:34 But BiPAP is considered non-invasive because it's just a mask that she would wear and delivers positive pressure oxygen.

    02:42 Meaning it's got a force of air behind it.

    02:45 Now, when you put a patient on BiPAP, it can reduce the need to intubate them. Sweet.

    02:50 We don't want to intubate anyone that we don't have to because it's invasive, because it can be difficult to get the patient off.

    02:57 BiPAP, whether you have COPD or some other respiratory disorder, is a way to try to help the patient stay off the ventilator if possible.

    03:07 As the ER nurse, now your job is to prepare the patient, Mrs. Taylor, for transfer.

    03:13 So you're gonna get all your information together so you can give a clear, concise, and objective report to the next nurse.

    03:20 Now, I wanna reinforce that often COPD patients can be treated, they might be able to discharge home, they might be able to go to the medical surgical floor, but Mrs. Taylor is in a little bit different spot.

    03:31 Remember, she's in that significant respiratory distress.

    03:34 She's also got the additional problem of a pneumonia.

    03:37 So your job is to prepare a new introduction SBAR.

    03:42 Remember, I took the R off of this one just because this is a quick way for you to give report.

    03:47 Kinda make sure that you've got everything in order and then you wanna talk to that telemetry nurse system by system.

    03:53 Let them know what's going on. Neuro, cardio, respiratory for sure, GI, working through all the systems.

    04:00 They talk to the telemetry nurse about your assessments of each system, any lab testing that applies to those systems, medications that you've given, diagnostic test.

    04:11 For example, if we're gonna talk about the respiratory system, you're gonna let her know information -- assessment data that we've collected so you're gonna tell her what the lungs sounded like.

    04:22 You're gonna tell her the results of the chest x-ray, the results of the ABGs.

    04:27 What you've been doing with oxygen, what her sat has been running.

    04:30 So think about all the most pertinent information.

    04:34 One very simple way to organize that is system by system.

    04:37 I always work head to toe because that's a system that works for me.

    04:42 You're gonna need to find the best system for you when you're practicing.

    04:46 So talk to other nurses. Ask them what they use.

    04:49 Talk through how they work it, you try it, see what's most effective for you.

    04:53 Now, it might change from unit to unit but the more information you learn from actual practicing nurses, it's gonna help you develop your best professional practice.

    05:04 So you're gonna get this ready. You're gonna pull an I-SBAR part together.

    05:08 You don't necessarily have recommendations or read back.

    05:11 It's not needed in this part because you're talking to another colleague.

    05:15 So in addition to the I-SBAR, introducing yourself, explaining the situation, the background, and the assessment section, you're gonna go through each one of the systems including in there your hands on physical assessment, lab work, results of chest x-rays, et cetera.

    05:32 Okay, so your recommendation will be for your colleague.

    05:36 Let them know what you think they need to keep an extra close eye on.

    05:39 Anything you've learned about Mrs. Taylor and her family and what your -- recommend would be a good follow up for the nurse.

    05:47 That will help you give an excellent report that's both clear and concise.

    05:52 Remember, always use objective information to make that for your colleague.

    05:57 Alright. Thank you for watching our video today.

    About the Lecture

    The lecture BiPAP and Prepare Transfer – COPD Nursing Care in ER by Rhonda Lawes, PhD, RN is from the course Respiratory Case Study: Nursing Care of COPD Patient.

    Included Quiz Questions

    1. Bilevel positive airway pressure (BiPAP)
    2. Mechanical ventilation
    3. Continuous oxygen saturation monitoring while the client remains on the venturi mask
    4. Stat arterial blood gasses
    1. It is non-invasive
    2. It delivers lower pressures on exhale, reducing the amount of effort it takes to breathe out
    3. It reduces the need for mechanical ventilation
    4. It delivers a higher pressure with inhalation
    5. It delivers a higher pressure with exhalation
    1. The client's current respiratory condition
    2. Medications administered to the client while in the emergency department (ED)
    3. Significant lab results of the client
    4. The client's medical history including co-morbidities
    5. The client's insurance coverage

    Author of lecture BiPAP and Prepare Transfer – COPD Nursing Care in ER

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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