You are working with a patient who is on non-invasive ventilation with bi-pap. You notice his oxygen saturation level has been lower than the healthcare provider would like it to be. He is still stable, alert and talking to you. What would be the next best step in this situation?

A. Increase the settings on the Bi-PAP machine on your own and continue to monitor the patient: Adjusting Bi-PAP settings independently is not within the nurse’s scope of practice and could risk barotrauma or hemodynamic instability.

B. Recommend starting the patient on antibiotics to the healthcare provider: Oxygen saturation alone does not indicate infection. Initiating antibiotics without other clinical evidence or provider orders is inappropriate and could lead to unnecessary treatment.

C. Communicate this to the healthcare provider and respiratory therapist you are working with and continue to monitor patient: Notifying the provider and respiratory therapist allows for professional evaluation and safe adjustment of Bi-PAP settings or other interventions. Continuous monitoring ensures patient safety while awaiting instructions.

D. Take no action at this time and continue to monitor the patient: While the patient is stable, leaving the provider uninformed delays potential interventions that may improve oxygenation. Active communication ensures timely and safe management of suboptimal oxygen saturation.

A. Increase PEEP: Positive end-expiratory pressure helps keep alveoli open at the end of expiration, improving oxygenation by increasing functional residual capacity and preventing alveolar collapse. Since the patient’s PaO2 is low (58 mmHg), increasing PEEP is the most effective first step to enhance oxygenation.

B. Increase respiratory rate: Increasing the respiratory rate primarily improves CO2 elimination rather than oxygenation. In this patient, hypoxemia is the priority concern, so adjusting rate will not adequately address low PaO2.

C. Increase FIO2: Increasing the fraction of inspired oxygen can raise PaO2, but prolonged high FIO2 levels increase the risk of oxygen toxicity. PEEP adjustments are generally prioritized before raising FIO2 to high levels.

D. Increase tidal volume: Raising tidal volume mainly improves CO2 removal and ventilation but has limited effect on oxygenation in a patient with alveolar collapse or shunting. Additionally, increasing VT carries a risk of volutrauma.