Risk of falls/confusion

• Could be due to hypoxia
• Could be due to past medical history e.g. dementia or learning disability

Patient anxiety

Anxiety related to syncing with the mask, finding the mask uncomfortable, feeling claustrophobic and/or feeling like they can’t breath when using the machine

• Check with doctors if medication can be given to help with this
• Ensure regular breaks are discussed with the patient
• Ensure the patient has their call bell within reach
• Regular reassurance and encouragement

If the patient has had the mask on for a few days they may be anxious when we are weaning down the pressures and oxygen

Continence

• Does the patient need a catheter?
• Will the patient be short of breath when using the commode?
• Does the patient want/need a pad for comfort?
• Consider that patient will become short of breath when using the toilet/commode/bedpan so oxygenation needs to be monitored.

Dry eyes/mouth

Does the patient need eye drops/artificial tears? Consider using mouth care pack to moisten lips and mouth.

• Do not use a paraffin-based product if the patient is on oxygen.

Pressure sores

Pressure areas to consider when patient is in bed:

• Any bony prominence on a patient e.g. sacrum, shoulders, heels
• Facial pressure sores due to NIV mask

Areas to consider:

• Cheeks
• Nose bridge
• Forehead
• Back of head where the straps come into contact with the skin
• Chin

Oral intake

Fluid

• Is the patient drinking enough?
• Do IV fluids need to be considered?

Food

• Is the patient able to have breaks off of the CPAP to eat, and do they maintain their oxygen saturations while eating?
• If not consider NGT/dietician referral.

Gastric distention

A consequence of tight fitting mask around mouth and nose is that pressurised air delivered by CPAP is sometimes swallowed (aerophagia) resulting in a progressively swollen/distended stomach. This most often results in patients experiencing more flatulence, but there remains a serious risk of vomiting and aspirating.

Nursing assessments