# A nurse is caring for a patient receiving continuous positive airway pressure (CPAP) therapy. Which nursing action is most important to ensure patient safety during CPAP treatment?

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> subject: Adult Health

## 문제

A nurse is caring for a patient receiving continuous positive airway pressure (CPAP) therapy. Which nursing action is most important to ensure patient safety during CPAP treatment?

## 보기

1. Encourage the patient to keep the mask on for at least 4 hours continuously
2. Apply petroleum jelly to the nasal bridge to prevent skin breakdown
3. Monitor for signs of gastric distension and aspiration risk **✔ 정답**
4. Increase the CPAP pressure gradually to improve patient tolerance

**정답: 3**

## 해설

Monitoring for gastric distension and aspiration risk is most critical during CPAP therapy due to positive pressure forcing air into the stomach. Other options address comfort or tolerance but are not the highest safety priority.

## 심화 해설

Understanding CPAP Therapy and Patient Safety

When caring for a patient on continuous positive airway pressure (CPAP), the nurse must prioritize monitoring for a critical, potentially life-threatening complication: gastric insufflation leading to distension and aspiration. CPAP delivers a constant stream of pressurized air to keep the upper airway open. However, if the pressure exceeds the lower esophageal sphincter pressure (typically around 20-25 cm H2O), air can be forced into the esophagus and stomach rather than the lungs . This is not just a comfort issue; it directly creates a high risk for vomiting and aspiration of gastric contents, which can rapidly deteriorate into aspiration pneumonitis or pneumonia.

Why Other Options Are Less Critical

While the other nursing actions have a place in CPAP management, they do not address an immediate safety threat in the same way.

- Option 1: Encouraging continuous mask use for at least 4 hours is a strategy to improve therapeutic adherence and efficacy, but it is secondary to physiological safety. A patient who aspirates will not benefit from adherence.

- Option 2: Applying petroleum jelly to the nasal bridge is a skin integrity intervention. However, petroleum-based products can degrade the mask's silicone cushion, leading to a poor seal. More importantly, preventing skin breakdown, while a nursing responsibility, is not a higher priority than preventing aspiration.

- Option 4: Gradually increasing CPAP pressure is a technique to improve comfort and tolerance, which is a key determinant of non-invasive respiratory support success . However, a pressure that is titrated too high or without close monitoring can directly cause the gastric distension we are trying to prevent. The nurse must first be vigilant for the complication before focusing on tolerance.

The Pathophysiology of the Risk

The connection between CPAP and gastric distension is a direct physiological consequence of positive pressure. The same pressure that stents open the airway can overcome the gastroesophageal junction. Patients with decreased level of consciousness, a weak cough, or those receiving analgosedation to tolerate the mask are at even greater risk because their airway protective reflexes are blunted . A comprehensive nursing assessment, therefore, must include frequent auscultation of bowel sounds, observation for abdominal distension, and vigilant monitoring for any signs of regurgitation or vomiting. This proactive surveillance is the cornerstone of safe practice, a principle mirrored in structured nursing interventions that improve patient outcomes during respiratory monitoring .

## 임상 시나리오

CPAP Safety MonitoringPreventing Gastric Insufflation and Aspiration
The most critical safety action during CPAP is monitoring for gastric distension. When CPAP pressure exceeds the lower esophageal sphincter (LES) pressure (typically 20-25 cm H2O), air can be forced into the stomach, creating a high risk for vomiting and aspiration.

Nursing assessment should include observing for abdominal distension, auscultating bowel sounds, and monitoring for nausea or regurgitation. Aspiration of gastric contents can rapidly lead to aspiration pneumonitis, a life-threatening complication.

CautionNever apply petroleum-based products to the face or mask. They can degrade the silicone cushion, compromising the seal and increasing leak. Use a protective dressing specifically designed for CPAP masks if skin breakdown is a concern.

## 핵심 개념

- **Gastric Insufflation** — The forcing of air into the stomach, a complication of positive pressure ventilation when airway pressure exceeds lower esophageal sphincter tone.
- **Lower Esophageal Sphincter (LES) Pressure** — The pressure barrier between the esophagus and stomach, typically 20-25 cm H2O; CPAP pressures above this level can cause air to enter the stomach.
- **Aspiration Pneumonitis** — Chemical injury to the lungs caused by inhalation of sterile gastric contents, a severe complication of vomiting and aspiration.

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