NORCET 7 Prelims -2024
Medical & Surgical Nursing
Medium
A nurse is using a non-rebreather mask on a patient, but the bag is not inflating. What should the nurse do next?
Appeared in: NORCET 7 Prelims -2024
Explanation
- The primary function of the reservoir bag on a non-rebreather mask is to store a high concentration of oxygen for the patient to inhale.
- If the bag is not inflating or is collapsing completely on inspiration, it indicates that the oxygen flow rate is insufficient to meet the patient's inspiratory demand.
- The immediate and correct nursing action is to increase the oxygen flow rate (typically to 10-15 L/min) to ensure the bag stays at least two-thirds inflated.
- This action prevents the patient from rebreathing exhaled carbon dioxide and ensures they receive the intended high fraction of inspired oxygen (FiO₂).
Why Other Options Were Wrong
- Option A: While checking for kinks is a valid troubleshooting step for any oxygen delivery system, it is not the most likely cause or the priority intervention for a consistently deflating reservoir bag. The primary cause is an inadequate flow rate.
- Option C: Changing to a nasal cannula is inappropriate and potentially dangerous. A patient on a non-rebreather mask requires a high concentration of oxygen (80-95%), which a nasal cannula cannot provide (it delivers a much lower 24-44%). This would lead to worsening hypoxia.
- Option D: Removing the mask would interrupt oxygen delivery entirely, which is harmful to a patient who is already hypoxic. The priority is to fix the equipment problem, not to remove the life-sustaining therapy.
Related Visual
- Visual 1: Diagram - A correctly functioning non-rebreather mask, showing the reservoir bag partially inflated during inspiration.
- Visual 2: Infographic - A comparison of different oxygen delivery devices (nasal cannula, simple mask, non-rebreather, Venturi mask) with their respective FiO₂ delivery ranges and flow rates.
Clinical Relevance
- Nursing practice connection: Use the key finding related to Management of a non-rebreather oxygen mask to guide bedside assessment, documentation, and the next nursing action.
- Proper management of a non-rebreather mask is a critical nursing skill to prevent severe hypoxia and carbon dioxide retention.
- Failure to ensure an adequate flow rate can negate the therapeutic effect of the high-flow device, leading to clinical deterioration.
- What if? - If the bag remains deflated after increasing the flow rate to 15 L/min, the nurse should immediately check for a poor seal around the patient's mouth and nose, or a leak/disconnection in the oxygen tubing or source. If no obvious leak is found, the patient's respiratory effort may be too great for the device, and escalation to a higher level of support (like BiPAP or mechanical ventilation) may be necessary.
How to Approach the Question
- First, identify the core clinical problem: The non-rebreather mask's reservoir bag is not inflating.
- Recall the function of a non-rebreather mask and its reservoir bag. The bag must stay inflated to provide a high concentration of oxygen.
- Analyze the cause of a deflating bag. This is a classic sign that the oxygen flow rate is too low to meet the patient's breathing demands.
- Evaluate the options based on priority. The most immediate action to correct the problem and ensure patient safety is to address the flow rate.
- Eliminate options that are incorrect or less of a priority. Checking for kinks is secondary. Changing to a lower-level device or removing the mask is contraindicated and harmful.
Concept Tested & Keywords
- Concept Tested: Management of a non-rebreather oxygen mask
- Stem keywords: non-rebreather mask, bag not inflating, nurse
- Lead-in keywords: do next
- Clinical cues: A non-inflating reservoir bag on a non-rebreather mask is a critical sign of inadequate oxygen flow.
Question ID
Qmt_YJ2Xwarmez8_fI9D3W
Practise the full NORCET 7 Prelims -2024
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