Final answer:
The nurse's priority in caring for a patient on BiPAP for acute decompensated heart failure includes monitoring expiratory and inspiratory times, ensuring the mask fits properly without causing skin breakdown, being prepared for possible intubation, and assessing for gastric distention and related symptoms.
Step-by-step explanation:
When caring for a patient with acute decompensated heart failure (HF) who is receiving BiPAP therapy, a nurse's priority includes several key factors. First and foremost, it is critical to ensure that bi-level positive airway pressure is being delivered appropriately, which means monitoring the expiratory time to ensure that it exceeds the inspiratory time to prevent air trapping and possible patient discomfort or additional respiratory distress. Secondly, it is essential to monitor for potential skin breakdown from the BiPAP mask, as a mask that is too tight can cause tissue damage. Third, while BiPAP can stabilize some patients and potentially avoid intubation, the nurse should always be prepared for the possibility that the patient's condition may deteriorate, requiring endotracheal intubation. Lastly, it is crucial to assess the patient for gastric distention, nausea, and vomiting due to the potential of air being forced into the stomach, causing discomfort or aspiration risk.