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airways Flashcards

1
Q

indications for artificial airways

A
  • Upper airway obstructions
  • Apnea
  • High risk for aspiration
  • Ineffective clearance of secretions
  • Respiratory distress
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2
Q

equipment used for endotracheal intubation

A

o Self-inflating BVM/ambu bag and mask and oxygen
o ET tube, guide wire, lubricant, securement device, End Tidal CO2 detector
o Suctioning equipment
o IV access and medications as indicated

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3
Q

preparation for endotracheal intubation

A

o Consent/resuscitation status
o Client teaching
o Position client
o Preoxygenate

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4
Q

what to do during endotracheal intubation

A

o Limit each intubation attempt to less than 30 seconds
o Ventilate client between successive attempts
o Rapid sequence intubation (RSI) (administer sedative and Paralytic agents)
o Monitor oxygenation status
o Assess for signs of hypoxia, dysrhythmias, aspiration

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5
Q

what do you do after endotracheal intubation

A
  • confirm placement of ET tube with: end-tidal CO2 detector (turns gold means its in correct placement
  • Auscultate lung bilaterally
  • Observe chest wall movement
  • Check O2 saturation
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6
Q

what to do after placement of endotracheal intubation was verified

A
  • Inflate cuff
  • Secure airway
  • Suction oropharynx and ET tube as needed
  • Obtain chest x-ray (2-6 cm above carina)
  • Record and mark position of tube in cm at teeth or gums
  • Monitor oxygen saturation continuously, may monitor end-tidal CO2 continuously
  • Obtain ABGs as ordered
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7
Q

2 types of artificial airways

A

endotracheal tube and trachestomy

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8
Q

what is a tracheostomy

A

surgically created stoma in anterior wall of trachea
(shorter in length and wider in diameter to make it easier to keep tube clean and facilitates better oral and bronchial hygiene; less risk for long-term damage to vocal cords; increase patient comfort)

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9
Q

indications for tracheostomy

A
  • establish patent airway
  • bypass upper airway obstruction
  • facilitate removal of secretions
  • permit long term ventilation
  • assist with weaning from mechanical ventilation
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10
Q

what are the types of tracheostomy

A
  • Single versus double cannula
  • Fome-cuff
  • Fenestrated tracheostomy tube
  • Speaking tracheostomy valves
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11
Q

prior to insertion of tracheostomy

A
  • Percutaneous insertion or surgical placement
  • Verify consent
  • Check coagulation status
  • Baseline assessment vital signs, O2 saturation
  • Confirm IV access and prepare medications
  • Gather equipment
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12
Q

after insertion of tracheostomy

A
  • Immediately after trach tube placement, inflate cuff
  • Confirm placement (auscultate breath sounds, end-tidal CO2, pass suction catheter thru tube
  • Secure tracheostomy tube
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13
Q

insertion of tracheostomy

A
  • Percutaneous insertion
  • Surgical placement
  • Check coagulation status
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14
Q

what is the assessment for ETT and Trach

A

ETT: look at tube type (oral or nasal); size of airway, location at teeth/gums (marking on the tube)

Trach: tubę type and size; assess insertion site/stoma

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15
Q

interventions for ETT and Trach

A
  • maintain correct tube placement (securement)
  • maintain proper chug inflation (minimal occluding volume/MOV; minimal leak technique/MLT)
  • monior O2 and ventilation (RRR, work of breathing, use accessory muscles, ABGs, signs hypoxemia)
  • Maintain tube patency
  • Assess need for suctioning q 1-2 hours and suction only as needed
  • Manage thick secretions
  • Provide oral care and maintain skin integrity q2-4 hrs
  • Provide for communication method
  • Perform trach care q shift & prn
  • Keep trach obturator and spare trach at bedside
  • Monitor oxygen source
  • Monitor for complications (unplanned extubation and aspiration)
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16
Q

indications for suctioning

A
  • Visible secretions in ET tube
  • Sudden onset of respiratory distress
  • Suspected aspiration of secretions
  • Increased respiratory rate or frequent coughing
  • Sudden decrease in SpO2
  • ↑ Peak airway pressures
  • Adventitious breath sounds
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17
Q

procedure for suctioning

A
  • Hyperoxgenate before and after
  • Limit suctioning time 10 sec or less
  • Monitor SpO2 and ECG
  • Limit suction pressure <120 mmHg
  • Insert until client coughs or meet resistance (whichever comes first)
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18
Q

complications of suctioning

A
  • Hypoxemia
  • bronchospasm
  • Increased intracranial pressure
  • Dysrhythmias
  • ↑ or ↓ BP
  • Mucosal damage
  • Pulmonary bleeding
  • Pain
  • infection
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19
Q

how to manage thick secretions

A 
o	Adequate hydration 
o	Supplemental humidification 
o	No saline instillation
o	Mobilize and turn client
o	Antibiotics as needed
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20
Q

how to provide. oral care. and maintain skin integrity q2-4 hrs

A

o Brush teeth BID
o Oral swabs with 1.5% hydrogen peroxide and/or mouthwash
o Chlorhexidine oral rinse twice/day
o Moisturizer- lips, tongue, gums
o Oropharyngeal suctioning
o Reposition and retape ET tube every 24 hours

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21
Q

how to prevent unplanned extubation

manifestations and actions

A

Manifestation: : low pressure alarm ventilator, decreased or absent breath sounds, respiratory distress, audible cuff leak

  • Ensure securement of ET tube/Trach tube
  • Support ET tube/trach tube during repositioning and procedures
  • Provide sedation and analgesia as ordered
  • Use soft wrist restraints as needed (requires HCP order)

actions: Stay with client, call for help, ventilate with BVM and 100% O2 as indicated

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22
Q

how to prevent aspiration

A
  • cuff inflation
  • epuglottic suction
  • increased secretions are to be suction through oral cavity
  • prevent vomiting by NGT or OGT, increase HOB to 30-45 degrees
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23
Q

what to. assess for with unplanned extubation

A
  • Patient vocalization
  • Activation of low-pressure alarm
  • Diminished or absent breath sounds
  • Respiratory distress
  • Gastric distention
24
Q

what to do with incorrect tube placement/unplanned extubation

A
  • Rapid client assessment
  • Call for help
  • Stay with client
  • Maintain airway and Support ventilation
  • If necessary, manually ventilate with ambu bag & 100% O2
25
Q

Process by which air/O2 is moved into and out of lungs by a mechanical ventilator

A

mechanical ventilation

26
Q

mechanical device designed to provide all or part of the work of the body to move gas in and out of the lungs

A

mechanical ventilator

27
Q

indications for mechanical ventilation

A
  • Apnea
  • impending inability to breathe or protect airway
  • Acute respiratory failure
  • Severe hypoxia (refractory hypoxemia)
  • Respiratory muscle fatigue
  • Respiratory arrest
28
Q

what is a positive pressure ventilation (PPV)

A

movement of gas into lungs through positive pressure

  • Used primarily for acutely ill adults
  • Delivers air into lungs under positive pressure during inspiration → intrathoracic pressure ↑ during lung inflation (opposite of normal)
29
Q

2 categories volume and pressure ventilation

A

o Volume ventilation – preset volume delivered with each breath and pressure varies
o Pressure ventilation – peak inspiratory pressure is Predetermined and volume varies breathe to breathe

30
Q

mechanical ventilator settings

A
  • rate
  • tidal volume (VT)
  • Fraction of inspired oxygen (FiO2)
  • positive end-expiratory pressure (PEEP)
  • Pressure support (PS)
  • I:E ratio
  • inspiratory flow rate and time
  • sensitivity
  • Alarm settings
31
Q

describe the setting rate

A
  • Definition – number of breaths the ventilator delivers

* Usual setting: 12– 20 breaths/min

32
Q

describe the setting tidal volume (VT)

A
  • Definition – volume of gas delivered with each ventilator breath
  • Usual setting: 6-8 mL/kg (based on client’s ideal weight); 4-6 mL/kg ARDS
33
Q

describe the setting fraction of inspired oxygen (FiO2)

A
  • Definition – fraction of inspired oxygen delivered to client
  • Set between 21 - 100%
34
Q

describe the setting positive end-expiratory pressure (PEEP)

A
  • Definition – positive pressure applied at end of expiration of ventilator breaths
  • Usual setting: 5 cm H2O
35
Q

describe the setting pressure support (PS)

A
  • Positive pressure used to augment the client’s inspiratory Pressure
  • Usual setting: 5-10 cm H2O
36
Q

describe the setting I:E ratio

A
  • Duration of inspiration to duration of expiration

* Usual setting 1:2 to 1:1.5

37
Q

describe mechanical ventilator modes

A
  • Based on how much work of breathing (WOB) client should or can perform
  • Determined by client’s ventilatory status, respiratory drive, & ABGs

(determines how breaths delivered to client)

38
Q

what are the 3 types of mechanical ventilator modes

A
  • assist-control ventilation (A/C)
  • Synchronized intermittent mandatory ventilation (SIMV)
  • Continuous positive airway pressure (CPAP)
39
Q

what is assist-control ventilation and the disadvantages

A
  • Used for clients who have weak respiratory muscles and may be unable to maintain adequate ventilation
  • disadvantages: Risk of hyperventilation, Risk of respiratory alkalosis, Muscle fatigues
40
Q

what are the 2 types of assist-contol ventilation (A/C)

A
  • Volume assist-control (V A/C): Delivers preset tidal volume and pressure varies
  • Pressure assist-control (P A/C): Predetermined peak inspiratory pressure and volume varies
41
Q

what is Synchronized intermittent mandatory ventilation (SIMV)

A

Ventilator synchronizes the mandatory breaths with the client’s own inspirations

42
Q

what is Continuous positive airway pressure (CPAP)

A

Provides continuous positive airway pressure during spontaneous breathing

43
Q

measurement of client/ventilator produced data

A
  • exhaled tidal volume (EVt): Should not be more than 50 mL difference from set VT
  • Peak inspiratory pressure (PIP)
  • minute ventilation
    • Amount of gas moved in and out of lung per minute
    • RR x TV = MV Normal 5–8 L/MIN
    • 12 bpm x .600 (or 600 TV) = 7.2 L/min
44
Q

what. to do with ventilator alarms

A
  • Never shut alarms off; silence only

- Manually ventilate if uncertain of problem until problem identified and resolved

45
Q

different kinds of mechanical ventilation alarms

A 
high pressure limit
low pressure limit
high tidal volume
high minute ventilation
high respiratory rate 
low tidal volume or low minute ventilation
ventilator inoperative
46
Q

complications of mechanical ventilation

A
  • Misplaced ETT right mainstem bronchus
  • Cardiovascular – Hypotension, decreased preload, decreased CO
  • Barotrauma – pneumothorax
  • Pneumomediastinum – pneumothorax
  • Volutrauma – movement of fluids and proteins into alveolar spaces
  • Alveolar hypoventilation – inappropriate vent settings, leakage air from tubing, obstruction
  • Alveolar hyperventilation rate or VT too high
  • Stress Ulcers and GI bleeding
  • Ventilator-associated pneumonia
47
Q

manifestations of ventilator-associated pneumonia

A 
fever
increased WBC
purulent sputum
crackles or wheezes
pulmonary infiltrates
48
Q

guidelines to prevent Ventilator-associated pneumonia

A

o Minimize sedation and spontaneous breathing trials
o Early exercise and mobilization (turn q 2hrs)
o Subglottic secretion drainage port
o Elevate HOB 30-45 degrees
o Oral care with chlorhexidine
o No routine changes of ventilator circuit tubing
o Good hand hygiene

49
Q

nursing diagnosis for mechanical ventilation

A
  • Ineffective airway clearance
  • Ineffective breathing pattern
  • Impaired gas exchange
  • Risk for infection
  • Decreased cardiac output
  • Impaired verbal communication
  • Dysfunctional weaning
  • Risk for aspiration
  • Risk for impaired mucous membranes
  • Risk for constipation
50
Q

Assessment for mechanical ventilation

A

o Respiratory rate, pattern of breathing, breath sounds, ventilator settings and mode, oxygen saturation
o Level of consciousness, sedation level (sedation scale)
o Heart rate, blood pressure, dysrhythmias

51
Q

actions to take with mechanical ventilation

A 
o	Prevent and manage delirium 
o	Manage sedation, analgesia, paralytics 
o	Collaborate with other disciplines 
o	Implement vent bundle
o	Monitor for complications and troubleshoot vent alarms
o	Implement VTE and GI prophylaxis
o	Determine need for suctioning
o	Provide enteral nutrition
52
Q

client criteria for weaning off mechanical ventilation

A
  • Reversal of underlying cause of respiratory failure
  • Adequate oxygenation
  • Hemodynamic stability
  • Adequate respiratory muscle strength
53
Q

methods of weaning off mechanical ventilation

A
  • Spontaneous breathing trial (SBT)
    o Pressure support
    o CPAP
    o T-piece trials
54
Q

procedure of extubation of mechanical ventilation

A

o Hyperoxgenate
o Suction
o Deflate cuff and have client cough as remove tube
o Supplemental oxygen

55
Q

assessment for extubation of mechanical ventilation

A

o Vital signs, continuous pulse oximetry
o Cardiac status
o Respiratory status including rate and effort
o Signs client not tolerating extubation: decreased SpO2, tachypnea, or bradypnea, tachycardia, decreased LOC, decreased PaO2, increased PCO2

56
Q

actions to take for extubation of mechanical ventilation

A
  • Encourage to cough and deep breathe
  • Encourage use of incentive spirometer
  • Monitor for signs of airway obstruction. (Dyspnea, cyanosis, coughing, stridor)
    * Notify HCP immediately for reintubation of client
57
Q

complications following extubation of mechanical ventilation

A
  • Respiratory distress
  • Airway obstruction
  • Aspiration
  • Sore throat
  • Hoarseness

complex (7 decks)

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