Airways, Suctioning and Trach's Flashcards
1
Q
Why might a nasopharyngeal be used over an oropharyngeal airway?
A
Easier to gag out the oro type, but naso is much more secure since it does not irritate gag reflex
2
Q
What sizes do oropharyngeal airways come in?
A
- Size 000 to 10, OR small, medium or large
- Babies and small children = 000-3
- Bigger children = 3-4
- Adults usually 4+
- Measure is based on age and size of person
3
Q
Why do we do oral suctioning?
A
- Yaunker suctioning common
- Removes secretions from the mouth (but will also remove O2; be mindful of pre-oxygenating)
4
Q
Where do we insert an oropharyngeal tube?
A
Inserted through the mouth to pharynx
5
Q
Where do we insert a nasopharyngeal tube?
A
Inserted through the nares to the pharynx
6
Q
What are complications of airway suctoning?
A
- Hypoxia
- Trauma to the airway
- Increased HR (remove O2, heart pumps harder) OR decreased HR if vagus nerve irritated
- Laryngo spasm
7
Q
Describe the anatomy of the trachea:
A
- The trachea is the first part of the airway not shared by GI tract
- Trachea stretches between the larynx and the carina
- In the average adult it is 10-12cm long and 2.5cm in diameter (determines size of tracheostomy)
- The trachea is protected by 16-20 hyaline cartilage rings which help to maintain patency
8
Q
What is a tracheostomy?
A
- An artificial opening (or stoma) in the trachea
- Surgically created between 2nd and 3rd cartilaginous ring
- Temporary or permanent
- Kept open by the insertion of a tracheostomy tube
- Shortens the length of the upper airway
- Decreases the work of breathing for the patient since dead space in nose/mouth eliminated, much easier for patients with labored work of breathing
9
Q
Why might someone have a permanent trach?
A
- Cancer (esp. head and neck)
- Quadriplegic
- Muscular dystrophy
- Myasthenia gravis
- ALS
- May or may not be ventilator dependent
10
Q
What are some general indications for trachs?
A
- Not usually a first line procedure, typically intubation done in other ways
- Fractures
- Traumas/burns
- Foreign bodies
- Infections
- Inability to protect own airway
- Respiratory insufficiency
- Upper airway obstruction and bleeding
- Inability to clear secretions effectively
11
Q
What are some complications of tracheostomy?
A
- Airway occlusion
- Tissue damage (necrosis, ulceration)
- Infection
- Pooling of food in airway d/t decreased functioning of epiglottis
- Communication difficulties
- Tube displacement/dislodgement (e.g. by coughing)
- Bleeding
- Tracheo-oesophageal fistula
- Inability to maintain nutrition/hydration needs
- Air leaks
- Loss of normal airway function
- Secretion accumulation in upper airways, requiring suctioning
- Dehydration of airway
- Poor oxygenation of tissues leading to atelectasis possible
12
Q
What are the different types of trach tubes?
A
- Vary in length, size, composition and number of parts
- Cuffed vs. uncuffed
- Fenestrated vs. non-fenestrated
- Fenestrated means there is a small hole in the tube, used to help promote speech; trachs with no trachs = no sound
- Downside of fenestration is accumulation of secretions/food in the tube, occluding the airway
13
Q
Describe the composition of trach tubes:
A
- Consists of an outer cannula with flange [the outer wings], inner cannula (changed q12h) and obturator (mostly for insertion and new trachs at risk of stoma closing; is NOT left in there since it would occlude)
- May have a speaking valve attached (but tube must be fenestrated)
14
Q
Describe nursing implications for trachs:
A
- Preparation (equip at bedside, pt assessment, discussed with patient, correct positioning, 2nd nurse to help with procedures)
- Assessment (airway, breathing, o2 sats, energy to breath, chest expansion, coughing, assessment of secretions, are they tolerating o2 or humidification)
- Education (family may want to learn how to suction)
- Communication/body image changes
- Procedures
- Emergencies
- Guidelines and documentation
15
Q
Describe patient assessment:
A
- Why does the patient have a tracheostomy?
- How long have they had a tracheostomy?
- Type/size of tube (think of size like straw and how appropriate it would be to easily breath through for the person)
- Level of respiratory support needed
- Respirations/breath sounds
- Cuffed?/inflated?
- Humidification method?
- Suction required?/how often?
- Thickness, colour, amount of sputum
- Cleaning of inner tube?
- Wound assessment/dressing changes (once a shift)
- Can the patient swallow?
- Assessment done?
- Weaning progress
- When does the outer tube need changing?
- What does the patient look like?
- Patient education
- Mouth care
