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Complex Care 1 > Artificial Airways > Flashcards

Artificial Airways Flashcards

1
Q

Compliance

A
  • The ability of the lungs to stretch & expand
    > low compliance = stiff lungs
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2
Q

Resistance

A
  • The resistance of the resp tract to airflow during inhalation & exhalation
    > asthma & bronchospasm: narrows the airways
    > secretions: narrow the airway & makes it harder for air to be inhaled & exhaled
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3
Q

What meds affect resistance?

A
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4
Q

Endotracheal Tube (ETT)

A

A flexible plastic tube w/ a cuff on the end which sits inside the trachea & terminates 3-4 cm above the carina secured w/ a commercial tube holder

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5
Q

Endotracheal Tube (ETT) - Placement

A
  • Through the orotracheal route via direct laryngoscopy, video laryngoscopy, or nasotracheal route via blind nasal intubation
    > fully secures the airway: the gold standard of airway management
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6
Q

Endotracheal Tube (ETT) - Uses

A
  • Maintenance of airway patency
  • Protection of airway from aspiration
  • Application of positive-pressure ventilation
  • Facilitation of pulmonary hygiene
  • Use of high oxygen concentrations
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7
Q

ETT Complications - During Intubation

A
  • Nasal & oral trauma
  • Pharygneal & hypopharyngeal trauma
  • Vomiting w/ aspiration
  • Cardiac arrest
  • Hypoxemia & hypercapnia: bradycardia, tachycardia, dysrhythmias, HTN, & hypotension
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8
Q

ETT Complications - After Intubation

A
  • Nasal & oral inflammation & ulceration
  • Sinusitis & otitis
  • Laryngeal & tracheal injuries
  • Tube obstruction & displacement
  • Laryngeal & tracheal stenosis and a cricoid abscess
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9
Q

Tube Obstruction - Causes

A
  • Pt biting tube
  • Tube kinking during respositioning
  • Cuff herniation
  • Dried secretions, blood, or lubricant
  • Tissue from tumor
  • Trauma
  • Foreign body
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10
Q

Tube Obstruction - Prevention & Treatment

A
  • Prevention
    > place bite block
    > sedate pt PRN
    > suction PRN
    > humidify inspired gases
  • Treatment
    > replace tube
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11
Q

Tube Displacement - Causes

A
  • Movement of pt’s head
  • Movement of tube by pt’s tongue
  • Traction on tibe from ventilator tubing
  • Self-extubation
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12
Q

Tube Displacememt - Prevention & Treatment

A
  • Prevention
    > secure tube to upper lip
    > sedate pt PRN
    > ensure tht only 2 in of tube extend beyond lip
    > support vent tubing
  • Treatment
    > replace tube
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13
Q

Sinusitis & Nasal Injury - Causes

A
  • Obstruction of paranasal sinus drainage
  • Pressure necrosis of nares
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14
Q

Sinusitis & Nasal Injury - Prevention & Treatment

A
  • Prevention
    > avoid nasal intubation
    > cushion nares from tube & tape or ties
  • Treatment
    > remove all tubes from nasal passages
    > administer antibiotics
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15
Q

Tracheoesophageal Fistula - Causes

A

Pressure necrosis of posterior tracheal wall, resulting from overinflated cuff & rigid nasogastric tube

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16
Q

Tracheoesophageal Fistula - Prevention & Treatment

A
  • Prevention
    > inflate cuff w/ minimal amnt of air necessary
    > monitor cuff pressure q8
  • Treatment
    > position cuff of tube distal to fistula
    > place gastrostomy tube for enteral feedings
    > place esophageal tube for secretion clearance proximal to fistula
17
Q

Mucosal Lesions - Causes

A

Pressure at tube & mucosal interface

18
Q

Mucosal Lesions - Prevention & Treatment

A
  • Prevention
    > inflate cuff w/ minimal amnt of air necessary
    > monitor cuff pressures q8
    > use appropriate size tube
  • Treatment
    > may resolve spontaneously
    > peform surgical intervention
19
Q

Laryngeal or Tracheal Stenosis - Causes

A

Injury to area from end of tube or cuff, resulting in scar tissue formation & narrowing of airway

20
Q

Laryngeal or Tracheal Stenosis - Prevention & Treatment

A
  • Prevention
    > inflate cuff w/ minimal amnt of air necessary
    > monitor cuff pressures q8
    > suction area above cuff frequently
  • Treatment
    > perform tracheostomy
    > place laryngeal stent
    > perform surgical repair
21
Q

Tracheostomy Tube

A

Preferred method of airway maintenance in a pt who requires long-term intubation (>7 days)

22
Q

Trach Complications - During Surgery

A
  • Misplacement of tracheal tube
  • Hemorrhage
  • Laryngeal nerve injury
  • Pneumothorax
  • Pneumomediastinum
  • Cardiac arrest
23
Q

Trach Complications - After Surgery

A
  • Stomal infection
  • Bleeding/hemorrhage
    > bleeding may occur after surgery & traumatic suctioning
  • Tracheoesophageal fistula
  • Tube obstruction & displacement
24
Q

Open Suctioning

A

The pt is disconnected from the vent & the suction catheter is introduced in the ETT/Trach

25
Q

Closed Suctioning

A

A sterile, closed tracheal suction system (CTSS) allows the pt to remain on the vent when suctioned

26
Q

Subglottic Suctioning

A
  • **Deep oropharyngeal suctioning at least q12 & before deflating the cuff or moving the tube **
    OR
  • Continuous (-20 to -30 cm H2O) or intermittent suction using the aspiration lumen tht ends w/ an opening above the cuff
27
Q

Artificial Airway: Nursing Interventions

A
  • Provide humidification
  • Manage the cuff (balloon)
    > cuff pressure are maintained w/in 20-30 cm H2O
  • Establish a method of communication
  • Provide oral hygiene
    > follow protocol
28
Q

Suctioning Complications - Hypoxemia

caused by
prevented by

A
  • Caused by:
  • Prevented by:

Complex Care 1 (3 decks)

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