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ASSESSMENT + MANAGEMENT OF AIRWAY Flashcards

1
Q

what are the different types of shock?

A
  • septic shock
  • anaphylactic shock
  • hypovolaemic/haemorrhagic shock
  • neurogenic shock
  • cardiogenic shock
  • distributive shock
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2
Q

what is septic shock?

A
  • severe sepsis complicated by persistent hypotension
  • severe drop in BP results in problems with how the cells produce energy
  • cell death occurs earlier in septic shock than other shock types
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3
Q

what are some risk factors for sepsis?

A
  • representation within 48 hours
  • recent surgery or wound
  • indwelling medical device
  • immunocompromised
  • age 65+
  • fall
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4
Q

what are some S&S of shock?

A
  • fevers and rigours
  • dysuria/frequency
  • cough/sputum/breathlessness
  • line-associated infection/swelling/redness/pain
  • abdominal pain/distension/peritonism
  • altered cognition
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5
Q

what is anaphylactic shock?

A
  • immune response
  • flood of chemicals released by the immune system on contact with the allergen can cause hypotension and narrowing airways, inducing shock
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6
Q

how do we treat anaphylactic shock?

A
  • adrenaline
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7
Q

what is hypovolaemic/haemorrhagic shock?

A
  • Loss of intravascular volume
  • Directly relates to the amount and speed of circulating blood volume
  • Massive sudden loss from trauma = no time for compensatory mechanisms
  • If volume is lost over time, compensatory mechanisms allow for short-term stability = a person may become more unwell overtime
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8
Q

how do we treat hypovolaemic/haemorrhagic shock?

A
  • blood transfusion
  • inotropes
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9
Q

what is neurogenic shock?

A
  • Damage to the nervous system or spinal cord causes an inability to maintain homeostatic mechanisms
    Ie. HR, BP and temp
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10
Q

how do we treat neurogenic shock?

A

→ collar to preserve the spine
→ dopamine, adrenaline and noradrenaline cause vasoconstriction to help treat hypotension and bradycardia

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11
Q

what is cardiogenic shock?

A
  • Impairment of the heart to contract
  • The inability of the heart to contract and dispel blood where it needs to go
  • Indirect problems = obstruction to blood flow
    Eg. cardiac tamponade, functional loss in the myocardium, acute MI, cardiomyopathy
  • The level of loss depends on the mechanism and how long the heart has continued like this
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12
Q

how do we treat cardiogenic shock?

A

→ optimisation of intravascular volume, inotropes and minimise cardiac workload

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13
Q

what is distributive shock?

A
  • Failure of the blood vessels to maintain the adequate tone
    Ie. change in tone and integrity of cells and blood vessels
  • Body’s ability to distribute blood to tissues and organs
  • Different mediators cause different responses
  • The inability to maintain pressure = decreased blood flow to vascular beds
  • The complex interaction between pathophysiology, vasodilation and relative/absolute hypovolemia
  • Early S&S may not indicate the level of unwellness
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14
Q

how do we treat distributive shock?

A

→ restoration of intravascular volume, mediate cause

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15
Q

what are the primary drugs used in cardiac arrest?

A
  • adrenaline
  • amiodarone
  • lignocaine
  • atropine
  • potassium
  • magnesium
  • calcium chloride
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16
Q

what is the MOA of atropine during a cardiac arrest and when do we administer it?

A

MOA:
- CNS stimulation → increases CO and HR by causing vasoconstriction
- Alpha and beta adrenergic effects

administration:
- VF/VT after initial counter shocks have failed (after 2nd shock loop)
- Asystole and PEA in the initial loop (then every 2nd loop)

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17
Q

what is the MOA of amiodarone during a cardiac arrest and when do we administer it?

A

MOA:
-Antiarrhythmic
- Prolongs action potential and slows the sinus rate

Administration:
- VF/pulseless VT (between 3rd and 4th shock)
- AF
- Atrial flutter

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18
Q

what is the MOA of lignocaine during a cardiac arrest and when do we administer it?

A

MOA:
- Antiarrhythetic

Administration:
- NOT TO BE USED IN SVT
- In cardiac arrest: 100mg bolus repeated after 5-10 mins
- Ventricular arrhythmias particularly when associated with AM

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19
Q

what is the MOA of atropine during a cardiac arrest and when do we administer it?

A

MOA:
- Anticholinergic
- Parasympathetic antagonist
- Blocks action of the vagus nerve on the heart
- Acts on the conduction system of the heart and accelerate the transmission of electrical impulses through cardiac tissue
- In a cardiac arrest, it reverses asystole and severe bradycardia

Administration:
- Bradycardia
- Asystole

20
Q

when is potassium given in a cardiac arrest?

A
  • Persistent VF and hypokalaemia
21
Q

when is magnesium used in cardiac arrest?

A
  • digoxin toxicity
  • VF/pulselessness
  • VT
  • hypokalaemia
22
Q

what is the MOA of atropine during a cardiac arrest and when do we administer it?

A

MOA:
- increases myocardial excitability and contractility + peripheral resistant
- increases BP

administration:
- hyperK+
- hypoCa
- CA blocker overdose

23
Q

what does AMPLE stand for?

A

A = Allergies
M = Medications
P = Past medical history
L = least meal
E = Events surrounding injury

24
Q

when is AMPLE used?

25
What are the normal vital sign ranges? ie. SpO2, BP, HR, RR, Temp
SpO2 - 95%-100% BP - SBP 100-180 HR - 50-120 RR - 10-25 Temp - 35.5-38.5
26
what are the normal ranges for arterial blood gasses? ie. pH, PCO2, HCO3, PaO2, SpO2
pH - 7.35-7.45 PCO2 - 35-45 HCO3 - 22-26 PaO2 SpO2 - 95-100%
27
What are the nursing responsibilities for a patient with an artificial airway?
- Checking the tube is secure and checking the markings at the teeth are correct (ETT) - Cuff pressure - ETCO2 monitoring - Suctioning - Ventilation - Patient positioning - Sedation and pain relief - to stop the patient from fighting the tube - NG insertion to decompress the stomach - Oral hygiene - DVT prophylaxis for intubated/sedated patient - Humidification of 02 - less drying out - 1:1 nursing of intubated and ventilated patients
28
What are some symptoms of complete airway obstruction?
- Cant talk, breathe, cough - Grasping at throat - LOC - Cardiorespiratory arrest - Cyanosis
29
What are the indications for an NPA and OPA?
Indicated for soft-palate obstruction such as posterior tongue displacement
30
When are NPA and OPA contraindicated?
- NPA: nasal/cranial trauma, the base of skull fracture - OPA: conscious patient, the patient has an intact gag reflex/cough
31
Outline the advantages and disadvantages of an LMA
Advantages: - Don't need a laryngoscope - Dont need muscle relaxants - Lower incidence of sore throats - Less invasive/traumatic than ETT - No risk of oesophageal/R main bronchus intubation Disadvantages: - Does Not protect against aspiration (although there is less risk) - Not for long term 0 only 10-24 hours - Complications: laryngospasm, nausea/vomiting, aspiration, coughing, stimulating a gag reflex
32
What are the complications of ETT insertion?
→ Risk of tissue perforation → Risk of epiglottis folding on itself → present of mucus plugs → risk of airway bleeding → ETT can be displaced if poorly secured → risk of oesophageal intubation → risk of R) main bronchus intubation → risk of aspiration → transient cardiac arrhythmia (vagal nerve irritation) → bronchospasm
33
What are some post-intubation complications?
- Trauma to lips, teeth, and vocal cords - Arrhythmia - Aspiration - Infection e.g. hospital-acquired/ventilation-acquired pneumonia - Tracheal ulceration / Pressure areas in the trachea - Tracheal stenosis/scarring - Laryngeal oedema - Bronchospasm - Biting on the ETT
34
How do you measure a guedel and an OPA?
35
Identify the different types of unsecured and secured artificial airways and outline its use
36
What is an airway and what can nurses do about it?
- Passage in which air reaches a person's lungs - Nurses have a responsibility to preserve patients' airways through frequent assessments. - It is to ensure that the airway is not lost or obstructed and individuals are able to breathe on their own. - In the case that an airway is at risk of being compromised nurses are to utilise airway devices and provide mechanical ventilation.
37
describe the anatomy of the airway
Begins at the nasal cavity and then proceeds through the: - pharynx - past the epiglottis - into the larynx where the vocal cords are - down the trachea - down to the bronchial tree - into the lungs
38
describe the physiology of the airway
Trachea, bronchi and terminal bronchioles → lungs then split into two lobes which contain alveoli to allow for gas exchange to occur.
39
identify the components of airway assessment
- Vocalisation → can the patient talk? - Loose teeth or foreign objects - Bleeding/vomit/secretions - See if there is tongue obstruction - Rise and all of the chest - Look, listen and feel for air movement - Clearing airway? Suction? - Auscultation
40
what is an airway obstruction?
A blockage of the airway. May partially or totally prevent air from getting into the lungs.
41
what are the different types of airway obstruction?
- Upper airway obstruction - Lower airway obstruction - Partial airway obstruction - Complete airway obstruction - Acute airway obstruction - Chronic airway obstruction
42
what might cause an airway obstruction?
- Foreign objects - Infections: epiglottis, bacterial tracheitis - Anaphylaxis - Trauma: neck hematoma - Poison and toxic exposure
43
identify the 5 life-threatening airway problems
o Inhalation injury: damage that occurs to the respiratory tract from chemicals such as smoke or heat during inspiration. o Laryngospasms: spasms of the vocal cords that make it difficult to breathe o Foreign bodies: can be lodged and make it difficult to breathe o Epiglottis: when there is inflammation of this and the adjacent supraglottic structures it can cause an obstruction o Mucus plug: mucus accumulates in the lungs and reduces airflow
44
how can we establish/manage an airway?
- Identify the correct head position (basic head manoeuvre) - Head tilt, chin lift or jaw thrust - Remove foreign object - Suction - Insert an airway - Endotracheal intubation - Needle or surgical airway (cricothyrotomy) - Adjuncts → guedels, nasopharyngeal tubes
45
what are the indications that an individual may need airway management?
- Apnoea - Obstruction - GCS <8 - Airway injuries such as facial burns and trauma - Inability to maintain airway or oxygenation - Mucus plug

3007 (7 decks)

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