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3007 > ASSESSMENT + MANAGEMENT OF AIRWAY > Flashcards

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?

A
25
Q

What are the normal vital sign ranges?

ie. SpO2, BP, HR, RR, Temp

A

SpO2 - 95%-100%
BP - SBP 100-180
HR - 50-120
RR - 10-25
Temp - 35.5-38.5

26
Q

what are the normal ranges for arterial blood gasses?

ie. pH, PCO2, HCO3, PaO2, SpO2

A

pH - 7.35-7.45
PCO2 - 35-45
HCO3 - 22-26
PaO2
SpO2 - 95-100%

27
Q

What are the nursing responsibilities for a patient with an artificial airway?

A
  • 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
Q

What are some symptoms of complete airway obstruction?

A
  • Cant talk, breathe, cough
  • Grasping at throat
  • LOC
  • Cardiorespiratory arrest
  • Cyanosis
29
Q

What are the indications for an NPA and OPA?

A

Indicated for soft-palate obstruction such as posterior tongue displacement

30
Q

When are NPA and OPA contraindicated?

A
  • NPA: nasal/cranial trauma, the base of skull fracture
  • OPA: conscious patient, the patient has an intact gag reflex/cough
31
Q

Outline the advantages and disadvantages of an LMA

A

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
Q

What are the complications of ETT insertion?

A

→ 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
Q

What are some post-intubation complications?

A
  • 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
Q

How do you measure a guedel and an OPA?

A
35
Q

Identify the different types of unsecured and secured artificial airways and outline its use

A
36
Q

What is an airway and what can nurses do about it?

A
  • 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
Q

describe the anatomy of the airway

A

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
Q

describe the physiology of the airway

A

Trachea, bronchi and terminal bronchioles → lungs then split into two lobes which contain alveoli to allow for gas exchange to occur.

39
Q

identify the components of airway assessment

A
  • 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
Q

what is an airway obstruction?

A

A blockage of the airway. May partially or totally prevent air from getting into the lungs.

41
Q

what are the different types of airway obstruction?

A
  • Upper airway obstruction
  • Lower airway obstruction
  • Partial airway obstruction
  • Complete airway obstruction
  • Acute airway obstruction
  • Chronic airway obstruction
42
Q

what might cause an airway obstruction?

A
  • Foreign objects
  • Infections: epiglottis, bacterial tracheitis
  • Anaphylaxis
  • Trauma: neck hematoma
  • Poison and toxic exposure
43
Q

identify the 5 life-threatening airway problems

A

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
Q

how can we establish/manage an airway?

A
  • 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
Q

what are the indications that an individual may need airway management?

A
  • 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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