Ch.36 Airway Management

Question 1

Define airway management.

Answer 1

Skills that maintain the patency of natural or artificial airways

Question 2

Identify the structural components of the airway.

Answer 2

Upper Airway:

Nose
Pharynx
     Nasopharynx
     Oropharynx
     Laryngopharynx

Lower Airways:

Trachea
Bronchi
Bronchioles
Alveoli

Question 3

Discuss natural mechanisms that protect the airway.

Answer 3

Epiglottis: is a protrusion of flexible cartilage above the larynx.

Tracheal cartilage: The rings of tracheal cartilage ensure that the trachea, the portion of the airway beneath the larynx, remains open.

Mucous membrane: a type of tissue from which mucus is secreted, lines the respiratory passages.

Cilia: Hairlike projections called cilia beat debris that collects in the lower airway upward.

Question 4

Explain the methods used by nurses to help maintain the natural airway.

Answer 4

Keeping respiratory secretions liquefied: nurses may assist with inhalation therapy (respiratory treatments that provide a mixture of oxygen, humidification, and aerosolized medications directly to the lungs).

Promoting their mobilization and expectoration with chest physiotherapy: Chest physiotherapy is usually indicated for clients with chronic respiratory diseases who have difficulty coughing or raising thick mucus.

Mechanically clearing mucus from the airway by suctioning: Nurses may suction the upper airway, lower airway, or both. In all cases, they suction the airway from the nose or mouth

Question 5

Name techniques for liquefying respiratory secretions.

Answer 5

Aerosol therapy improves breathing, encourages spontaneous coughing, and helps clients raise sputum for diagnostic purposes

The volume of water in mucus affects its viscosity or thickness.

Hydration , the process of providing adequate oral fluid intake, tends to keep mucous membranes moist and the mucus thin.

Question 6

Explain techniques of chest physiotherapy.

Answer 6

Postural Drainage: promotes the drainage of secretions from various lobes or segments of the lungs with the use of gravity

Percussion: helps dislodge respiratory secretions that adhere to the bronchial walls.

Vibration: the palms of the hands to shake underlying tissue and loosen retained secretions.

Question 7

Describe suctioning techniques used to clear secretions from the airway.

Answer 7

Nasopharyngeal suctioning (removing secretions from the throat through a nasally inserted catheter)

Nasotracheal suctioning (removing secretions from the upper portion of the lower airway through a nasally inserted catheter).

Oropharyngeal suctioning (removing secretions from the throat through an orally inserted catheter).

Oral suctioning (removing secretions from the mouth) with a suctioning device called a Yankauer-tip or tonsil-tip catheter

Question 8

Name examples of artificial airways.

Answer 8

Oral Airway: is a curved device that keeps a relaxed tongue positioned forward within the mouth, preventing the tongue from obstructing the upper airway

Tracheostomy Tube: (a curved, hollow plastic tube) is also called a cannula.

Question 9

Discuss indications for inserting an artificial airway.

Answer 9

Clients at risk for airway obstruction or who require long-term mechanical ventilation are candidates for an artificial airway.

Question 10

Identify components of tracheostomy care.

Answer 10

Tracheostomy care means:

Cleaning the skin around the stoma
Changing the dressing
Cleaning the inner cannula

Nurses perform tracheostomy care at least every 8 hours or as often as clients need to keep the secretions from becoming dried, which may narrow or occlude the airway.

Question 11

The ____________ is a protrusion of flexible cartilage above the larynx.

Answer 11

Epiglottis

Question 12

Hairlike projections called ____________ beat debris that collects upward in the lower airway.

Answer 12

Cilia

Question 13

The volume of water in mucus affects its ____________, or thickness.

Answer 13

Viscosity

Question 14

____________ therapy improves breathing, encourages spontaneous coughing, and helps clients to raise sputum for diagnostic purposes.

Answer 14

Aerosol

Question 15

Evaluation of ____________ is important for implementing appropriate interventions to prevent aspiration.

Answer 15

Dysphagia

Question 16

____________ relies on negative (vacuum) pressure to remove liquid secretions with a catheter.

Answer 16

Suctioning

Question 17

Nurses perform ____________ suctioning with a suctioning device called a Yankauer-tip or tonsil-tip catheter.

Answer 17

Oral

Question 18

____________ suctioning means removing secretions from the upper portion of the lower airway through a nasally inserted catheter.

Answer 18

Nasotracheal

Question 19

A nasopharyngeal airway, sometimes called a(n) ____________, can be used to protect the nostril if frequent suctioning is necessary.

Answer 19

Trumpet

Question 20

Respiratory cilia become less efficient with age, predisposing older adults to a high incidence of ____________.

Answer 20

Pneumonia

Question 21

Identify the type of therapy being performed here.

Answer 21

The figure shows a client using aerosol therapy.

Question 22

How does this therapy help the client?

Answer 22

Aerosol therapy improves breathing, encourages spontaneous coughing, and helps the client to raise sputum for diagnostic purposes.

Question 23

Identify the type of postural drainage technique used here.

Answer 23

The figure shows the nurse performing percussion.

Question 24

What is the purpose of this technique?

Answer 24

Percussion, rhythmic striking of the chest wall, helps to dislodge respiratory secretions that adhere to the bronchial walls.

Question 25

Movement of air in and out of the lung

Answer 25

Ventilation

Question 26

Respiratory treatments that provide a mixture of oxygen, humidification, and aerosolized medications directly to the lungs

Answer 26

Inhalation Therapy

Question 27

Indicated for clients with chronic respiratory diseases who have difficulty coughing or raising thick mucus

Answer 27

Chest physiotherapy

Question 28

Positioning technique that promotes gravity drainage of secretions from various lobes or segments of the lungs

Answer 28

Postural Drainage

Question 29

Removing secretions from the throat through an orally inserted catheter

Answer 29

Oropharyngeal Suctioning

Question 30

Presented here, in random order, are the steps that occur when the nurse performs percussion on a client. Write the correct sequence in the boxes provided.

1. Keep the fingers and thumb together.
2. Percuss for 3 to 5 minutes in each postural drainage position.
3. Cup the hands.
4. Apply the cupped hands to the client’s chest.

Answer 30

3. Cup the hands.
4. Keep the fingers and thumb together.
5. Apply the cupped hands to the client’s chest.
6. Percuss for 3 to 5 minutes in each postural drainage position.

Question 31

What are the factors that can jeopardize airway patency?

Answer 31

There are many factors that can jeopardize airway patency, including the following:
Increased volume of mucus
Thick mucus
Fatigue or weakness
Decreased level of consciousness Ineffective cough
Impaired airway

Question 32

What are the structures that protect the airway from a wide variety of inhaled substances?

Answer 32

The structures that protect the airway from a wide variety of inhaled substances include the following:
Epiglottis—It is a protrusion of flexible cartilage above the larynx that acts as a lid that closes during swallowing. It helps to direct fluid and food toward the esophagus rather than the respiratory tract. Tracheal cartilage—This ensures that the trachea, the portion of the airway beneath the larynx, remains open. Mucous membrane—This is a type of tissue from which mucus is secreted, which lines the respiratory passages. Cilia—These are hairlike projections that beat debris upward that collects in the lower airway.

Question 33

What are the most common methods of maintaining the natural airway?

Answer 33

The most common methods of maintaining the natural airway are keeping respiratory secretions liquefied, promoting their mobilization and expectoration with chest physiotherapy, and mechanically clearing mucus from the airway by suctioning.

Question 34

What are the two common types of artificial airway management?

Answer 34

Clients at risk for airway obstruction or requiring long-term mechanical ventilation are candidates for an artificial airway.

Two common types are:
An oral airway
A tracheostomy tube

Question 35

What is the purpose of an oral airway?

Answer 35

An oral airway is a curved device that keeps a relaxed tongue positioned forward within the mouth, preventing the tongue from obstructing the upper airway.
It is most commonly used in clients who are unconscious and cannot protect their own airway, such as those recovering from general anesthesia or a seizure.

Question 36

What are the common causes of pathologic pulmonary changes in older adults?

Answer 36

Many older adults with pathologic pulmonary changes have a history of smoking cigarettes since their youth, working in occupations where they inhaled pollutants that affected their lungs, or living for an extended time in industrial areas known for toxic emissions.

Question 37

A nurse is caring for a client who requires prolonged mechanical ventilation and oxygenation.

What intervention should the nurse perform for the client who is unable to talk because of the tracheostomy tube?

Answer 37

Because a tracheostomy tube is below the level of the larynx, clients usually cannot speak.

Communication may involve writing or reading the client’s lips.
Being unable to call for help is frightening; therefore, the nurse should check these clients frequently and respond immediately when they signal.