Day 5 - Airway Management Flashcards
What are some complications of oxygen therapy?
prevention?
Oxygen toxicity
* excess free radicals, neutralizing enzymes are tired
* causes ARDS
Absorption atelectasis AA
* excess O2 washes nitrogen out of the alveoli and they begin to collapse
* cannot breathe with closed alveoli; no gas exchange
Prevention
* maintain lowest concentration of O2
* increase FiO2 gradually
* limit 100% oxygen to 24 hours, starts within 30 mins
Why is it important to limit oxygen delivery to a patient with COPD?
COPD patients retain CO2 and abnormally breath with a Hypoxic drive
* if we bring up their O2/CO2 levels the patients chemoreceptors will not respond and they wont breathe
* peripheral chemoreceptors breathe for them ONLY once they are hypoxic
* if we keep them below 92% they will breathe on their own
* could develop hypercapnic respiratory failure
When would you consider using an artifical airway?
Indications
* impaired gas exchange
* ineffective breathing pattern
* retained secretions
* patient anxiety related to breathing
* decreased level of consiousness
What are the two types of pharyngeal airways?
indications
Oropharyngeal - intubated
* thick plastic
* measurement mouth to ear
Nasalpharygeal - awake or jaw/neck precautions
* flexible and soft
* lube ++
* nose to ear measurement
What are the components of an ETT?
Indications for one..
Components
* ETT size and markers
* ETT cuff / balloon
* pilot valve - to inflate
* universal adaptor for ambu bag
Indications:
* airway maintenance
* airway protection
* secretion
* control
* oxygenation
* mechanical ventilation
How do you properly use a manual resusitation bag?
Set flow meter for 15 L, ensure bag inflated
Bag with one hand every 5-6 seconds
What are the nurses roles before, during, and after intubation?
Prior
* confirm emergency line available
* ensure pulse ox is monitoring
* ensure ambu bag is set up
* confirm medications required
During
* monitor vital signs and cardiac monitor
After
* monitor O2
* get chest xray for placement
* watch for end tidal detector
* listen to bilat lungs
What is the importance of ETT/trach cuff? How do we monitor cuff pressures?
Keeps the tube in the patients airway
RT monitors cuff pressures through cuff leak techniques/vent for less than 20 mmHg
What are some complications of airways and their interventions?
Trauma to oral/nasal cavity
Gagging, vomiting
Laryngospasm
Obstruction of airway