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Dysphagia 2 - Anatomy & Physiology > Dysphagia 4 - Tracheostomy & Ventilator > Flashcards

Dysphagia 4 - Tracheostomy & Ventilator Flashcards

1
Q

Identify three types of artificial airways.

A

Endotracheal tube

Tracheostomy tube

Mechanical ventilation

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2
Q

What is the primary purpose of an endotracheal tube?

Identify the two types of endotracheal tubes.

How long is its intended use?

Describe how it functions.

Name three types of complications associated w/ using these tubes.

A

It is designed to help a person breath in emergency situation.

Oral & nasal tubes

Temporary use (7-10 days)

It goes thru the pharynx, the VFs & into the lungs. It is also connected to an air source.

Number of complications include hoarseness, VF weakness or paralysis

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3
Q

What is the difference b/w a Tracheotomy & Tracheostomy?

A

Tracheotomy (i.e. surgical procedure)

  • Upper airway obstructed/edema
  • Intubation prolonged (>10-21 days)
  • Ventilator (use requires trache)

Tracheostomy (breathing tube)–maintains airway

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4
Q

Describe six physiologic changes following a tracheotomy.

A
  • Decreased subglottic air pressure
  • Decreased laryngeal excursion
  • Poor VF closure
  • Poor airway sensitivity/cough reflex
  • Taste & smell disrupted
  • Increased secretions
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5
Q

In terms of swallowing function after tracheostomy, risk of aspiration is (higher/lower).

After tracheostomy, physiologic changes (increase/decrease) patient risk.

Identify three physiologic changes a tracheostomy patient undergoes.

A

Higher

Increase

Reduced laryngeal excursion
Reduced airway pressures
Saliva/secretion management

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6
Q

Describe the role of a SLP post-treacheostomy.

A
  • Evaluate & facilitate speech & swallowing
  • Help team address psychological issues
  • Facilitate patient communication
  • Monitor patient progress/Family education
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7
Q

A tracheostomy tube is located near which tracheal ring(s)?

A TT is well (above/below) the true VFs.

A

Located near second or third tracheal ring.

Well below the true VFs.

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8
Q

Identify the seven parts of a trache tube.

A 
Obturator
Outer cannula (Inside Trach)
Inner cannula
Pilot balloon/line
Hub/Lock
Neck flange or plate, ties
Plug or button
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9
Q

Identify both types of Trache tubes.

A

Cuffed/Cuffless

Fenestrated/Non-fenestrated

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10
Q

What part of a trache tube signifies the type of tube being utilized?

What part of a TT signifies a cuff is being used?

What type of information doe a trache plate provide?

A

Pilot Balloon

Pilot Line

Size & type of TT

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11
Q

T/F - Cuffed TT are NOT usually the type of tube placed.

A Cuff helps (?) the TT.

How can you tell if a cuffed TT is inflated or deflated?

A

False

Stabilize

The balloon will be either fully expanded or flat.

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12
Q

What two areas does a cuffed TT separate?

A cuffed TT aids in what type of protection?

Use of what type of piece on a TT increases a patient’s risk of suffocation?

Identify two types of methods of inflating/deflating a cuffed TT.

A

Upper from lower airway

Gross aspiraton

Speaking valve

Minimal leak or manometer

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13
Q

Identify four types of hazards associated w/ cuff use.

A

Overinflation
TE fistula
Rupture
Slippage

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14
Q

A (?) tube allows for greater airflow.

Specifically, this tube allows for > airflow thru what four areas of the swallowing mechanism?

A

Fenestrated

Vocal folds
Pharynx
Oral cavity
Nasal cavity

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15
Q

Identify two types of risks associated w/ Fenestrated Trache use.

Identify three TT sizes. Which is commonly used?

Identify three TT brands

Why is use of a speaking Valve contraindicated for patients w/ foam-filled tube?

A
  • Risk of granulation tissue in fenestration
  • Risk of hemorrhage if pulled at granulation site
  • 4 / 6 / 8* mm
  • Shiley, Bivona, & Jackson
  • b/c it requires a deflated cuff (i.e. they are not fenestrated).
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16
Q

Specialized talking trache is specifically used on which two types of patients?

A

People on ventilators (i.e. cannot deflate their cuff) or a person w/ a foam filled trache.

17
Q

Identify six types of complications associated w/ TT use.

A

Infection

Stenosis

Granuloma

Tracheomalacia

Tracheoesophageal fistula (TE fistula)

Esophageal compression

18
Q

Describe the basic aspects of a “decannulation plug”.

A

Removal of the trache

May be gradual (wean)

Trache plug is used before removal.

19
Q

Describe the process/protocol of conducting a “Trache & Swallowing assessment”.

A

Conduct a thorough case history review
Conduct an oral mechanism exam
Conduct trial studies
If necessary, Conduct Blue dye testing

20
Q

Describe the proper trial swallow procedures.

A 
Suction
Deflate cuff (if conducting a swallow evaluation)
Dry swallow (Finger occlude trache)
- Listen (breathing, voice)
- Encourage cough/throat clear

Bolus swallow (solids/liquids w/ blue dye)

  • Listen (breathing, voice)
  • Encourage cough/throat clear

Observe s/s aspiration
Suction

21
Q

Positive blue dye test results indicate (?).

Negative blue dye test results indicate (?).

T/F - Blue dye testing has HIGH reliability.

What role does blue dye testing have in trache/swallowing testing?

A

Positive: terminate; try different bolus types.
Negative: continue larger amounts

False

Used a screening tool

22
Q

Describe the basics of a passy muir speaking valve.

Where does it fit on a trache tube?

It is specifically designed to allow a person to (?).

T/F - It is NOT to be used w/ a cognitively impaired person.

A

One way valve
Close position valve (vs. open-position)
Come in three different Colors

Fit on the outside of TT

Talk

True

23
Q

Describe the signs indicating use of a passy muir SV is appropriate.

A

Patient must demonstrate alertness
Their vitals must be stable
Demonstrate tolerance for cuff deflation
Indicate trache type & size

24
Q

What do the following passy muir speaking valve colors indicate:

White
Aqua
Purple
Clear

A

White - Hardly used
Aqua – people on vents or non-vented (preferred)

Purple – just non-vented patients

Clear is for additional air.

25
Q

Identify seven contraindications for using a PMSV.

A 
Severe stenosis
Airway obstruction
Foam cuff
Patient can’t tolerate cuff deflation
Reduced alertness level
Malaise/persistent fatigue
Unstable vitals
26
Q

Describe appropriate PMSV assessment procedures.

A

Cuff deflation

Trial valve placement

27
Q

Describe the benefits of using a PMSV

T/F - Patient cannot sleep in valve.

A 
Eliminates negative physiologic changes
Facilitates swallowing
Facilitates voicing 
Helps patient cough and clear secretions
Speeds up decannulation

True

28
Q

Describe the process for conducting an evaluation for speaking valve use.

A

Conduct Oral motor exam (incl. head/trunk control)
Determine patient’s Comprehension
Gather Baseline vitals
Determine Cuff deflation tolerance
Assess Voicing qualities
Speaking valve placement (if voicing achieved)

29
Q

How is voicing evaluated for speaking valve use?

Describe the process of speaking valve placement.

A

After cuff deflation
Finger occlusion

If voicing achieved . . .
Assess patient’s Vitals
Determine Tolerance & duration
Assess Vocal quality & speech intelligibility

30
Q

Name the three types of ventilation.

A

Spontaneous
Manual
Mechanical

31
Q

Identify four types of Mechanical ventilators.

A

Endotracheal
Nasal
Tracheal
Mask

32
Q

Name the four important concepts for mechanical ventilation.

A

Volume *
Pressure *
Time (Rate)*
Flow *

33
Q

Explain each of the following mechanical ventilation concept:

Volume

Pressure

Time/Rate

Flow

A

Volume is how much air is coming into the lungs from the ventilator.

Pressure deals w/ out much force the lungs need to stay inflated.

Time/Rate deals w/ breath cycle.

Flow deals w/ how easy air moves in/out of lungs

34
Q

T/F - Use of excessive oxygen during mechanical ventilation use can damage the lungs.

In terms of ventilation flow, what does a patient demonstrating the following physical signs indicate:

“Fast breathing” indicates
“Slow breathing” indicates

A

True

Hyperventilating

Suffocation

35
Q

Identify six ventilator settings.

What does it mean when a patient needs more oxygen in their lungs?

What is the common number of breaths a person avg. per minute?

A
  • Tidal Volume (Vt)
  • Respiratory Rate (RR)
  • Flow
  • I:E ratio
  • FiO2 (Fraction of inspired oxygen content)
  • PEEP (Pressure)

Lung damage

8-12 per minute

36
Q

Identify the following ventilator modes:

CMV
A/C
IMV/SIMV
CPAP
PSV
PEEP
A

Control mode (CMV)

Assist control (A/C)

Synchronized intermittent mandatory ventilation

Continuous + airway pressure
BiPAP (Bilevel)

Pressure support (PSV)

Positive end expiratory pressure

37
Q

What is the difference b/w a person on control vs assisted control mode?

SIMV is preferably used w/ a patient who is ready to do what?

What must a patient be able to do in order to be placed on CPAP mode?

What is the primary objective of place a patient on PEEP mode?

A 
CMV = person is not doing any breathing 
A/C = person is doing partial work in breathing

Ready to ween off the ventilator

Breath completely spontaneously

PEEP is pressure in the lungs that keep it from collapsing. Keeps lungs open at the end of expiratory cycle.

38
Q

If using a cuffed TT, what do the following pressures indicate:

Low
High
Apnea

A

Low pressure indicates Cuff may have deflated, slippage or leakage in the system. As a result lungs are not receiving air.

High indicates a plug in the system.

Apnea means person is not getting a breath.

Dysphagia 2 - Anatomy & Physiology (6 decks)

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