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MS2 Exam 1 > ETTs & Trachs > Flashcards

ETTs & Trachs Flashcards

1
Q

Indications for ETTs/Trachs

A
  • Ventilatory/Respiratory failure
  • Failure to protect airway
  • Failure to clear airway
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2
Q

Oropharyngeal Airways

A
  • used for the upper airway only
  • easy to use
  • low risk of complications
  • should be well lubricated with water-soluble gel before insertion
  • measurement for correct airway size
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3
Q

Oropharyngeal airway stimulates…

A

the gag reflex

-only used for patients with altered levels of consciousness

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4
Q

Nasopharyngeal Airway

A
  • inserted through the nare
  • tolerated better by alert patients
  • frequent oral and nare care needed
  • reposition airway in other nare every 8 hours
  • not to be used with facial fracture
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5
Q

How often do you switch nares for nasopharyngeal

A

Q8

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6
Q

LMA

A

Laryngeal Mask Airway

  • considered advanced airway
  • supraglottic airway
  • anesthesia/unconsciousness
  • through mouth, down trachea, deployed on top of glottis
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7
Q

problem with LMA

A

do not prevent aspiration

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8
Q

ETT

A

7-71/2 female
71/2-8 male

  • most common in patients who have had general anesthesia or who are in an emergency situation
  • inserted by PCP, CRNA, Anesthesiologist, or RT with specialized education
  • passes through epiglottis and glottis so patient is unable to speak
  • air filled cuff to prevent air leakage
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9
Q

ETT placement is via..

A

laryngoscope

  • may be oral or nasal
  • taped into place after confirmation
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10
Q

Indications for Tracheotomies

A
  • Airway protection (prevents occlusion by tongue D/T cognitive changes)
  • Airway occlusion (D/T tumors, edema, tracheal atresia, paralysis, or injury to face)
  • Failure to wean or prolonged ventilatory support
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11
Q

Types of trachs

A
  • Plastic or metal
  • Different sizes
  • With or without cuffs
  • Non-fenestrated/fenestrated
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12
Q

Nurse provides tracheostomy care to…

A
  • Maintain patency of the tube

- Reduce the risk of infection

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13
Q

Children never get…

A

cuffed trachs, they are constantly growing

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14
Q

72 hour critical airway

A

stoma has to heal and form scar tissue before tube is inserted

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15
Q

Trach care

A
  • assess for airway clearance
  • watch for coughing, resp distress, rhonchi, decrease O2 stats
  • Q shift trach care (don’t change trach ties first 24 hours)
  • Frequent suctioning using sterile technique (Q 4 hours until secretions decrease significantly)
  • Humidify O2 therapy
  • Relieve anxiety
  • always watching for pulsations, can damage carotid
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16
Q

When to suction?

A
  • Decrease O2 sats
  • Gurgling
  • only when they need it, not on strict schedule
  • difficultly handling their secretions
  • when an artificial airway is in place
  • clear air passages
  • cyanosis/poor skin color
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17
Q

Relieving anxiety

A
  • explain everything to patients
  • provide simple means of communication
  • encourage frequenct family visits
  • emphasize importance of talking to patient
  • provide distractions
  • attend to physical needs promptly and completely
  • reassure patient
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18
Q

In terms of suctioning, RN assess….

A

patient for respiratory distress or evidence patient is unable to cough up secretions

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19
Q

Oral and oropharyngeal suctioning removes secretions….

A

from upper respiratory tract

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20
Q

Nasopharyngeal and nasotracheal suctioning requires….

A

sterile technique

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21
Q

Suctioning an Airway

A
  • prepare patient
  • apply appropriate gloves depending on type of suction catheter
  • test suction pressure and catheter patency
  • provide supplemental oxygen if needed
  • lubricate catheter
  • perform suction
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22
Q

Performing the suction

A
  • remove supplemental oxygen
  • insert suction catheter without applying suction
  • apply finger to suction part of the catheter
  • gently rotate catheter as catheter is being withdrawn
  • apply suction for 5-10 seconds
  • 1 suction attempt should last 10-15 seconds max from start to finish
  • rinse catheter
  • relubricate and repeat suction as needed until airway is clear
  • allow sufficient time between suction passes for ventilation and oxygenation
  • encourage patient to CBD between passes
  • use supplemental O2 if appropriate
  • limit suctioning time to 5 minutes TOTAL
  • obtain a specimen if needed
  • promote patient comfort
  • dispose of equipment
  • assess effectiveness of suctioning
  • document
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23
Q

Documentation of specimen

A
  • characterisitics
  • pt’s resp status before and after procedure
  • frequency of attempts
24
Q

Complications of Suctioning

A
  • hypoxemia
  • trauma to the airway
  • nosocomial infection
  • cardiac dysrhythmias
25
Q

How to minimize/decrease complications of suctioning

A
  • hyperinflation

- hyperoxygenation

26
Q

hyperinflation

A
  • give breaths 1-1.5 times the set tidal volume

- give 3-5 breaths before and after each pass of the catheter

27
Q

hyperoxygenation

A

-increase O2 flow before and between suction attempts

28
Q

outer diameter of the suction catheter should not exceed…

A

half the internal diameter of the trach or ETT

29
Q

Speaking with Trach

A
  • must force air up and around trach and over vocal cords in larynx
  • fenestrated trach
  • speaking trach tube (two pigtails)
  • speaking trach valve (Passy-Muir)
30
Q

When is a patient considered to have a critical airway?

A
  • patient anatomy suggesting difficulty airway and/or physical limitations
  • previously documented difficult intubations
  • type of trach or ETT in use (specialty trachs)
  • any adult with a fresh trach with mechanical ventilation will be C.A. for 72 hours
  • in peds, fresh trach is considered a C.A. for 7 days with or without mechanical ventilation unless otherwise ordered
31
Q

Critical Airway Precautions

A
  • order is required to initiate and D/C
  • report should include notification of CAP
  • Place CAP sigh above HOB
  • Document presence of CAP on the daily care in EMR/flowsheet
32
Q

CAP: Safety Considerations

A
  • for patients on mechanical ventilation, a dedicated RN or RT will specifically be assigned to assess and stabilize the C.A. when pt is turned, moved up in bed, transported, performing ADLs, etc…
  • Equipment will accompany the patient
33
Q

Decannulation

A
  • pt needs to pass aspiration test
  • plug trach for prolonged periods of time, increasing as ordered
  • deflate cuff before plugging
  • when pt tolerates trach plugged all time, it is ready to come out
  • suction or have pt clear secretions before removal
  • slide trach out
  • cover with sterile, dry occlusive dressing
  • hole will close in a few days
  • can use steri-strips if ordered
  • instruct pt to split stoma with finger when coughing, swallowing, or speaking
  • watch for airway obstruction and anxiety
34
Q

Why is it important to keep patient hydrated?

A

-prevent accumulation of thick secretions, mucous plugs, and atelectasis

35
Q

surfactant

A

controls surface tension, keeps the alveoli from collapsing and sticking to themselves

-produced only with adequate oxygentation

36
Q

Increased CO2 …..

A

drive the breath

-receptor sites in medulla and pons are sensitive to CO2 levels

37
Q

V-Q ratio

A

Ventilation-perfusion ratio: movement of O2 across the alveolar-capillary membrane into a well-perfusing capillary

38
Q

Child airway

A
  • shorter, narrower
  • greater potential for obstruction
  • trachea primarily grows by length not diameter up to age 5
  • tracheal division of R/L bronchi is higher for child airway
  • cartilage rings more flexible
  • narrow airway= increased airway resistance
39
Q

Hypercarbia

A

leads to drive to breathe

  • interferes with ability to respond appropriately to increase levels of CO2
  • leads to decrease O2 driving breaths (COPD pts)
40
Q

Hypoxemia

A
  • decrease O2
  • chest wall in-drawing early indicator
  • cyanosis late sign (AA grey coloration)
  • clubbed nail beds (180 degrees)

Tx: admin O2

41
Q

Dyspnea

A
  • SOB
  • labored

Tx: underlying, admin O2

42
Q

Apnea

A

not breathing

-lack of respiratory effort leads respiratory arrest

Tx: underlying, admin respiratory stimulants as appropriate

43
Q

Tachypnea

A

RR >20 child/adult
RR >60 infant

  • rapid breathing at rest
  • shallow breathing

Tx: underlying

44
Q

Orthopnea

A
  • difficulty breathing when lying down
  • dyspnea while lying down

Tx: underlying; raise HOB while sleeping

45
Q

Pneumothorax

A
  • Partial lung collapse
  • Chest pain
  • SOB

Tx: underlying; observe; needle/chest tube; sx

46
Q

Hematocrit and Hemoglobin

A
  • significant inherited pattern of variation in hemoglobin
  • hematocrit=lower genetic effect
  • women have lower hematocrit/Hemoglobin
47
Q

Stridor

A

-high-pitched sound within the trachea that suggests narrowing of trachea

48
Q

Crackles

A

high pitched popping sounds heard on inspiration

-atelectasis

49
Q

Rhonchi

A

long, low pitched sound that continues throughout inspiration that suggests blockage of large airway

-can sometimes be cleared with coughing

50
Q

Wheezing

A

high pitched whistling heard on both expiration and inspiration

caused by narrowing of bronchi

51
Q

Sputum specimen

A

identify the presence of microbes, metabolites of inflammation, and immunogloblins

52
Q

Sputum culture

A

identify specific microbes within the lower resp. tract

**important to ensure sputum came from lung fields, not just spit from the mouth. Leads to emergence of drug-resistant microbes due to getting microbes from mouth versus lung fields.

53
Q

sputum

A

expectorant matter that may contain mucus, cellular debris, blood, microorganisms, and purulent matter from resp. tract

54
Q

ABG’s

A

direct indication of O2 and CO2 exchange and the acid-base balance within the blood

PH: 7.35-7.45
CO2: 35-45
PaO2: 75-100
HCO3: 24-28

55
Q

Pulse Ox

A

assesses arterial blood oxygenation; >95%

56
Q

PFTs

A

pulmonary function tests

-provide info about ventilation airflow, lung volume, capacity, and the diffusion of gas

57
Q

incentive spirometer

A

measures the forced emptying of alveolar gas

MS2 Exam 1 (13 decks)

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