ETTs & Trachs Flashcards
1
Q
Indications for ETTs/Trachs
A
- Ventilatory/Respiratory failure
- Failure to protect airway
- Failure to clear airway
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
3
Q
Oropharyngeal airway stimulates…
A
the gag reflex
-only used for patients with altered levels of consciousness
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
5
Q
How often do you switch nares for nasopharyngeal
A
Q8
6
Q
LMA
A
Laryngeal Mask Airway
- considered advanced airway
- supraglottic airway
- anesthesia/unconsciousness
- through mouth, down trachea, deployed on top of glottis
7
Q
problem with LMA
A
do not prevent aspiration
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
9
Q
ETT placement is via..
A
laryngoscope
- may be oral or nasal
- taped into place after confirmation
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
11
Q
Types of trachs
A
- Plastic or metal
- Different sizes
- With or without cuffs
- Non-fenestrated/fenestrated
12
Q
Nurse provides tracheostomy care to…
A
- Maintain patency of the tube
- Reduce the risk of infection
13
Q
Children never get…
A
cuffed trachs, they are constantly growing
14
Q
72 hour critical airway
A
stoma has to heal and form scar tissue before tube is inserted
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
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
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
18
Q
In terms of suctioning, RN assess….
A
patient for respiratory distress or evidence patient is unable to cough up secretions
19
Q
Oral and oropharyngeal suctioning removes secretions….
A
from upper respiratory tract
20
Q
Nasopharyngeal and nasotracheal suctioning requires….
A
sterile technique
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
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
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
How to minimize/decrease complications of suctioning
- hyperinflation
| - hyperoxygenation
26
hyperinflation
- give breaths 1-1.5 times the set tidal volume
| - give 3-5 breaths before and after each pass of the catheter
27
hyperoxygenation
-increase O2 flow before and between suction attempts
28
outer diameter of the suction catheter should not exceed...
half the internal diameter of the trach or ETT
29
Speaking with Trach
- 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
When is a patient considered to have a critical airway?
- 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
Critical Airway Precautions
- 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
CAP: Safety Considerations
- 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
Decannulation
- 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
Why is it important to keep patient hydrated?
-prevent accumulation of thick secretions, mucous plugs, and atelectasis
35
surfactant
controls surface tension, keeps the alveoli from collapsing and sticking to themselves
-produced only with adequate oxygentation
36
Increased CO2 .....
drive the breath
-receptor sites in medulla and pons are sensitive to CO2 levels
37
V-Q ratio
Ventilation-perfusion ratio: movement of O2 across the alveolar-capillary membrane into a well-perfusing capillary
38
Child airway
- 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
Hypercarbia
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
Hypoxemia
- decrease O2
- chest wall in-drawing early indicator
- cyanosis late sign (AA grey coloration)
- clubbed nail beds (180 degrees)
Tx: admin O2
41
Dyspnea
- SOB
- labored
Tx: underlying, admin O2
42
Apnea
not breathing
-lack of respiratory effort leads respiratory arrest
Tx: underlying, admin respiratory stimulants as appropriate
43
Tachypnea
RR >20 child/adult
RR >60 infant
- rapid breathing at rest
- shallow breathing
Tx: underlying
44
Orthopnea
- difficulty breathing when lying down
- dyspnea while lying down
Tx: underlying; raise HOB while sleeping
45
Pneumothorax
- Partial lung collapse
- Chest pain
- SOB
Tx: underlying; observe; needle/chest tube; sx
46
Hematocrit and Hemoglobin
- significant inherited pattern of variation in hemoglobin
- hematocrit=lower genetic effect
- women have lower hematocrit/Hemoglobin
47
Stridor
-high-pitched sound within the trachea that suggests narrowing of trachea
48
Crackles
high pitched popping sounds heard on inspiration
-atelectasis
49
Rhonchi
long, low pitched sound that continues throughout inspiration that suggests blockage of large airway
-can sometimes be cleared with coughing
50
Wheezing
high pitched whistling heard on both expiration and inspiration
caused by narrowing of bronchi
51
Sputum specimen
identify the presence of microbes, metabolites of inflammation, and immunogloblins
52
Sputum culture
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
sputum
expectorant matter that may contain mucus, cellular debris, blood, microorganisms, and purulent matter from resp. tract
54
ABG's
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
Pulse Ox
assesses arterial blood oxygenation; >95%
56
PFTs
pulmonary function tests
-provide info about ventilation airflow, lung volume, capacity, and the diffusion of gas
57
incentive spirometer
measures the forced emptying of alveolar gas
