Fund 51 airway management Flashcards
tracheostomy
Definition
Tracheostomy is the surgical incision or opening that results from a tracheotomy
Indications
Weakness of chest muscles causing impaired gas exchange
Inability to wean from mechanical ventilation
Airway obstruction
Airway protection
Laryngeal trauma
Head and neck surgery involving airway manipulation
Long tern mechanical ventilation
trach surgical procedure - complications - what about the lungs?
Perioperative Nursing Care
Preoperative
Procedure is open (OR) or percutaneous (bedside/)DaVinci)
Complications during procedure include misplacement of the tracheal tube, hemorrhage, laryngeal nerve injury, pneumothorax, pneumomediastinum, and cardiac arrest
Postoperative
advantage of trach (trach helps speech and airways)
Tracheostomy
Easily secured and stabilized
Reduces risk of unintentional extubation
Well tolerated by patient
Enables swallowing, speech, and oral hygiene
Avoids upper airway complications
Allows for a larger diameter of tube which facilitates:
Work of breathing
Suctioning
bronchoscopy
trach - used for patients who need intubation how long?
Preferred method of airway maintenance in the patient who requires long term intubation, > 7-10 days. Made of plastic, metal, can have one or two lumens, and all have a 15mm adaptor at the end.
Single lumen tubes have a tube, built in cuff, which is connected to a cuff for inflation purposes, and an obturator which is used during insertion
Larger internal diameter = less resistance and more air flow
Double lumen tubes consist of a tube with an attached cuff, an obturator and an inner cannula that can be removed, cleaned and reinserted or replaced by a new sterile inner cannula
nursing resp. trach - humidify? And how often to change humidify and hand ventilate?
make sure tube has humidified o2. change humidify once every 24 hrs. make sure cuff is up or down, not overinflated. check cuff. suction to prevent deoxygenation. make sure to hyperoxygenate before.
trach nursing management - how often oral care?
Nursing Management
Priorities
Provide humidification
Maintaining cuff management
Prevent desaturation
Suctioning
Establish a method of communication
Providing oral hygiene every 2-4 hrs.
Prevent infection
nursing responsibility -trach - how often is skin care? (trach at 8)
- maintain patent airway
- Change or clean inner cannula
Check balloon inflation - administer o2 and humidify
- assure trach tube is secure
- maitina peristomal skin (Tracheostomy care at least every 8-12 hours
Change tracheostomy ties when soiled (2 licensed staff; RNs, respiratory therapists, MD) - assess for complications (Bleeding, infection, position, pneumothorax, subcutaneous emphysema, obstruction, skin breakdown, pneumonia, cuff malfunctions, tube obstruction or dislodgment, fistula formation, tracheal stenosis, trachealmalacia (collapse of airway), tube placement)
trach safety
Signage
Patient name, MD, upper airway/none, trach size, cuffed/uncuffed
Care Supplies
Tracheostomy tube same size and one size smaller
Inner cannulas or cleaning kit
Gloves
NS
Hydrogen peroxide (according to agency policy)
Cotton swabs
Sterile container
Tracheostomy ties
Fenestrated tracheostomy sponge
4 X 4’s
Suction set up and connected
Suction catheters (14F) unless otherwise indicated
Hand ventilation bag HOOKED TO OWN O2 SUPPLY
metal trach - don’t use what with it?
don’t use hydrogen peroxide it pits it
trach complications - basic - tube can what?
tube displacement or tube obstruction
trach safety (what signs at the HOB) STC
Laryngectomy or tracheostomy SIGNAGE AT HOB
Type and size of tube of tube SIGNAGE AT HOB
Indication for procedure or tube
POD
Humidification
Cuff up or down SINAGE AT HOB
Passe muir valve
Secretions
Cough
Standby/transport equipment at bedside
Laryngectomy - how to ventilate stoma?
Removal of part or all, of the larynx
Total creates a tracheostoma. THERE IS NO UPPER AIRWAY OR CONNECTION TO THE NOSE OR MOUTH. Nursing Implications for hand ventilation: Must hand ventilate stoma
peristomal trach care - how often to assess skin? (trach is different)
Assess peristomal skin
Palpate perisotmal area
Check security of tracheostomy ties, tracheostomy tube
moisture
pressure areas
Clean with NS or hydrogen peroxide 1/3: 1 NS
No hydrogen peroxide with metal trachs
Protect skin with gauze or foam. assess every few hours.
airway suctioning - how long to suction and what not to use?
Basic Principles
Clear the airway ONLY when the patient cannot
Least invasive first
Oropharyngeal, nasopharyngeal, nasotracheal, endotracheal, tracheostomy tube
Pre oxygenate with 100% oxygen
One suctioning event is 10 seconds MAXIMUM
No routine normal saline installations to “thin” secretions or stimulate cough (saline can cause pneumonia)
suctioning purpose
Purpose
Removes secretions and prevents mucous plugs
Stimulates cough reflex
indications for suctioning
Change in VS
O2 desaturation
Dyspnea
Restlessness
Presence of rhonchi
Frequent coughing
Visible secretion is ETT/TT
Audible secretions
With or without ambu
types of suctioning (just endo, naso, trach)
Endotracheal
Naso tracheal
Tracheal
trach suctioning complications (trach is my blood and heart) (think, if you’re suctioning the air out..)
Atelectasis
Trauma
Infection
Increased ICP
Hypoxemia
Cardiac dysrhythmias
Blood pressure fluctuations
Tube dislodgement - when is it a medical emergency?
Tube dislodgement priorities depend on maturity of tracheostomy/laryngectomy
Within 48 hour of surgery dislodgement is a medical emergency
In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress, which finding is the earliest sign of reduced oxygenation? (restless with ALS)
increased restlessness
A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client’s condition is worsening when he: (just accessory muscles)
uses the sternocleidomastoid muscles.
“Viruses like influenza are the most common cause of
pneumonia.
A client continues to report dyspnea on exertion and overall weakness. A pulmonary artery catheter is placed and the mean pulmonary arterial pressure is 35 mm Hg. What condition is the client experiencing?
Pulmonary arterial hypertension
The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client (the peak is hard and fast)
Exhales hard and fast with a single blow
indications that COPD is worsening - from post-test (Cee, the dry cough is worse)
increased dry cough, tachypnea, chest pain, increased anxiety
Mr Brody understands COPD managment when he states
avoid irritants, smoking cessation, use diphragmatic breathing, alternating periods of rest and activity. NOT peak flow meter.
normal PaO2 levels (oxygen in the blood)
75 to 100 mm Hg
normal peak flow numbers - peaky needs 400
400 - 700 per minute
trach complications - stiff
tracheal stenosis
trach complications - fistula
tracheosophageal fistula, tracehoinnominate artery fistual, tracheocutaneous fistula
trach complication - the usual
hemmorage, wound infection
trach complication - what about emphysema?
subcanteous emphysema
