Gas Exchange: ARDS Flashcards
How to determine proper placement of tracheostomy tube
Chest X-ray
Immediate post-op care for tracheostomy
Ensure airway,
Confirm bilateral breath sounds,
Resp assessment Q 2hr,
Assess for complications
Complications after tracheostomy
Tube obstruction, Dislodgement and accidental decannulation, Pneumothorax, Subcutaneous emphysema, Bleeding, Infection
S/S of Tracheostomy tube obstruction
Difficulty breathing, Noisy respirations, Difficulty inserting suction catheter, Thick, dry secretions, Unexplained peak pressures (w/ mech. Vent.)
Prevention of tracheostomy tube obstruction
Assess at least hourly for patency, Prevent obstruction by having pt cough & deep breathe, Provide inner cannula care, Humidify O2 source, Suction as needed
How to prevent trach tube dislodgement and decannulation
Secure tube in place
(If happens in 1st 72 hrs is emergency),
Trach tube replacement of same size or one size smaller should be at bedside along with trach insertion tray
Assess for subcutaneous emphysema in pt with Tracheostomy
Inspect and palpate for air under the skin (crepitus)
Assess for bleeding in pt with new tracheostomy
Small amounts are normal; constant oozing is not,
Wrap gauze around tube and pack into the wound to apply pressure to bleeding sites
Infection prevention for tracheostomy tubes
Use sterile technique during suctioning and trach care,
Assess stoma for s/s of infection,
Use stoma dressings to keep clean & dry,
General careful wound care
Tissue damage prevention for tracheostomy pt
Keep cuff pressure between 14-20 mm Hg or 20-30 cm H2O,
Check pressure once per shift
Other issues for potential tissue damage in pt with trach
Malnourished, Dehydrated, Hypoxia, Older, Receiving corticosteroids, Tube friction and movement
Reduce tracheostomy tissue damage
Maintain proper cuff pressure, Stabilize tube, Suction only PRN, Prevent and treat malnutrition, dehydration, and hypoxia, Humidify the air
Practices for suctioning pts with artificial airway
Assess need, Check suction source; pressure should be between 80-120 mm Hg, Set up sterile field, Preoxygenate pt for 30 sec-3 min, Insert catheter until resistance, Withdraw over 10-15 sec with int suction, Hyper oxygenate 1-5 min to pt baseline, Repeat PRN up to 3 times, Suction mouth and provide mouth care, Document secretions and pt response
When to suction tracheostomy pt
Secretions are audible or noisy, Crackles or wheezes are heard on auscultation, Increased pulse or resp rates, Mucus in artificial airway, Pt request, Increase in peak airway pressure
Prevent hypoxia when suctioning tracheostomy pt
Hyperoxygenate pt with 100% O2
Prevent tissue trauma from frequent suctioning of trach pt
Suction only as needed, Lubricate catheter, Apply suction only during withdrawal, Use twirling motion during withdrawal, Use intermittent suction for 10-15 sec only, Use sterile technique, Suction mouth AFTER airway
Tracheostomy care
Wash hands; don PPE,
Suction if needed,
Remove old dressings and excess secretions,
Set up sterile field,
Remove and clean inner cannula or replace it,
Clean stoma site,
Change trach ties (secure new in place before removing old),
Document secretions, stoma, surrounding skin, pt response, and teaching/learning
Oral hygiene
Use sponge tooth cleaner or Soft bristled toothbrush moistened in water, Help pt rinse with NS Q4 while awake, Examine mouth for sores or dental probs, Apply lip-balm
Prevent aspiration in pt with trach
Avoid meals when pt fatigued,
Provide smaller more frequent meals,
Don’t hurry the pt,
Provide close supervision if pt is self-feeding,
Keep emergency suction equip nearby and ready,
Avoid thin liquids; thicken liquids,
Position pt as upright as possible,
Partially or completely deflate cuff during meals as tol,
Suction after cuff deflation to clear airway,
Encourage to eat slowly and dry swallow,
Avoid consecutive swallows of liquids,
Teach to tuck chin and move forehead forward while swallowing,
Pt controls next bite,
Monitor resp status,
HOB elevated for >30 min
Promote communication for trach pt
Writing tablet, Magic slate, Communication board, Flash cards, Hand signals, Computer, "Yes" or "no" questions
Promote psychosocial needs of pt with trach
Allow time for communication,
Set realistic goals,
Promote self-care,
Provide encouragement & positive reinforcement,
Provide acceptance & caring behaviors,
Assess for need for counseling
Discharge needs/teaching for trach pt
Care for trach tube,
Clean suction technique,
Use shower shield over trach tube when bathing,
Cover airway lightly with cotton cloth to protect during the day,
Increase humidity in the home,
Use communication method that began in hosp,
Wear Med Alert bracelet identifying inability to speak,
Provide outside referrals as needed
Priority problems for pt’s requiring tracheostomy
Reduced oxygenation, Inadequate communication, Inadequate nutrition, Potential for infection, Damaged oral mucosa
How to prevent VAP
“Ventilator Bundle”:
Hand hygiene,
Oral care,
HOB elevation
ARDS is acute respiratory failure with:
Hypoxemia persisting with 100% O2, Decreased pulmonary compliance, Dyspnea, Noncardiac associated bilat pulmonary edema, Dense pulmonary infiltrates on XR
What is associated with ARDS?
Occurs after acute lung injury such as: Sepsis, Pulmonary embolism, Shock, Aspiration, Inhalation injury, History of hyper-inflammatory response, Severe neurological damage, Fluid leads to alveolar collapse, Unresponsive to oxygenation
Direct lung injury causes of ARDS
Aspiration of acidic gastric contents, Lung radiation, Submersion in water with aspiration, Inhalation of toxic gases, Trauma, Sepsis, Drowning, Burns, DIC
Prevention of ARDS
Early recognition of pts at high risk for the syndrome,
Monitor those at risk for aspiration,
Follow meticulous infection control
