Oxygenatio And Gatric Intubation Flashcards
How much oxygen are we administering on room air/ various mask
Room air= RA=21%
Nasal cannula=NC= 1-6 liters. 24%-44%
Face mask= 5-8 liters
Venturi mask=4-10 liters 24%- 55% incorporates room air, not used w/cannula Can dial FiO2
Non- rebreather=6-15 liters 70%-100% high quality O2
If Tracy tube is dislodged
Grab retention sutures, spread the opening
How often should we check nares and cannula prongs
Observe nares and cannula prongs at least once per shift for irritation and breakage
What type of lubricant to use on nares
Water soluble
Oxygen administration
Timing for suctioning
10 seconds or less/ oxygenate for 30 seconds beforehand
Oral suctioning w/Yankauer catherer
Used for cleaning the mouth
One time usage
Don clean gloves
Gently and search tip of the suction catheter into one side of the mouth and glide it toward The oropharynx without suction move the catheter around the mouth until secretions are cleared
Encourage the patient to cough
Rinse tip until connecting tube is cleared of secretions
Repeat as necessary
Nasopharyngeal suctioning
Be sure nose is unobstructed
Open suction catheter kit don
Mark correct length for insertion
Lubricate catheter w/water soluble jelly or dip tip into sterile saline
Gently insert catheter into one side of nasal passages
Limit suctioning to 10-15 seconds
Endotracheal intubation
Tube inserted thru pt mouth and into upper airway to provide a patent airway
O2 given thru this tube via O2 setup/ventilator
Suctioning can be done thru ET tube
ET tubes are usd for short term management of airway
Used for pt undergoing anesthesia
Used in emergency situation to provide an airway
Replaced by tracheotomy if artificial airway is needed for more than 2 weeks
If more than 14 days pt may experience tissue damage/vocal cord damage
Tracheostomy
Artificial opening/ surgical incision
For pts experiencing apnea/some form of Respiratory obstruction
Can also be used to prevent aspirations of secretions and blood
Nursing responsibilities for tracheostomy
Keep the airway clear
Keep the inner cannula clean
Prevent impairment of surrounding tissue
Provide the patient with a means of communication

Tracheostomy suctioning and care (1)
Tracheostomy
Tracheostomy suctioning and care (2)
Tracheostomy suctioning and care (3)
Tracheostomy suctioning and care (4)
Tracheostomy suctioning frequency
Suction as often as necessary
Pt can indicate a need for suctioning
Cuffed tracheostomy
Used for mechanical ventilation
Care of cuffed tracheostomy
T tube/ tracheostomy collar
Ch 15 elimination n gastric intubation standard steps before and after
Simple straight catheter
Drain bladder And remove
Bladder training
Voluntary control over voiding
Kegel exercise-tightening the muscles of the perineum
Muscle control develops gradually (4 to 6 wks)
Habit training q 1.5 to 2 hours
 schedule avoiding times to correlate with patients activities
Typical voiding times are upon rising before each meal and at bedtime
Stress Incontinence
Small leakage of urine win the person laughs coughs or lifts something heavy
Usually caused by a weak sphincter
Urge incontinencex
Constant leakage whenever the bladder contains urine
Overactive bladder
Incontinent skin
Urine and feces are very irritating to the skin to help prevent skin impairment make sure to change the undergarments or under pads frequently cleanse the skin thoroughly after each episode of incontinence with warm soapy water and dry completely it is important that the patient is not meant to feel as though they are a burden
Indwelling catheter (foley)
Stays in
Balloon keeps them in place
Nasotracheal suctioning
Transtracheal oxygen delivery
A method of oxygen delivery for the patient with a tracheostomy is the tracheal catheter which is inserted directly into the trachea between the second and third tracheal cartilages how much transtracheal catheter does not interfere with drinking eating or talking oxygen is delivered throughout the entire Respitory cycle 1-2 L
Obturator
Used when changing inner cannula of trach
Ostomy irrigation
Hey colostomy irrigation requires special equipment attach a tone to tubing lubricate the con insert the con into the stoma do a top of sleeve do not force the cone into the stoma. Use gentle pressure to hold a tip and place in stoma why are you hold con in place allow solution to flow slowly into the: patient complains of cramping stop flow without removing a call it’s so cramps subside instruct patient to sit about 15 to 20 minutes while we train solution flows into toilet Patient cannot sit this long it is acceptable to close the end of the irrigation sleeve with a clamp and allow the patient to be up and walking drain sleeve rinse and remove it I was very patient and results of irrigation ash toilet perform colostomy care document. From step 7
Performing ostomy care (1)
Performing ostomy care (2)
Nursing skills
Be organized
Teaching
Safety
Efficiency
Standard steps- before during and after
Amount of time for suctioning
15 seconds /oxygenate for 30 seconds beforehand
Timing for suctioning
15 seconds
Trach collar
Mask for someone who has a trach
No ventilator
Colostomy Care products
Paper tape
Barrier paste
Basin w/ warm water
Bedpan or trash bag
Clean gloves measuring guide
Pouch clamp. Scissors
Skin sealant wipes
Washcloth(or disposable)
Nasogastric tube. Other types of NG tubes-PEG tube (percutaneous endoscopic gastronomy) or G-tube
Hollow tube passed into stomach via the nasopharynx
Used to remove gas fluids or toxic substances from stomach one to administer fluids and nutrients into the stomach
Can help to prevent vomiting
Gastric Gavage
NG tube can be attached to a feeding pump or feeding can flow in by gravity via bag/ syringe
Slow and gradual to prevent dumping syndrome (caused by rapid infusion)
Verify placement of tube
Gastric lavage
Used in cases of poisoning
Room temp meds instilled in stomach and then suctioned out
Repeated until ordered amt of solution is used
Removed solution must be evaluated and documented
Enemas (1)
Can be pre filled and let lubricated
Introduction of solution into the colon the defecation of patient with constipation
Various reasons cleansing colon before surgery or abdominal surgery or fecal impaction
.
Enema (2)
Hemorrhoids
Swollen inflamed veins in anus and lower rectum
Can result from straining during bowel movements/pregnancy
Goal is to decrease pain, prevent elimination problems, prevent further damage
Maintain high fiber diet adequate fluid intake
Use lubricate for any insertion
Urostomy care
Bladder removed
Flatulence
The presence of air or gas in the intestinal track typically occurs in person consumes Gas producing liquids and food or decreased peristalsis
Many cause distention of stomach and abdomen
Hypoxic drive
Pts with COPD Respiratory effort driven by hypoxia. Give O2 w/caution (2liters)
Signs and symptoms of hypoxia
Why ausculatae lung sounds
To verify adequate oxygenation and patency of the airway
Oxymizer
Similar to nasal cannula in delivery
collects and conserves oxygen allowing higher percent of oxygen to be delivered
can be set as high as 15 liters
What is tracheostomy
An artificial opening in trachea
Primary responsibility for Trach care
Minimize infection risk by evaluating the patient
for excess secretions suction as often as necessary
provide constant airway humidification
change or clean respiratory therapy equipment every eight hours
Remove water that condenses in equipment tubing
provides frequent mouth care apply moisturizing agents to the dry cracked lips
Maintain nutritional levels
Patients with a tracheostomy may drink fluids and eat once the initial healing phase of the new tracheostomy has passed
Endotracheal tube
Tube inserted thru mouth and into upper airway to provide a patent airway
O2 is administered via ET tube via oxygen setup or ventilator
Pt with ET tube are allowed nothing by mouth
It is necessary to provide parenteral or enteral nourishment
Suctioning can be performed thru ET tube
Used for emergency/short term
T tube/Trach collar
Attached to Trach to deliver to deliver oxygen or moisture
It is T shaped the collar covers open end of the tracheostomy tube and has adjustable strap that extends around the neck
Urinary catheters
used for treatment and diagnosis
used to maintain urinary flow, to divert urine flow
to facilitate healing after surgery and to introduce medication
to dilate or prevent narrowing of some portions of the urinary track
used for intermittent and continuous urinary drainage
*****Can be placed in the bladder ureter or the kidney
Nursing interventions for a patient with urinary drainage system
Check for infection and trauma
follow aseptic technique when inserting a catheter
keep collection bag off of the floor
Record fluid intake and urinary output
check drainage system for proper placement and function
regularly encourage patient to drink plenty of fluids to flush the urinary tract
do not open drainage system after it is in place unless there is a drs order open
irrigation of the catheter as necessary and then only with an order from the doctor
Catheter care
Patient with a Catheter iS especially vulnerable to urinary tract infections
encourage oral fluid intake of at least 2000 mL a day
Have patient ambulate‘s if possible to facilitate urine flow
Avoid kinks or compression of the drainage tube to prevent pooling of urine
Teach signs and symptoms of urinary track infection which are urgency frequency hesitancy burning sensation bladder spasms
Patient should receive routine catheter care and perineal hygiene at least two times per day to prevent urinary track infection
Gastric decompression
The purpose of gastric decompression is to remove the air and fluids that build up when gastrointestinal motility is slowed
It is used frequently after surgery to help with distention that may occur and to prevent nausea and vomiting
Removal of nasogastric tube
Assemble equipment reassure patient that nasogastric tube removal is less distressing than insertion
evaluate patient’s abdomen for bowel sounds evaluate patient’s nasal and oral cavity
if tube is attached to suction turn off suction and disconnect tubing
place towel or waterproof pad across patients chess
instruct patient to take deep breath and hold it pinch tube with fingers or clamp
place tubing in a plastic bag
provide oral and nasal care
position patient for comfort
dispose of tube and equipment
measure drainage and characteristics of drainage
inspect condition of nares and oral cavity
document any abnormalities
Ostomy
An artificial opening
The site of the opening is called a stoma
Ostomies can be created because of trauma to the intestine, severe inflammation or diseases
they can be temporary or permanent
is it dependent on the reason they are present
Bowel elimination
Elimination of bowel where is defecation is a basic human needs and is essential for normal body function
Paul elimination depends on several factors
A balanced diet including high fiber foods daily fluid intake 2000 to 3000 mL and activity
Every patient should have a bowel movement at least every 1 to 3 days
Give patients as much privacy as possible avoid continually checking on the patient
Self catheterization
for a patient who has a spinal cord injuries
or other neurological disorders that interfere with urinary elimination promote independence for the patient
Clean technique can be use rather than sterile technique at home
