rcp 330 week 1 Flashcards
bronchospasm
abnormal contraction of the smooth muscle of the bronchi, resulting in acute narrowing and obstruction.
bronchospasm stimulated by
catheter in the lower airway
patients with hyperactive airway disease
*stop suctioning and administer aerosolized bronchodilator
preventing hypoxemia when suctioning
preoxygenate the patient
not disconnecting the ventilator
closed suction technique
steady FiO2/ PEEP - lung decruitment
Maxillary trauma
NPA (nasopharyngeal)
- direct visualization
- blind passage
size of artificial airway adapter
15mm
purpose of pilot balloon
used to measure cuff status and pressure when the tube is in place
Complications associated with suctioning
hypoxemia cardiac dysrhythmias hypotension / hypertension atelectasis mucosal trauma ICP bacterial colonization of lower airway
hypoxemia
not pre oxygenating enough, use closed suction technique and maintain FiO2 levels and PEEP
cardiac dysrhythmias
vagal nerve stimulation, agitation, hypoxemia, stop suctioning, keep a pulse ox on during admistering and apply O2/ ventilation
hypotension / hypertension
cardiac dysrhythmia, hypoxemia, anxiety, stress, pain, coughing, stop suctioning, apply O2 / ventilation, explain procedure, be calm, pre oxygenate
atelectasis
too much negative pressure and not appropriate catheter size, use closed-system technique and do not disconnect patient, pre oxygenate
mucosal trauma
too much negative suction pressure, shallow suction method and use NPA
ICP
cough, discomfort, previous injury, administer lidocaine 15 min before suctioning to minimize ICP to prevent
bacterial colonization of lower airway
using normal saline, open-system technique, and disconnecting vent. ETT patients, sterile technique should be used with a closed-system. Only use normal saline when necessary
steps for intubation
assemble and check equipment position patient pre oxygenate / ventilate insert laryngoscope visualize glottis displace glottis insert tube assess tube position stabilize tube and confirm placement
position patient
align mouth, pharynx, and larynx
moderate cervical flexion extension of atlantooccipital joint placement of pillows under shoulders flexes neck and tilts head backward sniffing position
features on ETT that indicate placement
tube markings in cm
radiopaque
assess tube position
auscultation of chest and abdomen observation of chest movement tube length light wand capnometry colorimetry flexible laryngoscopy / bronchoscopy videolaryngoscopy ultrasound
miller blade
straight blade and directly displaces epiglottis
mcintosh
curved blade and indirectly displaces epiglottis
ETT depth
men 21-23
women 19-21
indications for tracheostomy tube
overcoming upper airway obstruction or trauma
people with poor protective reflexes
prolong period of intubation
cuff pressures
normal 20-30cmH2O
high = cuts off mucosal blood flow
- tissue damage
- tracheal wall injury
low = aspiration of oral secretions
how often are patients suctioned
only when indicated
suctioning adults pressures
-120 to -150
suction time vs total time
suction time = 10 seconds
total time = 15 seconds
when a patient does not tolerate suctioning
discontinue treatment
equipment needed for intubation
oxygen flowmeter and tubing suction apparatus flexible sterile suction catheters sterile gloves for endotracheal suctioning yankauer tip suction manual resuscitation bag and mask colorimetric carbon dioxide detector oropharyngeal airways laryngoscope (two) with assorted blades endotracheal tubes (three appropriate sizes) tongue depressor stylet stethoscope tape or endotracheal tube holder 10-mL or 12-mL syringe water-soluble lubricating gel magil forceps local anesthetic towels barrier precautions
equipment needed for nasotracheal suctioning
vacuum source
calibrated, adjustable regulator
collection bottle and connecting tube
disposable, sterile gloves
sterile suction catheter
standard precautions, goggle, masks
oxygen source with calibrated flow meter or ventilator
pulse oximeter
manual resuscitation bag equipment with O2 enrichment device for emergency use
stethoscope
**sterile water-soluble lubricating jelly
nosopharyngeal airway
patients who require nasotracheal suctioning
- minimizes damage to mucosa
facial surgery
helps maintain patency of upper airway
artificial airway inserted into larynx
endotracheal tube
murphys eye
side port
ensures gas flow if the main port should become obstructed
purpose of artificial airway cuff
prevent tracheal mucosal injury
minimize aspiration
seal to prevent air leaks during ventilation
advantages of tracheostomy with inner cannula versus without
can be cleaned or replaced if obstructed or occluded instead of changing a whole trache
prevents emergency changing of whole device
recommended for patients going home with a TT or in situations in which humidity delivered to the airway is less than optimal
tracheostomy inserted
traditional - over second or third ring
percutaneous - circoid and first ring or between first and second ring
symptom of vocal cord inflammation and glottic edema
stridor
retractions
inability to feel airflow in upper airway
complications with intubation / rare and serious
laryngeal lesions glottis edema vocal cord inflammation laryngeal / vocal cord ulcerations vocal cord paralysis vocal cord stenosis
steps to wean a patient off a tracheostomy tube
- fenestrated tubes
- progressively smaller tubes
- tracheostomy buttons
- patient should have sufficient muscle strength to generate cough ( peak expiratory pressure > 40 cmH2O)
- ideally there should be no active pulmonary infection, and the volume and thickness of secretions should be acceptable
- patency of upper airway assessed via bronchoscopy
- adequate swallow must be present to decrease risk of aspiration
device commonly used to suction secretions or fluids from the oropharynx
rigid tonsillar
yankauer suction tip
special catheter used to facilitate entry into the left mainstem bronchus
curved-tip catheter
emergency tracheal airway
orotracheal (oral passage)
why is suction equipment needed for intubation
vomitus or secretions may obscure the pharynx or glottis
disadvantage os using colorimetric / capnography
patients who recently consumed carbonated fluids
cardiac arrest patients that get a false-negative due to poor pulmonary blood flow
final step to confirm ETT placement
bronchoscope
advantages of LMA
ease and speed someone who is inexperienced you dont need equipment greater amount of ventilation emergency use
disadvantage of LMA
doesnt protect against aspiration
cannot be used in conscious or semicomatose patients bc of the stimulation of gag reflex
8 basic steps of trach care
assemble and check equipment explain procedure suction patient clean inner cannula clean and examine stoma site change tie and holder replace clean inner cannula reassess patient
3 airway emergency
tube obstruction
cuff leaks
unplanned extubation
tubing becomming obstructed
kinking of tube or patient biting tube
herniation of the cuff over the tube tip
obstruction of the tube orifice against the tracheal wall
mucous plugging
patients that might need to remain intubated even after the ventilator is removed
surgically treated throat and laryngeal cancer
patients with respiratory failure
when a patient does not tolerate endotracheal suctioning
patient becomes bradycardic from vasovagal reflex, STOP and provide 100% FiO2
when a patient does not tolerate nasotracheal suctioning
patient may gag or regurgitate … avoid suctioning after meals
if gagging or regurgitating occurs, reposition patient and suction oropharynx
