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Dysphagia > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Indications for Artificial Airway

  1. _______
  2. Loss or impairment of ___ ___ ___
  3. Inability to maintain ____
  4. Need for _________
A
  1. Upper Airway Obstruction
  2. Loss or impairment of airway protective reflexes
  3. Inability to maintain clearance of bronchial secretions
  4. Need for mechanical ventilatory support
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2
Q

Artificial Airways

  1. 2.
    3.
    4.
A
  1. Nasopharyngeal Airway
  2. Oropharyngeal Airway
  3. Endotracheal Tube
  4. Tracheostomy Tube
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3
Q

Complications of Intubation

  1. Complications can occur during or following ____ as well as a result of ____.
  2. __, ___, __injuries
  3. ___ injury
  4. ___ ___
  5. _____ injury
  6. ______
  7. Reduction in ___ ____
A
  1. Complications can occur during or following intubation as well as a result of extubation.
  2. Nasal, oral, pharyngeal injuries
  3. Laryngeal injury
  4. Subglottic edema
  5. Tracheal injury
  6. Laryngospasm
  7. Reduction in mucociliary transport
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4
Q

Tracheostomy Tubes

Cricothyroidotomy

-surgical incision directly into the ____ aspect of the ____ at the junction of the ___ and ____ cartilages

-typically done ____ in cases of ___ ___ ___; faster procedure “in the field”

A

Cricothyroidotomy

-surgical incision directly into the anterior aspect of the larynx at the junction of the thyroid and cricoid cartilages

-typically done emergently in cases of severe airway obstruction; faster procedure “in the field”

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5
Q

tracheostomy tubes

Tracheotomy / Tracheostomy

  • ____ is the procedure
  • ____ is the opening
  • surgical incision directly into the _____ aspect of the ____ through the ____
  • occupies only ___ of tracheal space
A

Tracheotomy / Tracheostomy

  • tracheotomy is the procedure
  • tracheostomy is the opening
  • surgical incision directly into the anterior aspect of the trachea through the second or third tracheal ring
  • occupies only 2/3 of tracheal space
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6
Q

Tracheostomy Tubes

Tracheostomy Tubes: Materials

  • Hollow ___, goose quills lead, silver, gold, rubber, ____ …
  • ____ (stainless steel)
  • Jackson , Montgomery
  • ____ (polyvinyl chloride)
  • ____, Blom
  • ____ (polysiloxane)
  • Bivona
A

Tracheostomy Tubes: Materials

  • Hollow reeds, goose quills lead, silver, gold, rubber, nylon …
  • Metal (stainless steel)
  • Jackson , Montgomery
  • PVC (polyvinyl chloride)
  • Shiley, Blom
  • Silicone (polysiloxane)
  • Bivona
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7
Q

Tracheostomy Tubes

Advantages of Tracheostomy Tubes

  1. ___ ____
  2. Facilitates weaning from __ ____
  3. Decreased risk of __ ___
  4. __ ___ delivery possible
  5. Options for __ ____
  6. Improved __ ___
  7. Increased ___ ____
A
  1. Pulmonary toilet
  2. Facilitates weaning from mechanical ventilator
  3. Decreased risk of laryngotracheal injury
  4. PO nutrition delivery possible
  5. Options for oral communication
  6. Improved oral hygiene
  7. Increased patient comfort
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8
Q

Disadvantages of Tracheostomy Tubes

```
1. Possible complications:
10
2. Reduced ___ ____
3. Diminished ___ and ___
4. ____
5. Increased _____
~~~

A
  1. Possible complications: hemorrhage, thyroid injury, laryngeal nerve injury, tracheal stenosis, tracheal granulation, infection, tracheoesophageal fistula, tracheomalacia, pneumothorax, tube obstruction
  2. Reduced cough efficiency
  3. Diminished taste & smell
  4. Dysphagia
  5. Increased secretions
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9
Q

Why Reduced Cough?

  • _____
  • _____
  • _____ (intercostals/abdominals)
  • _____
  • Loss of ability to build-up ___ ___ = limited ___ force
A 
Irritation
Inspiration
Compression (intercostals/abdominals)
Expulsion
Loss of ability to build-up subglottic pressure  = limited expulsion force
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10
Q

Why Diminished Taste & Smell?

  1. On expiration, air will take the path of ___ ___ (tracheostomy tube)
  2. Thereby reducing ___ through the ___ ___ (nose and mouth)
  3. Thereby reducing ____
  4. ~ 90% of taste is dependent upon ___ (orthonasal & retronasal)
  5. Decreased senses of smell and taste = decreased ___= decreased ___ = decreased ___!
A
  1. On expiration, air will take the path of least resistance (tracheostomy tube)
  2. Thereby reducing airflow through the upper airway (nose and mouth)
  3. Thereby reducing smell
  4. ~ 90% of taste is dependent upon smell (orthonasal & retronasal)
  5. Decreased senses of smell and taste = decreased appetite = decreased nutrition = decreased healing!
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11
Q

Why Increased Secretions?

  1. Nasophaynx is natural ___, ___, ___ system
  2. With air inspired through __ ___ have bypassed ___, ___, ____ system
  3. Cold, dry, and dirty air is ___ ___
  4. But remember! Have __ ___ ___
A
  1. Nasophaynx is natural heating, warming and filtering system
  2. With air inspired through tracheostomy tube have bypassed warming, filtering, and humidification system
  3. Cold, dry, and dirty air is pulmonary irritant
  4. But remember! Have decreased cough efficiency
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12
Q

Cuffed vs. Uncuffed Trach. Tubes

Components of Cuffless Tracheostomy Tube

  • Outer ____
  • Inner _____
  • __ ___
  • ____
  • ____
  • ____
  • ______ (?)
A 
Outer cannula
Inner cannula
Capping cannula
Obturator
Flange 
Shaft
Fenestration (?)
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13
Q

Cuffed vs. Uncuffed Trach. Tubes

Components of Cuffed Tracheostomy Tube

  • ____ cannula
  • ___ ____ Cannula
  • ____
  • ____
  • ___/____(?)
  • ____
  • _____ (?)
A 
Outer cannula
Disposable Inner Cannula
Obturator
Flange 
Pilot balloon/Cuff (?)
Shaft
Fenestration (?)
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14
Q

Cuffed vs. Cuffless Tracheostomy Tubes

  1. What? _____
  2. Why? To ____ to control the ___ of inspired and expired air
  3. Where? At the point where the _____ meets ______
  4. How? __, ___, ____ via syringe through ___ ___ & tubing
A
  1. What? Balloon shaped extension on the shaft of an endotracheal or tracheostomy tube
  2. Why? To separate the upper from the lower airway to control the volume of inspired and expired air
  3. Where? At the point where the outer most surface of the cuff meets the inner wall of the trachea
  4. How? Water, air, saline via syringe through pilot balloon & tubing
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15
Q

Cuff: Aspiration Prevention?

  1. Cuff was actually designed to ___
  2. BUT… aspiration has been reported in -% of patients with ___ __ ___
  3. Aspirated material sits on ___ ___, eventually ___ cuff, aspirate falls into airway
  4. CUFF IS NOT ___ ____
  5. Shiley has introduced new cuffed trach tube with ___ ___ just above cuff; suction prior to cuff deflation
A
  1. Cuff was actually designed to prevent aspiration
  2. BUT… aspiration has been reported in 30-70% of patients with fully inflated cuff
  3. Aspirated material sits on inflated cuff, eventually deflate cuff, aspirate falls into airway
  4. CUFF IS NOT ASPIRATION PREVENTION
  5. Shiley has introduced new cuffed trach tube with suction port just above cuff; suction prior to cuff deflation
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16
Q

Effects of Endotracheal Intubation on Deglutition

  1. Reduced sensitivity in ___, ___, ___
  2. Atrophy of ___ ___
  3. Oropharyngeal muscle strength is diminished following _______
  4. ___ ____ (airway protection)
  5. ___ ____
  6. Diminished ___ ___ (airway protection)
A
  1. Reduced sensitivity in oral cavity, pharynx, and larynx
  2. Atrophy of oropharyngeal musculature
  3. Oropharyngeal muscle strength is diminished following 24 hours of non-use
  4. Glottic closure (airway protection)
  5. TVC edema
  6. Diminished cough efficiency (airway protection)
17
Q

Effects of Tracheostomy Tubes on Deglutition

  1. Diminished airflow through __ __ = decreased senses of __ & __ = decreased ___ = decreased ___
  2. Decreased ___&___ ___
  3. Decreased __ ___
  4. Decreased ___ ___
  5. Bolus ____
  6. ___ closure
  7. ____ efficiency
A
  1. Diminished airflow through nasal cavity = decreased senses of taste and smell = decreased appetite = decreased nutrition
  2. Decreased oropharyngeal and laryngeal sensitivity
  3. Decreased laryngeal elevation
  4. Decreased pressure valving
  5. Bolus propulsion
  6. Glottic closure
  7. Cough efficiency
18
Q

Effects of Mechanical Ventilation on Deglutition

  1. Diminished airflow through nasal cavity = decreased ___ ___ = decreased ___ = decreased ____
  2. __ __ ___
  3. Decreased ____ & __ ___
  4. Decreased __ ____
  5. Decreased ___ ___
  6. Bolus ____
  7. ____ closure
  8. ___ efficiency
A
  1. Diminished airflow through nasal cavity = decreased senses of taste and smell = decreased appetite = decreased nutrition
  2. Oropharyngeal muscle atrophy
  3. Decreased oropharyngeal and laryngeal sensitivity
  4. Decreased laryngeal elevation
  5. Decreased pressure valving
  6. Bolus propulsion
  7. Glottic closure
  8. Cough efficiency
19
Q

Effects of One-Way Speaking Valve on Deglutition

  1. Increased sense of __& ___ = increased appetite = increased ____
  2. Restoration of __ ___ __
  3. __ ___
  4. __ ___
  5. ____ closure
A
  1. Increased sense of taste and smell = increased appetite = increased nutrition
  2. Restoration of pressure valving system
  3. Bolus propulsion
  4. Cough efficiency
  5. Glottic closure
20
Q

Contraindications for PO Intake

  1. Pressure Support > ___ cmH2O
  2. Peep > ___ cmH2O
  3. _____
  4. > 70 RR in ___
  5. > 30 RR in ____
  6. Immediately following extended ____, especially with poor __ ___ or ___
  7. Decreased ___ Saturation
  8. > ___% Oxygenation
  9. Continuous __/___
A
  1. Pressure Support > 15 cmH2O
  2. Peep > 5 cmH2O
  3. Tachypnea
  4. > 70 RR in infants
  5. > 30 RR in adults
  6. Immediately following extended intubation, especially with poor cough efficiency or dysphonia
  7. Decreased O2 Saturation
  8. > 90% Oxygenation
  9. Continuous BiPAP/CPAP
21
Q

Post-surgical Dysphagia

  1. ___
  2. __ ___ damage
  3. ___ ____ damage
A
  1. Edema
  2. Cranial Nerve damage
  3. Brainstem innervation damage
22
Q

Surgeries

  1. ____- Cranial Nerve __
    - -Wasserman, et al. 49% has __ ___; 73% had ____
  2. __ ____- Monini, et al.=17.5%
  3. __ ___ Procedures
  4. _____
  5. Skull Base/__ __ surgery
A
  1. Thyroidectomy- Cranial Nerve X
    - -Wasserman, et al. 49% has preoperative dysphagia; 73% had post-operative
  2. Carotid Endarterectomy- Monini, et al.=17.5%
  3. Cervical Spine Procedures
  4. Esophagectomy
  5. Skull Base/ Posterior Fossa surgery

Dysphagia (13 decks)

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