Term
| What is the purpose of airway maintenance? |
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Definition
| Ensure adequate ventilation (patient may have respiratory effort, but not moving air |
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Term
| How do you know your patient is adequately ventilating? |
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Definition
| Good skin color, rise and fall of chest, Good O2 sat, etc. |
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Term
| What clinical scenario require airway management? |
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Definition
| Resp. Failure, Excess secretions, Prevention of aspiration, chest trauma, Sign. Pulmonary edema, Upper Airway obstruction, Infections, Tumors, Laryngeal edema |
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Term
| What is indication for head tilt or jaw thrust maneuver? |
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Definition
| Loss of natural airway, i.e. epiglottis may occlude airway |
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Term
| What is the contraindications of head tilt/chin lift? |
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Definition
| Unstable cervical spine - use jaw thrust |
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Term
| What are indications for oropharyngeal airway? |
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Definition
| Depressed LOC, Loss of muscle tone, Airway obstruction, Prevent biting of endotracheal tube |
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Term
| How do you measure oropharyngeal airway length? |
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Definition
| Tip of airway to edge of mouth extending to bottom of ear. |
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Term
| What may happen if oropharyngeal airway is too short? too long? |
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Definition
| Too short - forces tongue back into pharynx, Too long - Stimulates gag reflex |
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Term
| What are the management principles for oropharyngeal airway? |
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Definition
| Assess for adequacy of ventilation and observe and ausculate breath sounds |
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Term
| What are the complications with oropharyngeal airway? |
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Definition
| Damage teeth/soft tissue from forcing airway, cannot use on conscious patient (will induce gag/vomiting), difficult to perform |
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Term
| What are indications for nasopharyngeal airway? |
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Definition
| Depressed LOC, Loss of muscle tone/obstruction, oral airway contraindicated, reduce nasal trauma in suctioning |
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Term
| How do you measure a nasopharyngeal airway? |
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Definition
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Term
| What else in important for insertion of nasopharyngeal airway? |
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Definition
| Ensure nare is patent, Lubricate with water soluble lubricant or water, insert along floor of nare to reduce trauma, insert until flange is against nostril |
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Term
| Management Principles of nasopharyngeal airway |
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Definition
| Assess nares and skin for breakdown, assess adequacy of ventilation, suction airway to remove blood/secretions, may use with other devices |
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Term
| Complications of nasopharyngeal airway |
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Definition
| Contraindicated in coagulopathy (sever epistaxis), will damage nare if in too long |
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Term
| What are advantages of pocket facmask? |
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Definition
| Eliminate direct contact, positive pressure ventilation, Oxygenates will if O2 connected, easier to perform bag mask ventilation, best for small hands |
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Term
| What are complications of pocket airway? |
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Definition
| Does not establish a patent airway, adequate volume may not be achieved |
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Term
| What are indications for endotracheal tube? |
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Definition
| Persistent airway obstruction, secretion management, protect airway for regurgitation/aspiration, decreased LOC/ineffective reflexes, Need for higher O2 concentration, mechanical ventilation or general anesthesia |
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Term
| What is the usual size ET tube for adult woman? |
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Definition
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Term
| What is the usual size ET tube for adult man? |
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Definition
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Term
| What is the usual size ET tube for infants? |
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Definition
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Term
| How do you figure the size ET tube for children up to age 8? |
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Definition
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Term
| What equipment do you need to insert ET tube? |
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Definition
| Suction, O2 source, Manual bag & mask, water soluble lube, 10 ml syring for cuff inflation, tape, Magill forceps, stylet, bite block or oral airway, PPE/stethoscope, Laryngyscope (ensure light bulb is good), End tidal CO2 detector |
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Term
| How do you prepare patient for ET tube? |
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Definition
| Explain, sedate, supine position, roll towel between shoulder blades, suction mouth, notify RT for vent set up, place on cardiac monitor |
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Term
| What are steps for insertion of ET Tube? |
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Definition
| Physician inserts tube, inflate cuff, Ausculate breath sounds, check end-tidal CO2 detector, stabilize tube, CXR (should be 3-7 cm above carina), monitor cardiac monitor/O2 sats, ABG |
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Term
| What are complications that may occure with ET tube insertion? |
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Definition
| Aspiration or vomiting, trauma, bradychardia (vagal), hypoxemia (longer than 30 seconds attempt), cardiac dysrhythmias, Esophageal intubation, movement of tube, necrosis/pressure ulcers, airway edema, tube obstruction/kinking, loss of cuff integrity, self extubation, aspiration, right main stem intubation |
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Term
| Explain nursing care with ET tube. |
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Definition
| Need two persons to apply/change device, change position of commercial ETT holder q 2 hours, note appearnce of skin beneath tube, frequent mouth care/oral suctioning, maintain sterile technique |
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Term
| Nasotracheal intubation procedure steps are similar except what position will patient be in? |
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Definition
| Semi Fowlers, High Fowlers, or supine |
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Term
| Do you use a laryngyscope with nasotracheal tube insertion? |
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Definition
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Term
| When is tube advance through vocal cords with nasotracheal tube insertion? |
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Definition
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Term
| What is the difference in nasal vs. oral intubation (indications)? |
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Definition
Nasal - non-emergent/elective and suspected or known c-spine injury
Oral - emergent airway, techically difficult with suspected c-spine injury |
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Term
| What are advantages of naso vs. oral intubation? |
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Definition
Nasal - when oral access difficult, more comfortable, less gagging, easier to stabilize, oral hygiene easier, communication enhanced (read lips
Oral - less kinking, easie to insert |
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Term
| What are disadvantages of naso vs. oral intubation? |
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Definition
Naso - difficult to place, use smaller lumen (increase resistant to gas flow and difficut secretion removal), kinks easily, epistaxis during insertion, contribute to sinusitis/otitis media
Oral - less comfortable (cause gagging, stimulate oral secretions), more difficult to stabilize, may bite down on airway, difficult oral hygiene, communication difficult |
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Term
| Describe Minimal Occlusive Volume (MOV) cuff inflation |
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Definition
| Minimal Occlusive Volume - inject air into cuff until no leak is heard while auscultating over trachea, remove air until leak is hear, then reinstill |
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Term
| Describe Minimal Leak Technique(MLT) cuff inflation |
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Definition
| During ausculation over trachea, inject air until no leak is heard, remove air in 0.1 ml increments until small leak is heard |
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Term
| Advantages of MOV vs. MLT |
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Definition
MOV - less potential for aspiration, no loss of tidal volume
MLT - avoids pooling of secretions above cuff, less injury to trachea |
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Term
| Disadvantages of MOV vs. MLT |
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Definition
MOV - potential injury to tracheal wall
MLT - Aspiration, loss of tidal volume |
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Term
| When securing a nasal vs oral tube, where do you apply tape? |
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Definition
Oral - upper lip, not mandible
Nasal - above upper lip, not nose |
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Term
| What do you need for extubation? |
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Definition
| Equipment - suction, O2, 10ml syringe, chux pad; educate patient, Monitor ECG, O2 sats, breath sounds, RR; ABG |
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Term
| What are some post extubation complications? |
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Definition
Laryngospasm or edema - obstruction
Tracheal dilation, stenosis, tracheomalacia
Laryngeal or tracheal granuloma
Vocal cord paralysis or paresis - causes aspiration |
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Term
| What are purpose of tracheostomy tube? |
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Definition
| Long term management, reduces dead space/airway resistance, protects airway from aspiration, upper airway obstruction - prevents ETT, prolonged mechanical ventilation |
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Term
| What are advantages of cuffed tracheostomy tube? Disadvantages? |
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Definition
Disposable, cuff is bonded to tube, low cuff pressure, reduced risk of tracheal damage
Disadvantage - expensive |
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Term
| What are advantages of uncuffed tracheostomy tube? Disadvantages? |
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Definition
(used in children) Advantages - reduced risk of tracheal damage
Disadvantages - free flow of air around larynx, increased risk of aspiration, may need adapter for vent |
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Term
| What is a fenestrated tracheostomy tube? |
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Definition
Permits speech (external opening is capped and cuff is deflated)
Permits mechanical ventilation with inner cannula
Easily cleaned, but fenestrations may become occluded; inner cannual may be occluded or become dislodged |
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Term
| What are some complications with tracheostomy tube? |
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Definition
Ischemia leading to necrosis of tissue due to high cuff pressure
Trachesophagheal fistula
Tracheomalacia
Tracheal stenosis/obstruction
Vascular injury leading to bleeding |
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Term
| Suctioning Techique with tracheostomy |
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Definition
Hyperoxygenate before and after with 100% O2
Set suction below 120
Limit to 15 seconds
Suction when withdrawing catheter
Observe O2 sats, monitor (ECG), BP
Do Not instill NS |
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Term
| What are complications of suctioning? |
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Definition
Hypoxia
Dysrhthmias - Brady, Tachy (incl V-tach)
Atelectasis
Mucosal damage
Aspiration |
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Term
| Indications for O2 therapy? |
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Definition
Correct hypoxemia
Decrease work of breathing
Improve oxygenation in patients with decrease O2 carrying capability |
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Term
| Complications with O2 therapy? |
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Definition
Hypoventilation/CO2 narcosis
Absorption atelectasis
Pulmonary Oxygen Toxicity
Retrolental Fibrosis |
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Term
| Describe Nasal Cannula use? |
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Definition
Requires unobstructed nare
Delivers FiO2 from .24 to .44
Maximum is 6 L/min |
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Term
| When using a nasa cannula, each liter increases Fi02 by how much? |
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Definition
| .04. Normal room air is .21, if you give 2L you are giving .29 - Max is 6L or .45 |
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Term
| Advantages vs. Disadvantages of Nasal Cannula |
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Definition
Advantages - inexpensive, well tolerated, patient can eat/drink, may be used with COPD, can humidify
Disadvantages - pressure sores, irritating to ears/nose |
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Term
| What is the flow rate for simple face mask? |
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Definition
Must be > 5 L/min or greater
Flow rates > 10L/min do not increase FiO2 |
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Term
| What are the advantages of a simple face mask? |
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Definition
| Delivers high FiO2, easy to use, lightweight, can be humidified, delivers up to .60 FiO2 |
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Term
| What are the disadvantages of a simple face mask? |
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Definition
| Confining, limited access to face, hard to use with NG/OG tubes, uncomfortable in facial trauma, may dry eyes |
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Term
| How much FiO2 can a partial non-rebreather deliver? |
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Definition
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Term
| Describe a partial non-rebreather |
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Definition
| Has a reservoir bag, patient draws air from mask, bag, and holes in side of bag |
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Term
| What do you set the flow rate at for a partial non-rebreather? |
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Definition
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Term
| What are advantages of partial non-rebreather? |
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Definition
| Delivers .60 FiO2, exhaled dead space is preserved |
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Term
| Disadvantages of partial non-rebreather |
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Definition
May lead to rebreathing of CO2
Claustrophobic
limited acess to mouth/nose |
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Term
| Describe a non-rebreather |
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Definition
| Has a reservoir bag with one way valve and prevents inhalation of room air |
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Term
| How much 02 inhalation does a non-rebreather allow for? |
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Definition
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Term
| Why would you only get .80 to .90 FiO2 with a non rebreather? |
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Definition
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Term
| What are the advantages of a non-rebreather? |
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Definition
Delivers > .80 FiO2
Delivers highest FiO2 without intubation |
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Term
| What are the disadvantages of a non-rebreather? |
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Definition
| uncomfortable, limited nose/mouth access, valves get moist and stick, may irritate eyes/nose |
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Term
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Definition
| It has a jet adapter to adjust different mixtures of room air and O2 to correspond with differnt FiO2's |
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Term
| What are advantages of a venturi mask? |
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Definition
| Delivers predictable FiO2, good choice for precise O2 delivery in patients where excess O2 could depress resp. drive |
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Term
| What are disadvantages of a venturi mask? |
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Definition
| limited mouth/nose access, uncomfortable, irritates nose/eyes |
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Term
| Describe a high humidity T-piece? |
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Definition
Attaches to ETT/trach
Provides O2 and humidification
FiO2 can range from .20 to 1.0
Set initial flow rate at 10L/min
should see constant mist |
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Term
| What are the advantages of a high humidity T-Piece? |
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Definition
High humidity keeps secretions moist/thin
lightweight
Delivers precise Fi02 |
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Term
| What are the disadvantages of a high humidity T-Piece? |
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Definition
tubing is cumbersome/fills with water
risk of aspiration when pt changes position
may create a low flow system if not properly used |
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