Artificial Airways and Airway Care.txt

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coreygloudeman
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118347
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Artificial Airways and Airway Care.txt
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2011-11-21 14:41:50
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Crafton Hills College RESP 131 Artificial Airways Airway Care
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Crafton Hills College RESP 131 Artificial Airways Airway Care
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  1. In writing, list the four situations that dictate the need for artificial airways.
    • There are four:
    • 1. relief of airway obstruction
    • 2. facilitation for suctioning
    • 3. protection of the airway
    • 4. for maintaining prolonged artificial ventilation
  2. What is the most common cause of upper airway obstruction?
    Soft tissue obstruction
  3. What is the characteristic sound present with upper airway obstruction?
    snoring or stridor sounds, intercostal retractions, use of accessory muscles and extreme agitation if conscious
  4. What are the other common causes of airway obstruction?
    • 1. Tumor
    • 2. Bleeding
    • 3. Edema
    • 4. Vomitus
    • 5. Lesions
    • 6. Foreign bodies
  5. How would you provide temporary relief for a patient with upper airway obstruction?
    the head tilt or jaw thrust maneuver until an artificial airway can be placed
  6. What types of airway reflexe(s) is associated with Gag and swallowing?
    Pharyngeal
  7. What types of airway reflexe(s) is associated with Closure of epiglottis?
    Laryngeal
  8. What types of airway reflexe(s) is associated with Cough?
    Tracheal and Carinal
  9. What type of patient is an oropharyngeal airway is indicated for?
    • 1) To facilitate and maintain upper airway patency in conjunction with head positioning;
    • 2) Prevent airway obstruction from a flaccid tongue;
    • 3) Establish route to apply suctioning;
    • 4) Support for endotracheal tubes (oral only);
    • 5) Prevent obstruction by lips and teeth;
    • 6) Promote more effective ventilation.
  10. What type of patient is an nasopharyngeal airway is indicated for?
    • 1) To facilitate and maintain upper airway patency in conjunction with head positioning;
    • 2) Prevent airway obstruction from a flaccid tongue;
    • 3) Establish route to apply suctioning;
    • 4) Prevent obstruction by lips and teeth;
    • 5) Promote more effective ventilation.
  11. What are the appropriate steps involved in determining an airway cuff�s minimal occlusive volume or minimal leak volume?
    • minimal amount of air to allow air to pass around cuff (MLT - Minimal Leak Technique)
    • enough air to cover the seal (MOV - minimal occlusion volume)
  12. What are the advantages of using a nasotracheal tube over an orotracheal tube?
    • 1) It is easier to stabilize;
    • 2) It is easier to suction through;
    • 3) Equipment is more stable when attached to a nasal E.T.
  13. What considerations must be taken into account when one places an artificial airway that will allow direct access to the lower airway?
    • 1. in time lead to contamination of the lower airway
    • 2. effectiveness of the cough is lost because of the loss of functioning vocal cords
    • 3. patient has lost the ability to vocally communicate, intimidating environment; be aware of this and make an effort to try to understand and communicate with the patient
    • 4. Heated humidification must be used
  14. What are complications related to the placement of an endotracheal tube?
    • 1. Vocal Cord Damage
    • A. Superficial damage
    • 1. Granuloma damage
    • B. Trauma during intubation
    • 2. Edema
    • A. Common in larynx and trachea
    • 3. Laryngospasm
    • 4. Tracheal Stenosis and Tracheomalacia
    • 5. Obstruction due to secretions
    • 6. Tracheoesophageal Fistula
    • 7. Leak due to broken cuff
    • 8. Tracheal Necrosis
    • 9. Subcutanous Emphysema
    • 10. Disconnection from Ventilator
    • 11. Displacement into main stem bronchi
  15. What is the biggest problem associated with Endotracheal and Tracheostomy tubes?
    • over inflated cuffs
    • a. 30 Torr or > stops arterial capillary blood flow (ischemia)
    • b. 18 Torr or > venous flow obstruction (congestion)
    • c. 5 Torr or > lymphatic flow obstruction(edema)
  16. What are complications related to the placement of an tracheostomy tube?
    • 1. Obstruction due to secretions
    • 2. Tracheoesophageal Fistula
    • 3. Leak due to broken cuff
    • 4. Tracheal Necrosis
    • 5. Subcutanous Emphysema
    • 6. Disconnection from Ventilator
    • 7. Displacement into tissues
    • 8. Lumen up against tracheal wall
    • 9. Displacement into main stem bronchi
    • 10. Infection
    • 11. Bleeding
  17. With the use of multiple-choice and short written answers, What are the physical characteristics found on endotracheal tube?
    • 1) Are usually made from PVC or silicone;
    • 2) Standard 15mm endotracheal tube (E.T.) adapter inserted into machine end;
    • 3) Pilot line (inflating tube);
    • 4) Pilot balloon;
    • 5) Body;
    • 6) Cuff;
    • 7) Murphy eye;
    • 8) Radiopaque locating strip;
    • 9) Beveled patient end
  18. With the use of multiple-choice and short written answers, What are the markings found on endotracheal tube?
    • 1) I.D. (inner diameter) in mm;
    • 2) O.D. (outter diameter) in mm;
    • 3) Length markings in cm;
    • 4) I.T. (implant tested);
    • 5) Z-79;
    • 6) Brand name.
  19. With the use of multiple-choice and short written answers, What are the physical characteristics found on tracheostomy tube?
    • 1) Machine end with 15 mm adapter;
    • 2) Flange;
    • 3) Inflating tube;
    • 4) Pilot balloon;
    • 5) Cuff;
    • 6) Patient end;
    • 7) May or may not have an inner cannula;
    • 8) Made of PVC or silicone.
  20. With the use of multiple-choice and short written answers, What are the markings found on tracheostomy tube?
    • 1) I.D. (inner diameter) in mm;
    • 2) O.D. (outter diameter) in mm;
    • 3) Length markings in cm;
    • 4) I.T. (implant tested);
    • 5) Z-79;
    • 6) Brand name.
  21. How do you determine tube length via oral route?
    • You take the height (in cm) and divide by 10 then add 5
    • (cm/10) + 5
  22. How do you determine tube length via nasal route?
    • You take the height (in cm) and divide by 10 then add 8
    • (cm/10) + 8
  23. How far should the tube be placed above the carina?
    2 cm, or within the 2/3 area of the airway
  24. If it takes more than ____ cc to inflate a tube, then the tube is too small and should be replaced with a larger tube.
    10
  25. When determining suction catheter size:
    take the I.D. in mms of the artificial airway times 3 and divide by 2 plus 2
  26. Critical Thinking Ch. 20 # 1: Why is a water-soluble lubricant used for inserting a nasal airway?
    • - lubricant is needed to ease insertion
    • - water-soluble is needed to prevent toxic reactions that would occur if using petroleum products
  27. Critical Thinking Ch. 20 # 2: What complications might arise from the use of a nasopharyngeal airway?
    • - adhesion to the nasal mucosa
    • - Epistaxis (nose bleeding)
    • - Sinusitis
    • - Airway obstruction and gagging if improperly sized
  28. Critical Thinking Ch. 20 # 3: What complications might arise from an improperly sized oropharyngeal airway?
    • - gag and vomit
    • - Airway obstruction
    • - Laryngospasm
  29. Critical Thinking Ch. 20 # 4: What complications might arise from an improperly sized nasopharyngeal airway?
    • - Airway obstruction
    • - Gagging and vomiting
    • - Septo perferation
  30. Critical Thinking Ch. 20 # 5A: What type of airway should be used on a Semiconscious patient in the recovery room?
    - Nasopharyngeal Airway
  31. Critical Thinking Ch. 20 # 5B: What type of airway should be used on an Elderly, nonintubated patient who requires frequent suctioning?
    - Nasopharyngeal or Nasal Trumpet
  32. Critical Thinking Ch. 20 # 5C: What type of airway should be used on a Patient in cardiac arrest in the emergency room receiving basic life support (BLS)?
    - Oropharyngeal until oral intubation can be performed
  33. Critical Thinking Ch. 20 # 6: A patient is brought into the emergency room with an Esophageal-Tracheal Combitude (ETC) in place. The physician wants you to intubate the patient with an endotracheal tube. What is the proper sequence of actions for replacing the ETC?
    • 1. Suction the pharynx
    • 2. Expose vocal cords with Laryngoscope
    • 3. Intubate Patient with E.T. Tube
    • 4. Ensure proper placement of E.T. Tube and inflate cuff
    • 5. Deflate ETC cuff and remove tube
    • 6. Be prepared to suction if patient vomits
  34. Critical Thinking Ch. 20 # 7: You are called to the recovery room to administer 40% oxygen to a patient with a laryngeal airway in place. Describe the equipment setup you would employ, including all connectors and adaptors needed.
    - LVN at 40% with corrigated tubing and water trap to a brigg's T-adapter attached to 15mm adapter at LMA
  35. Critical Thinking Ch. 20 # 8: The patient in question 7 has regained consciousness and the laryngeal airway has been removed. What should you do with the device at this time?
    • - in non-disposable, place in biohazard bag, label, and send to get sterilized
    • - If disposable, thow into trash
  36. Critical Thinking Ch. 23 # 1: You are changing a tracheostomy tube in a patient with no spontaneous respirations who is being mechanically ventilated. You cannot get the new tube in. Describe in detail what you would do.
    • - Dialate stoma with Kelly's
    • - Or place smaller Trach. Tube
    • - Or bag patient, while covering stoma, or with bennett seal over stoma to bag directly through stoma airway
  37. Critical Thinking Ch. 23 # 2: Al Strachen is a 16-year old quadriplegic. He is currently in a rehabilitation facility. He has a size 6 nonfenestrated cuffed tracheostomy tube in place. The physiatrist has requested that the nurse provide a tracheostomy adjunct to allow the patient to speak. The nurse obtained a Passy-Muir valve and attached it to the 15-mm adaptor of the inner cannula. You were then called stat to evaluate the patient for severe respiratory distress. Explain why the patient did not tolerate the procedure and what you would need to do to correct the situation.
    • - insufficient airflow above cuff because the nurse did not necessarily deflate the cuff
    • - should be changed to non-cuffed fenestrated trach tube
    • - or can take inner canula out and deflate cuff before placing Passy-Muir valve again

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