Airway Care

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Author:
Anonymous
ID:
198854
Filename:
Airway Care
Updated:
2013-02-08 01:50:24
Tags:
Respiratory Thearpy
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Description:
Respiratory Thearpy
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  1. Indications Oropharyngeal 
    • Unconscious patient
    • Support base of tongue
    • Bite Block
    • Oral Suctioning 
  2. Indications nasopharyngeal 
    • Conscious patient
    • Support base tongue
    • Deep tracheal suctioning
    • Decrease trauma during nasotracheal suctioning
  3. Complications Oropharyngeal 
    • Left unsecured
    • gagging-remove, suction, O2
    • Vomiting
    • Laryngospasm
    • Airway obstruction 
  4. Complications Nasopharyngeal
    • Trauma to mucosa
    • Epistaxis-change 24hr
    • Increased Raw-use largest 
  5. Placement of Oropharyngeal 
    Distance angle of jaw to tip of chin or angle jaw past corner of mouth. 
  6. Placement Nasopharyngeal 
    Tip ear lobe to center of nostrils
  7. Medications that can go down ET tube
    • Narcan                           Narotic overdose
    • Atropine                         Bradycardia
    • Valium/Versed                 Sedative
    • Epinephrine                     Asystole
    • Lidocaine                        PVC
  8. Complications Intubation
    • Cuff pressure
    • Right mainstem bronchus intubation 
  9. Two Types Of Blades
    • Curved/Macintosh-raises epiglottis
    • Straight/Miller Blade-under epiglottis infant intubation
  10. Light does not work on blade
    • Tighten bulb
    • Check handle
    • Change blades
    • Check batteries
  11. Blade Sizes
    Adult
    Pediatric
    Term Infant
    Pre Term Infant 
    • Adult                        3
    • Pediatric                   2
    • Term Infant               1
    • Pre Term Infant         0
  12. When is a stylet used?
    Oral intubation
  13. When are magill forceps used?
    Nasal Intubation 
  14. ET tube markings
    21-25 @ patients lips
  15. Nasal Intubation Markings
    26-29 patient nare. 
  16. How to monitor cuff pressure?
    • Cufflator,manometer,stopcock
    • Pressure should not exceed 25cmH2O
  17. What is used for independent lung ventilation
    • Double lumen endotracheal tube
    • Endobronchial tube
    • Carlens tube
  18. Laryngeal mask airway (LMA)
    • Position over opening into trachea(hypophyarnx)
    • Short Term ventilation when intubation
  19. Extubation Complications
    • Severe Resp distress & marked insp stridor
    • Moderate distress/stridor
    • Mild distress/stridor sore thorat 
  20. When is a tracheostomy used?
    Require long term ventilation
  21. When is the cuff inflated?
    • Patient is eating
    • Patient on positive pressure ventilation 
  22. When to change tracheostomy ?
    • Obstructed:unable to pass suction catheter, remove tube, insert new
    • Too small tube: high cuff pressure >20, change to larger tube 
  23. Fenestrated Tube
    • Used weaning & temp mechanical vent with inner cannula
    • When plugging tube, deflate cuff, remove inner cannula & plug trach
  24. Indications Laryngectomy & Laryngectomy 
    • Surgical removal of larynx
    • No connection between upper and lower resp. tract 
  25. Prone
    Lying face done
  26. Supine
    • Lying on spine
    • Post crainotomy 
  27. Fowlers, semi fowlers, revere trendelenburg
    • Hypoxic pts
    • obese w/dyspnea
    • post abdominal 
    • pulmonary edema 
  28. Trendelenburg
    Low BP
  29. Lateral Fowlers
    obese pt with air hunger
  30. Lateral Flat
    Prevent aspiration
  31. Unilateral consolidation
    place affected lung up to allow it to drain, increasing perfusion to unaffected lung. 
  32. PEP Therapy 
    • 15-20 min, 3-4 day
    • Reduce residual volume
    • Cystic Fibrosis, PNA
    • D/C: sinusitis,epistaxis,middle ear infection 
  33. Vibratory/oscillartory PEP Devices 
    • Fluuter, Acapella, Quake
    • Helps remove secretions from airways
  34. Vaccum
    Adult
    Child
    Infant
    • Adult     100-120
    • Child     80-100
    • Infant   60-80
  35. Suctioning troubleshooting
    • Check catheter for patency 
    • Assure vent system is working
    • Change or empty full collection bottle
    • Check all connections 
  36. No sound occurs in a bubble humidifier 
    • Leak present 
    • Cracked or loose humidifier bottle/jar
    • Worn/missing gasket
    • Broken/loose connections
  37. Whistling sound in bubble humidifier 
    • Oxygen flow excessively high
    • Obstruction or kinking of tubing 
  38. Where to place HME?
    Between wye and patient
  39. Why use a spacer/holding chamber?
    Allows larger particles to attach to walls of device and decrease oral depostion.
  40. How to use MDI
    • Take cap off mouthpiece and shake 
    • Prime
    • Breath out completely
    • Hold inhaler 1-2 in front of mouth.
    • Start breathing slowly and press down 
    • Continue breathing slowly, take deep breath
    • Hold breath & count to 10
    • Exhale normally 
  41. Short Acting Beta2 Agonists (SABA)
    • Albuterol (ventolin/proventil)
    • Levalbuterol (xopenex)
    • Terbutaline (brethine/brethaire)
    • Pirbuterol (maxair)
  42. Long Acting Beta2 (LABA)
    • Salmeterol (Serevent)
    • Formoterol
    • Arformoterol (Brovana)
  43. Side effects/hazards beat adrenergic bronchodialtors
    • Tachycardia
    • Palpiations
    • Hypertension/Hypotension
    • Headache
    • Tremors,shakes,quivering
    • Paradoxical hypoxemia
    • Tachyphylaxis
    • Nausea/vomiting
  44. Parasympatholytics (anticholingerics)
    • Atropine sulfate
    • Ipratropium bromide (atrovent)
    • Tiotropium Bromide (spiriva)
    • Oxitropium bromide (oxivent)
  45. Theophylline
    Increase diaphragmatic contractility & simulates CNS infants w/ apnea prematurity 
  46. Corticosteriods
    • Fluticasone (flovent)
    • Beclomethasone, Beclovent, Vanceril,Qvar
    • Budesonide, Pulmicort
    • Fluisolide, Aerobid, Aerboid-M
    • Triamcinolone,Azmacort
    • Prednisone
    • Methylprednisolone
    • Solumedrol 
  47. Mucolytics
    • Acetycysteine-dissolves disulfide bonds
    • Give prior to bronchodilator
  48. Side effects Mucolytics
    • Nausea/vomiting
    • Bronchospasm
    • Bronchorrhea
    • Airway obstruction
  49. DNAse (pulmonzyme)
    Cystic Fibrosis 
  50. Leukotriene Modifers
    • Non-steroid drugs used mild to moderate asthma. 
    • Monetelukast (singular)
    • Zafirlukast (Accolate)
    • Zileuton (Zyflo)
  51. Loop Diuretics
    • Furosemide (Lasix)
    • Pulmonary edema, liver, kidney disease, CHF
  52. Osmotic Diuretics
    • Mannitol (osmitrol)
    • Cerebral edema, drug toxicity, & OD
  53. Depolarizaing neuromuscular blocking agents
    • Succinylcholine (anectine)
    • Used endotracheal intubation 
    • Muscle paralysis
  54. Nondepolarizaing neuromusclar blocking agents
    • Paralysis longer period of time,prevent stimulation of muscles
    • Pancuronium (pavulon)
    • Vecuronium (Norcuron)
    • Atracurium (Tracrium)
    • cisatracurium (Nimbex)
  55. Sedatives
    • Decrease anxiety & promote relaxation 
    • Benzodiazepines
    • Alprazloam (xanax)
    • Diaepam (valim)
    • Midazolam (versed)
    • Lorazepam (ativan)
  56. Reversal for sedatives
    Flumazenil (romazicon)
  57. Analgesics 
    Reduce sensation of pain reversed w/ naloxone (narcan)
  58. Surfactant Replacement
    • Prevent and tx IRDS/HMD
    • Calfactant (infrasurf-bovine)
    • Beractant (survanta-bovine)
    • porcantalfa (curosurf-porcine)
  59. Treat central sleep apnea
    • Doxapram-dopram
    • Medroxyprogesterone (hormone)
    • Aminophylline, tehophylline, caffeine 
  60. Aminoglycosides 
    • gram negative
    • tobramycin(nebcin)-CF patient
    • Amikicin -amikin
    • Gentamicin-garamycin
  61. Antibiotics treat bacterial infections 
    Penicillins: ampicillin, amoxicillin, nafcillin

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