chapter 33

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3rikita
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277783
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chapter 33
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2015-07-09 19:10:16
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airway management
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  1. what is the primary indication for tracheal suctioning
    retention of secretions
  2. what is the most common complication of suctioning
    hypoxemia
  3. complication of tracheal suctioning include all except? 
    A) bronchospasm 
    B) mucosal trauma 
    C) elevated icp
    D) hyperinflation
    D) hyperinflation
    (this multiple choice question has been scrambled)
  4. how often should patients be suctioned
    when physical findings support the need 

    a patient should never be suctioned on a schedule
  5. what is a normal range of negative pressure to use when suctioning?
    • Adult: 150-120 mm Hg 
    • Children: 120-100 mm Hg 
    • Infants: 80-100 mm Hg
  6. How do you estimate what size suction catheter to use for a pt?
    multiply the inner tube diameter by 2 then take the next smallest size catheter

    example: 6 mm ET tube: 2 x 6=12>>>10F
  7. To prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do what?
    preoxygenate the patient with 100% oxygen.
  8. to maintain positive end-expiratory pressure (peep) and high FIO2's when suctioning a mechanically ventilated patient, what would you recommend?
    use a closed system multi-use suction catheter.
  9. total application time for endotracheal suction in adults should not exceed which of the following ?
    keep total suction time to less than 10- 15 seconds.
  10. while suctioning a patient, you observe an abrupt change in the electrocardiogram wave from being displayed on the cardiac monitor. Which of the following actions would be most appropriate?
    stop suctioning and immediately administer oxygen.

    If any major change is SEEN in the heart rate (15% or more) or rhythm, immediately stop suctioning and administer oxygen to the patient,providing manual  ventilation as needed.
  11. which of the following methods can help to reduce the likelihood of atelectasis due to tracheal suctioning?

    1) limit the amount of negative pressure used.
    2) hyperinflate the patient before and after the procedure.
    3) suction for as short a period of time as possible.
    Atelectasis can be caused by removal of too much air from the lungs . You can avoid this complication by (1) limiting the amount of negative pressure used, (2) keeping the duration of suctioning as short as possible, and (3) providing hyperinflation before and after the procedure.
  12. which of the following can help minimize the likelihood of mucosal trauma during suctioning?

    1) use as large a catheter as possible
    2) rotate the catheter while withdrawing
    3) Use as rigid a catheter as possible
    4) limit the amount of negative pressure
    1 & 4

    Limit the amount of negative pressure used and always rotate the catheter while withdrawing.
  13. absolute contraindication for nasotracheal suctioning includes which of the following?

    1) epiglottis 
    2) croup
    3) irritable airway
    1 & 2

    Epiglottitis and croup
  14. which of the following equipment is NOT needed to perform nasotracheal suctioning?

    A) suction kit (catheter, gloves, basin, etc..)
    B) larygoscope with MacIntosh and Miller blades
    C)oxygen delivery system (mask and manual resuscitator)
    D)bottle of sterile water or sline solution.
    B)

    Laryngoscope blades
    (this multiple choice question has been scrambled)
  15. after repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend?

    A) orally intubate the pt for better access to the lower airway
    B) stop the bleeding and use a nasopharyngeal airway for access
    C) perform a tracheotomy for better access to the lower airway
    D) discontinues nasotracheal suctioning for 48 hrs and reassess
    B) stop the bleeding and use nasopharygeal airway for access 

    explanation: Placement of a nasopharyngeal airway can help minimize nasal trauma when repeated accesss is needed.
    (this multiple choice question has been scrambled)
  16. Before the suctioning of a patient, auscultation reveals coarse  breath sounds during  both inspiration and expiration. After suctioning,the coarseness   disappears, but expiratory wheezing is heard over both lung fields. What is most likely the problem?

    A) secretions are still present and the pt should be suctioned again 
    B) the pt has hyperactive arways and has developed bronchospasm 
    C) a pneumothorax has developed and the pt needs a chest tube 
    D) the pt. has developed a mucous plug and should undergo bronchoscopy.
    B)The patient has hyper active airways and has developed bronchospasm. 

    Explination:The broncho spastic response may be particularly strong in patients with hyperactive airway disease. These patients should be accessed for the development of wheezes associated   with suctioning.
    (this multiple choice question has been scrambled)
  17. What general condition requires airway management?

    1) Airway compromise
    2) respiratory failure 
    3) Need to protect the airway
    • 1) Airway compromise
    • 2) respiratory failure 
    • 3) Need to protect the airway

    Explanation: in general conditions that require management of the airway are IMPENDING OR ACTUAL  1) Airway compromise2) respiratory failure 3) Need to protect the airway
  18. Which of the following conditions require emergency tracheal intubation?
    1) upper airway or laryngeal edema
    2) loss of protective reflexes
    3) cardiopulmonary arrest
    4) Traumatic upper airway obstruction
    • 1) upper airway or laryngeal edema
    • 2) loss of protective reflexes
    • 3) cardiopulmonary arrest
    • 4) Traumatic upper airway obstruction

    • explanation:conditions requiring emergency tracheal intubation include but are not limited to
    • persistent apnea
    • traumatic upper airway obstruction
    • tonsillopharyngitis or retropharyngeal abscess
    • suppurative paroitis
    • coma with potential for ICP
    • neonatal-pediatric- s[ecific conditions
    • perinatal asphyxia
    • severe adenotonsillar hypertrophy
    • severe laryngomalacia
    • bacterial tracheitis
    • neonatal epignathus
    • obstruction from abnormal laryngeal closure owing to arytenoid masses
    • mediastanial tumor
    • congenitals diaphragmatic hernia
    • presence of thick or particulate meconium in amniotic fluid 
    • absence of airway protective reflexes
    • cardiopulmonary arrest
    • massive hemoptysis
  19. Which of the following autonomic or protective neural responses represent potential hazards of emergency airway management?
    1) hypotension
    2) bradycardia
    3) cardiac arrhythmias
    4) Laryngospasm
    • 1) hypotension
    • 2) bradycardia
    • 3) cardiac arrhythmias
    • 4) Laryngospasm
  20. all of the following indicate an inability to adequately protect the airway EXCEPT:
    A)lack of gag reflex
    B) WHEEZING
    C)coma
    D) inability to cough
    B) WHEEZING

    Explanation: inability to protect the airway adequately (e.g., coma, lack of gag reflex,inability to cough) with or without other signs of respiratory distress.
    (this multiple choice question has been scrambled)
  21. Which of the following types of artificial airways are inserted through the larynx ?

    1) pharyngeal airways
    2) tracheostomy tubes
    3) NASOTRACHEAL TUBES
    4) OROTRACHEAL TUBES
    • 3) NASOTRACHEAL TUBES
    • 4) OROTRACHEAL TUBES

    explanation: The two basic types of tracheal airways are endotracheal tubes (translaryngeal)and tracheostomy tubes. Endotracheal tube are inserted through either the mouth or the nose (orotracheal or nasotracheal) through the larynx  and into the trachea
  22. compared with the nasal route, the advantages of oral intubation include all of the following except:

    A) less retching and gagging 
    B) less traumatic insertion.
    C) reduced risk of kinking.
    D) easier suctioning.
    A) LESS RETCHING AND GAGGING
    (this multiple choice question has been scrambled)
  23. Compared with the oral route, the advantage of nasal intubation include all of the following except:

    A) less accidental extubation 
    B) reduce risk of kinking
    C) less retching and gagging
    D) greater long-term comfort 
     
    B) REDUCED RISK OF KINKING
    (this multiple choice question has been scrambled)
  24. compared with translaryngeal intubation, the advantages of TRACHEOSTOMY include all of the following except:

    A) decrease frequency of aspirations
    B) no upper airway complications
    C) greater patient comfort
    D) reduced risk of bronchial intubation
    A) DECREASED FREQUENCY  OF ASPIRATIONS
    (this multiple choice question has been scrambled)
  25. What is the standard size for endotracheal or tracheostomy tube adapters?
    15mm external diameter.
  26. What is the purpose of the additional side port (murphy eye) on most modern endotracheal tubes?
    To ensure gas flow if the main port is blocked, in addition to the beveled opening at the tip, there should be an additional side port or murphy eye which ensures gas flow if the main port should become obstructed. The tube cuff is permanently bonded to the tube body.
  27. What is the purpose of a cuff on an artificial tracheal airway?
    to seal off and protect the lower airway.
  28. what is the purpose of the pilot balloon on an endotracheal or tracheostomy tube?
    to monitor cuff status and pressure.
  29. Which of the following feature incorporated into most modern endotracheal tube assist in verifying proper tube placement?

    a) length markings on the curved body tube
    b) embedded radiopaque indicator near the tube tip
    c) additional side port near the tube tip (murphy  eye).
    • a) LENGTH MARKINGS ON THE CURVED BODY OF THE TUBE
    • b) EMBEDDED RADIOPAQUE INDICATOR NEAR THE TUBE TIP
  30. The removable inner cannula commonly incorporated into modern tracheostomy tubes serves which of the following purposes:
    • a) AID IN ROUTINE CLEANING AND TRACHEOSTOMY CARE <<<
    • b) prevent the tube from slipping into the trachea.
    • c) PROVIDE A PATENT AIRWAY SHOULD IT BECOME OBSTRUCTED<<<<
  31. What is the purpose of a tracheostomy tube obtruator?
    to minimize trauma to the tracheal mucosal during insertion.
  32. In the absence of neck or facial injuries  what is the procedure of choice to establish a patent tracheal airway in an emergency?
    orotracheal intubation.
  33. while checking a crash cart for intubation  equipment , you find the following: suction equipment, oxygen apparatus, two laryngoscopes and assorted blades, five tubes, Magill forceps, tape, lubricating gel, and local anesthetic. What is missing?
    • a)obstruator
    • b) SYRINGE<<
    • c) RESUSCITATOR BOG OR MASK<<
    • d) TUBE STYLET<<
  34. Before beginning an intubation procedure,the practitioner should check and confirm the operation of which of the following:
    • a) LARYNGOSCOPE LIGHT SOURCE<<
    • b) ENDOTRACHEAL TUBE CUFF<<
    • c) SUCTION EQUIPMENT
    • d) cardiac defibrillator

    Before beginning an intubation procedurethe practitioner should confirm the operation of suction equipment, oxygen, airway equipment, monitors and esophageal detectors and check position of the patient.
  35. while checking a MILLER and MacINTOSH blade on an intubation tray during an emergency intubation, you find that the MILLER blade "lights" but the MacINTOSH blade does not. What should you do now?
    Check and replace the bulb on the MacINTOSH blade
  36. What size endotracheal tube would you select to intubate a 3 year old child?
    4.5 to 5.0 mm
  37. what size endotracheal tube would you use to intubate a 1500g newborn infant?
    3.0mm
  38. what size endotracheal tube would you use to intubate an adult female?
    8mm
  39. what is the purpose of the endotracheal tube stylet?
    it adds rigidity n shape
  40. to make oral intubation easier how should the patients head and neck positioned?
    neck flexed with head supported over towels and tilt back 
  41. what should be the amount of time devoted to any intubation attempt
    30 secs
  42. which of the following statements are false about methods used to displace the epiglottis during oral intubation?

    a.regardless of the blade used,  the laryngoscope is lifted up and forward 

    b.the curved (MacIntosh) blade lifts the epiglottis indirectly

    c. The straight (Miller) blade lifts the epiglottis directly 

    d. Levering the laryngoscope against the teeth can aid displacement 
    D. LEVERING THE LARYNGOSCOPE AGAINST THE TEETH CAN AID DISPLACEMENT !!!
  43. during oral intubation of an adult, the endotracheal tube should be advance into the trachea about how far?
    until its cuff has passed the cords!!!
  44. immediately after insertion of an oral endotracheal tube on an adult, what should you do?
    once the tube is in place, stabilize it with the right hand, and use the left hand to remove the laryngoscope and the stylet, then inflate the cuff to seal the airway and immediately provide ventilation and oxygenation
  45. ideally the distal tip of a properly positioned endotracheal tube  ( in an adult man) should be positioned how far above the carina
    3-6 CM
  46. what bedside methods can absolutely confirm proper endotracheal tube position in the trachea?
    fiberoptic laryngoscope
  47. what is the average distance from the tip of a properly positioned oral endotracheal tube to the incisors of an adult man
    21-23cm




     and 19-21 is ideal of a female 
  48. when using bulb type esophageal detention device during an intubation attempt, how do you know that the endotracheal tube is in the esophagus??
    the bulb fails to re expand upon release 
  49. after an intubation attempt, an expired capnogram indicates a co2 levels near 0, what does this finding probably indicate ???
    placement of the endotracheal tube is in the esophagus 
  50. when using a capnometry or colorimetry to differentiate esophageal from tracheal placement of an endotracheal tube, which of the following conditions can result in false-negative finding??????
    CARDIAC ARREST
  51. after intubation of a cardiac arrest victim you observe a slow but steady rise in the expired CO2 levels as measured by a bedside capnometer, what can explain this?
    return of spontaneous circulation 
  52. what are some serious complications of oral intubation?
    • cardiac arrest
    • acute hypoxemia 
    • bradycardia
  53. you are assisting a physician in the emergency care of a patient with a maxillofacial injury who will require short-term ventilatory support, which airway approaches would you recommend?
    nasal route 
  54. to provide local anesthesia and vasoconstriction during nasal intubation, what would you recommend?
    a mixture of .25 phenylephrine and 3 lidocane may be applied to the mucosal with a long cotton tip swab to provide local anesthesia and vasoconstriction of the nasal passage 
  55. when performing a blind nasotracheal intubation, successful tube passage through the larynx i indicated by 
    a harsh cough followed by vocal silence 
  56. what is the primary indication for tracheostomy?
    when a patient has long-term need for an artificial airway 
  57. what factors should be considered when deciding to change from an endotracheal tube to a tracheostomy
    • projected time the patient will need the an artificial airway
    • patients tolerance of endotracheal tube
    • patients overall condition
    • patients ability to tolerate surgical procedure
    • relative risk of continued endotracheal intibation vs. tracheostomy
  58. in a properly performed traditional surgical tracheotomy, entrance to the trachea is made through an incision in what area
    through or between the second and third tracheal rings 
  59. a surgical resident has asked that you assist in an elective tracheotomy procedure on an orally intubated patient. which of the following would be appropriate action??
    a.remove the oral tube just before tracheostomy tube insertion
    b. romove the oral tube just b4 the tracheostomy is performed 
    c. pull the oral tube only after the tracheostomy tube is in placed 
    d. withdraw the oral tube 2-3 inches while the incision is made 
    D
  60. compared with traditional surgical tracheaostomy , all of the following are true about percutaneous dilatational tracheaostomy except:
    D: precutaneous dilatational tracheostomy does not require anterior neck dissection. 
  61. Which of the following techniques may be used to diagnose injury associated with artificial airways?

    1)laryngoscopy or bronchoscopy
    2)physical examination
    3)air tomography
    4)pulmonary function studies
    1,2,3,4
  62. what is the most common sign associated with the transient glottic edema or vocal cord inflamation that follows extubation?

    A)difficulty in swallowing
    B)wheezing
    C)hoarseness
    D)orthopnea
    C) HOARSENESS
    (this multiple choice question has been scrambled)
  63. soon after endotracheal tube extubation, an adult patient exhibits a high pitched inspiratory noise, heard without a stethoscope. Which of the following actions would you recommend?

    A) immediate reintubation via the nasal route 
    B)careful observation of the patient for 6 hours
    C)STAT heated aerosol treatment with saline
    D)STAT racemic epinephrine aerosol treatment
    D) STAT racemic epinephrine aerosol treatment.
    (this multiple choice question has been scrambled)
  64. After removal of an oral endotracheal tube, a patient exhibits hoarseness and strider that do not resolve with racemic epinephrine treatments. What is most likely the problem?

    A)tracheomalacia
    B)glottic edema or cord inflamation
    C)tracheoesophageal fistula
    D) vocal cord paralysis
    D) VOCAL CORD PARALYSIS
    (this multiple choice question has been scrambled)
  65. Which of the following injuries are NOT seen with tracheostomy tubes?

    1)tracheomalacia
    2)tracheal stenosis
    3)GLOTTIC EDEMA
    4)vocal cord granulomas
    • 3 & 4
    • -glottic edema
    • -vocal cord granulomas
  66. tracheal stenosis occurs in as many as 1 in 10 patients after prolonged tracheostomy. At what sites does this stenosis usually occur?

    1) cuff site
    2) tip of the tube
    3)stoma site
    D) 1,2,3
  67. a patient is being evaluated for tracheal damage sustained while having undergone prolonged tracheostomy intubation approximately 3 months earlier. The flow-volume loop demonstrates a fixed obstructive pattern. What is most likely the cause of the problem?


    A) tracheomalacia 
    B)cord paralysis
    C) tracheal stenosis
    D)laryngeal web
    C) TRACHEAL STENOSIS
    (this multiple choice question has been scrambled)
  68. a patient has been recieving positive pressure ventilation through a tracheostomy tube for 4 days. In the past 2 days, there is evidence of both recurrent aspiration and abdominal distention but minimal air leakage around the tube cuff. What is most likely cause of the problem?


    A) tracheoesophageal fistula
    B) underinflated tube cuff
    C) paralysis of the vocal cords
    D)tracheoinnominate fistula
    A) TRACHEOESOPHAGEAL FISTULA
    (this multiple choice question has been scrambled)
  69. A physician is concerned about the potential for tracheal damage due to tube movement in a patient who recently underwent tracheostomy and is now receiving 40% oxygen through a T- tube (briggs adapter). Which of the following would be the best way to limit the tube movement in this patient?

    A) switch from the T-tube to a tracheostomy collar
    B) give a neuromuscular blocker to prevent patient movement
    C)secure the T-tube delivery tubing to the red rail
    D)tape the T-Tube to the tracheostomy tube connector
    A) SWITCH FROM THE T-TUBE TO A TRACHEOSTOMY COLLAR
    (this multiple choice question has been scrambled)
  70. which of the following techniques or procedures should be used to help minimize infection of a tracheostomy stoma?

    1)regular aseptic stoma cleaning
    2)adherence to sterile techniques
    3)regular change of tracheostomy dressings
    D) 1,2,3
  71. when checking for proper placement of an endotracheal tube or tracheostomy tube on a chest radiograph, how far above the carina should the distal tip of the tube be positioned?

    A) 2 to 4 cm
    B) 1 to 2 cm
    C) 6 to 8 cm
    D) 3 to 6 cm
    D) 3 to 6 cm
    (this multiple choice question has been scrambled)
  72. when checking for proper placement of an endotracheal tube in an adult patient on chest radiograph, it is noted that the distal tip of the tube is 2 cm above the carina. Which of the following actions would you recommend?

    A)withdraw the tube by 2 to 3 cm
    B) advance the tube by 2 to 3 cm
    C) withdraw the tube by 7 to 8 cm
    D) advance the tube by 7 to 8 cm
    A) WITHDRAW THE TUBE BY 2 TO 3 cm
    (this multiple choice question has been scrambled)
  73. an alert patient with a long term need for tarcheostomy tube is having difficulty communicating with the intensive care unit staff. Which of the following would you recommend to help this patient communicate better?

    1) use a letter, phrase, or picture board
    2)consider switching to a fenestrated tracheostomy tube
    3) consider a "talking" tracheostomy tube
    1 & 3
  74. to ensure adequate humidification for a patient with an artificial airway, inspired gas at the proximal airway should be 100% saturated with water vapor and at  which of the following temperatures?

    A) 40 to 42 degress C
    B) 32 to 35 degress C
    C) 30 to 32 degress C
    D) 37 tp 40 degress C
    B) 32 TO 35 DEGREES C
    (this multiple choice question has been scrambled)
  75. Tracheal airways increase the incidense of pulmonary infections for all of the following reasons except:

    A) increased aspiration of pharyngeal material
    B) ineffective clearence through cough
    C) contaminated equipment or solutions
    D)lower levels of humidification
    D) LOWER LVELS OF HUMIDIFICATION
    (this multiple choice question has been scrambled)
  76. which of the following is likely to increase the likelihood of damage to the tracheal mucosa?

    A) using a low residual volume low compliance cuff
    B) monitoring intracuff pressures every 1 to 2 hours
    C) maintaining cuff pressures below 20 to 25 mmHg
    D) using the minimal leak technique for inflation
    A) USING A LOW RESIDUAL VOLUME LOW COMPLIANCE CUFF
    (this multiple choice question has been scrambled)
  77. What is the maximum recommended range for tracheal tube cuff pressures?

    A) 20 to 25 mmHg
    B) 25 to 30 mmHg
    C) 30 to 35 mmHg
    D)15 to 20 mm Hg
    A) 20 to 25 mmHg
    (this multiple choice question has been scrambled)
  78. repeated connecting and disconnecting of a cuff pressure manometer to the pilot tube of a cuffed tracheal airway will do which of the following?

    A) increase cuff pressure
    B) decrease cuff pressure 
    C) rupture the cuff
    D) not affect cuff pressure
    B) DECREASE CUFF PRESSURE
    (this multiple choice question has been scrambled)

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