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Trach/Death&Dying
Adv Procedures
| Question | Answer |
|---|---|
| What is an artificial airway? | inserted to maintain patent air passage in pt whose air way has become or may become obstructed |
| Reasons for artificial airways (4) | relieve mechanical airway obstruction, provide mechanical ventilation, permit easy access for secretion removal, protect airway from aspiration d/t impaired cough/gag reflex |
| Types of airways (3) | endotrachel, tracheostomy, permanent tracheostomy |
| Types of synthetic trachs (4) | obturator, cuff trach, double cuffed trach (high pressure), single cuff (low pressure) |
| Purposes of cuff (3) | anchor tube in place, creates seal that prevents aspiration of secretions, prevents leakage of air |
| Fenestrated def | whole on both sides so air can come past tube and be able to talk |
| Disadvantages of trachs (3) | lost cough reflux, reduction of ability to speak normally, lose all fx or features that normal upper respiratory passage can do - normal person has warming and humidifying upon inhalation and track doesnt have that |
| complications of trachs (9) | obstruction below trach (end) & tube itself, expulsion of tube (use hemastat), itis & infection, pneumothorax, hemorrhage,ischemia & necrosis which leads to fistula formation, aspiration of secretions, cardiac arrest d/t anoxia from prolonged suctioning |
| Purposes for suctioning (4) | clear airway of secretion & prevent obstruction, relieve respiratory distress, reduce or prevent hypoxia, prevent pneumonia from secretion accumulation - new pt needs suctioning every 10-15 min |
| Cleaning trachs purposes (3) | prevent infection at site, maintain patent airway, prevent skin breakdown around stoma |
| Signs death is near (10) | gradual loss of motion and sensation, begins in extremities, activity of GI tract decreased, reflexes gradually disappear, circulatory collapse, respiration's change, restlessness, pupil changes, sphincter muscles relax, mental alertness change |
| signs of circulatory collapse (4) | skin cool/clammy but increase body temp, skin color changes - pale & gray, pulse becomes irregular, fast, weak, BP decreases |
| For removal of life support the following has to happen (4) | unreceptive & unresponsive to external stimuli as evidence by coma, no muscle movement esp breathing, no brainstem reflexes, no EEG activity for 24 hrs |
| Rigor mortis | muscles become contracted and joints immobilized b/c of lack of ATP (needed for muscle contraction) - once starts it can last up to 36hrs |
| Algor mortis | post mortum cooling, temp will decrease 1 degree C per hr until reaches room temp |
| Liver mortis | RBC breakdown esp in areas where blood is pooling (collecting), discoloration of skin (bruising/mottled appearance), important for position - supine |
| Tissue softening | b/c of bacteria in body - works away at tissue until it becomes liquidified - heat increases the process |
| Post mortum care purposes (2) | maintain best possible appearance of body by preventing skin damage & discoloration, retain dignity of deceased by safely handling belongings & body |
| Pt rights for dying (6) | right to die with dignity & peace, right to not die alone (NODA), right to be free of pain, right to have questions answered honestly, right to express feeling/emotions about dying in own way, right to be cared for |
Created by:
breinard
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