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Airway Care 1

Airway Care Review 1

QuestionAnswer
Compare and Contrast the main indication for Oral and Nasal Pharyngeal Airways OROPHARYNGEAL NASOPHARYNGEAL Unconscious PT Conscious PT Base on Tongue Base on Tongue Bite Block Tracheal Suctioning Oral Suctioning Use to decerse Trauma
The main indication for OROPHARYNGEAL Pharyngeal Airways OROPHARYNGEAL Unconscious PT Support Base on Tongue Bite Block (ET tube Or Seizure) Facilitate Oral Suctioning
The main indication for NASOPHARYNGEAL Pharyngeal Airways NASOPHARYNGEAL Conscious PT Support Base on Tongue Facilitate Deep Tracheal Suctioning Use to decerse Trauma during Nosotracheal Suctioning
List the complications which could be associated with Oral Pharyngel Airways suggest a solution to prevent each complication This airway should be left unsecured Gagging- remove airway, suction airway, give oxygen Vomiting Laryngospasm Airway Obstruction-remove,clear-out or replace, may also be too small
List the complications which could be associated with Nasal Pharyngel Airways suggest a solution to prevent each complication Trauma to mucosa (most common) use water soluble or water based lubricant Epistaxis (nasal bleeding) change every 24 hours Increased Airway Resistance- use largest size that will fit
How should the respiratory therapist determine the appropriate size airway for a ORAL PT Length should be equal distance from angle of jaw to tip of chin or from the angle of jaw
How should the respiratory therapist determine the appropriate size airway for a NASAL PT Outside diameter of airway should be equal to inside diameter of patients external nares. Length of airway is from tip of earlobe to center of nostrils
Describe the insertion techniques for Oral airways inserted opposite its anatomic shape (upside down) to back of throat and then rotated into its correct position
Describe the insertion techniques for Nasal airways inserted the way it is anatomically shaped with water soluble lubricant
List five purpose for ENDOTRACHEAL Intubation Provide a PT Airway Access for Suctioning Means for Mechanical Ventilation Protect the Airway (Aspiration,Obstruction) Direct instillation of Medication
List four drugs that can be safely admistered by direct instillation into an endotracheal tube. Nacan Narcotic Overdose Atropine Bradycardia Valium/Versed Sedative Epinephrine Asystole Lidocaine PVC NAVAL
How should the respiratory therapist respond to the following physiological changes brought about by ENDOTRACHEAL Intubation? By-passing normal humidification mechanisms Provide Adequate Humidity
How should the respiratory therapist respond to the following physiological changes brought about by ENDOTRACHEAL Intubation? Disruption of normal mucus clearnce Suction PRN
How should the respiratory therapist respond to the following physiological changes brought about by ENDOTRACHEAL Intubation? Inability of the PT to communicate Provide Method of Communication
What Level of Cuff Pressure (mmHg) would obstrust the following? Arterial Capillary Blood Flow >20 mmHg Results Necrosis
What Level of Cuff Pressure (mmHg) would obstrust the following? Venous Blood Flow >10 mmHg Results Edema
What Level of Cuff Pressure (mmHg) would obstrust the following? Lympatic >5 mmHg Results Edema
Describe the procedure for ENDOTRACHEAL INTUBATION Head in Sniffing Postion, Adequately Hyperoxygenate Hold laryngoscope in left hand ET in right hand Insert blade down right side of mouth Advance Blade. lift epiglottis,visualize cords,have suction Cricoid pressure,Insert tube,Inflate cuff
Describe how to perform the following cuff pressure assessments MIDDLE OCCULDING VOLUME (MOV) Listen for air leak as cuff is inflated during pos-pressure ventilation stop inflating at minimum volume necessary to eliminate air leak via trach or endotracheal tube
Describe how to perform the following cuff pressure assessments MINIMAL LEAK TECHNIQUE (MLT) slowly inject air into the cuff during pos-pressure inspiration until leak stops a small amount of air is removed to allow a slight leak during peak inspiration
Identify three methods to determine correct postion of an ENDOTRACHEAL TUBE INITIAL METHOD Insepection- look for bilateral chest expansion during inspiration
Identify three methods to determine correct postion of an ENDOTRACHEAL TUBE SECOND METHOD Ausculation breath sounds should be heard on both sides of the chest
Identify three methods to determine correct postion of an ENDOTRACHEAL TUBE BEST METHOD Chest xray- the radiopaque line on the endotracheal tube can be easly visualized to assess placement. tip of tube 2 cm or 1in above carina or at the Aortic Knob/Notch
How Should the respirtory therapist maintain airway patency? Suctioning
What level of humidification should be maintained in order to pervent dehydration? 100% Humidity @ 37 oC Best way to prevent obstruction
List two ways to measure cuff pressure Minimal leak, Minmal occluding volume Use high volume/low pressure cuff (equal to or ,20 mmHg pressure)
Name two types of Laryngscope blades commly used to intubate adult patients and describe how each is used. Laryngoscope-handle,always hold in left hand,hold batt for light blades Curved/Macintosh-fits into vallecula,indirectly raises epiglotis Stright/Miller blades-fits directly under the epiglotis (perfered for infant intubation)
What steps should the therapist take if the light on the Laryngoscope blade does not work Tighten bulb, Check handle attachment, Change blades, Check Batteries
What size laryngoscope blade is commly used for ADULT PT Size 3
What size laryngoscope blade is commly used for TERM INFANT Size 1
When is a stylet useful? Used only to Aid in ORAL INTUBATION
During what procedure are MAGIll forceps used? Used in the Aid in NASAL INTUBATION inserted in mouth to lift tube into tracheal
List the approximate Endotracheal tube sizes for PRE-TERM INFANT 2.5-3.0 mm
List the approximate Endotracheal tube sizes for FULL-TERM INFANT 3.0-3.5 mm
The appropriate endotracheal tube size for ADULT MALES ranges between __to __ mm and For ADULT FEMALES _ to _ mm. ADULT MALES 8.0 to 9.0mm ADULT FEMALES 7.0 to 8.0 mm
A PT receiving mechanical ventilation is being transported to radiology for CT scan. the therapist is arranging equipment the low volume alarm ,begins to sound, Notes that the oral endotracheal tube is taped at the 28cm mark. The tube should be between 21 cm -25 cm
ORAl endotracheal tube should be taped at 21-25cm mark at PT lips
NASAL endotracheal tube should be taped 26-29cm mark at PT nare
compare and contrast the two basic types of ENDOTRACHEAL tube cuffs High Pressure,Low volume, - Low compliance cuff Low pressure,High volume-High Complinance, floppy cuff (perferred type)
Double-LUmen ENDOTRACHEAL tube/ENDOBRONCHEAL TUBE describe the structure of this type of tube? tube with two independent lumens of different lenghts;the longer lumen is inserted into either the left or right mainstem and the shorter lumen is placed in the above the carina each lumen can ventilate one lung separately
List four indications for using this type of tube? Independent lung ventilation Unilateral lung disease to improve ventilation and oxygenation or to provide airway protection to the unaffected lung Used during surggery, disruption and surgical openings of openings of a large airway
List ADVANTAGES of using an ESOPHAGEAL TRACHEAL COMBITUBE Can be readily inserted Does not require visualization of the larynx
List DISADVANTAGES of using an ESOPHAGEAL TRACHEAL COMBITUBE Placement of an endotracheal tube is difficult with combitube in place Cannot be used in PT with a gag reflex
Where should the LARYNGEAL MASK AIRWAY (LMA)be properly positioned? Consists of an inflatable mask that is positioned directly over the opening into the trachea (HYPOPHARYNX)
List the two indications for use of the LARYNGEAL MASK AIRWAY (LMA) Short term ventilation When intubation is not possible
When is a Hi-Lo EVac tube been show to reduce the incidence of? Ventilator Acquired/ Associated Pneumonia (VAP)
What level of continuous suction is applied to this type of Hi-Lo EVac tube? Continous suction is provided via separate pilot tube connected to a vacum pressure of 20 mmHg
Why should the ETT be removed at peak inspiration? to pervent vocal cord damage
Identify possible complications of extubations and how to manage each one. Severe Respiratory distress and/or Marked Inspiratory stridor REINTUBATE the PT
Identify possible complications of extubations and how to manage each one. MODERATE DISTRESS STRIDOR Oxygen, cool mist aersol and racemic epinephrine as necessary to reduce swelling
Identify possible complications of extubationsand how to manage each one. MILD DISTRESS/STRIDOR SORE THROAT Provide humidity, oxygen and/or racmic epinephrine as necessary
PT in the ICU is extubated after being on pos-pressure ventilation for three weeks. Two days later exhibits stridor. Therapist should the PT for evidence of? TRACHEOSTENOSIS
Other Post-extubation Complications Vocal cord polyps Due to chronic inflammation
Other Post-extubation Complications Mucosal ulceration torn mucosa does not require reintubation
Other Post-extubation Complications Tracheomalacia softening or dilation of tracheal cartilage
Other Post-extubation Complications Tracheostenosis gradual obstruction (narrowing) that occurs with healing causing stridor
Created by: Cam1228