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Trach/Death&Dying

Adv Procedures

QuestionAnswer
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