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Respiratory

artificial airway and management

500 characters500 characters
What is Complete Airway Obstruction? Complete Airway Obstruction is a MEDICAL EMERGENCY
What is Partial Airway Obstruction Partial Airway Obstruction may occur as a result of aspiration of food or a foreign body. It my result from:: LARYNGEAL EDEMA ff extubation LARYNGEAL OR TRACHAEL STENOSIS CNS Depression Allergic Reactions.
What are symptoms of Partial Obstruction Stridor Use of Accessory Muscles Suprasternal and Intercostal retractions Wheezing Restlessness Tachycardia Cyanosis
What are interventions for Partial Obstructions? Interventions to reestablish a patent airway include the obstructed Airway: Heimlich Maneuver Cricothyroidotomy Endotracheal Intubation Tracheostomy
What is TRACHEOTOMY A Tracheotomy is a surgical incision into the teaches for the purpose of establishing an airway.
What is TRACHEOSTOMY A Tracheostomy is the stoma (opening) that results from the tracheotomy.
What are indications for TRACHEOSTOMY Indications fro a Tracheostomy: 1) To facilitate removal of secretions 2) To bypass an upper airway obstruction 3) To permit long term mechanical ventilation 4) To permit oral intake and speech in the pt who requires long term mechanical ventilation
What is Percutaneous Tracheostomy It can be performed at the beside using local anesthesia and some sedation/analgesia. It is a valid alternative to a surgical inserted tracheostomy, with LESS BLEEDING and FEWER POST OPERATIVE INFECTION.
What are the Advantages of Tracheostomy? 1) Less risk of long term damage to the airway compared with an E T 2) Pt comfort may be increased bed no tube is present in the mouth. 3)Pt can eat with a Tracheostomy bec the tube enters the lower in the airway. 4) Increased pt mobility
Nursing Management of TRACHEOSTOMY: PROVIDING TRACHEOSTOMY CARE 1) Explain to the pt and family the purpose of the procedure. 2)Inform the pt that the pt will not be able to speak while an inflated cuff is used.
Tube and Characteristics: Tracheostomy Tube with Cuff and Pilot Baloon When properly inflated, Low Pressure, High Volume cuff distributes cuff pressure over large area, minimizing pressure on tracheal wall.
Nursing Mgmt of Tracheostomy tube with cuff and Pilot Balloon. Procedure to cuff inflation in mechanically ventilated patient. Inflate the cuff to minimal occlusion pressure by slowly injecting air into the cuff until no leak (sound) is heard at peak inspiratory pressure (end of ventilator inspiration), when the stethoscope is placed over the trachea.
Continue = Procedure to inflate Tracheostomy tube with cuff and Pilot Balloon. Mechanically Ventilated MLT (Minimal Leak Technique) An Alternative approach, its involve inflating the cuff to minimal occlusion pressure and then withdrawing 0.1 ml of air.
Tracheostomy tube with cuff and pilot balloon. Procedure to cuff in Spontaneously Breathing Pt. Inflate cuff to the minimal occlusion pressure by slowly injecting air into the cuff until no sound is heard after deep breath or during inhalation with manual resuscitation bag.
If using MLT in Spontaneous Breathing what a nurse should do? Remove 0.1 ml of air while maintaining seal. MLT should not be used if there is a risk of aspirations.
What should a nurse do immediately after cuff inflation in Tracheostomy tube with cuff and Pilot Balloon in both mechanically ventilated and spontaneously breathing patients? Immediately after cuff inflation in both groups: Verify pressure is within accepted range (</= 20 mm Hg or </= 25 cm H2O) with a manometer. Record cuff pressure and volume of air used for cuff inflation in chart.
Care of patients with an Inflated Cuff Monitor and record cuff pressure q8hr Cuff pressure should be </= 20 mmHg or </= 25 cmH2O to allow adequate tracheal capillary perfusion PRN remove or add air to the pilot tubing using a syringe and stopcock Verify cuff pressure within acceptd rnge
Continue Care of patients with inflated cuff Report inability to keep the cuff inflated or need to use progressively larger volume of air to keep cuff inflated.
Continue Care of patient with inflated cuff: Potential Causes of inability to keep the cuff inflated or need to use progressively larger volume of air to keep cuff inflated Tracheal dilation at the cuff site a crack or slow leak in the housing of the one way inflation valve If the leak is due to tracheal dilation, the physician may intubate the pt with a larger tube
Continue care of patient with inflated cuff Potential cause: How to managed the cracks? The cracks in the inflation valve may be temporarily managed by clamping the small bone tubing with a hemostat. The tube should be changed within 24 hrs.
How Fenestrated Tracheostomy tube (Shilley, Portex) with cuff, inner cannula, and decannulation plug used for pt to speak? When inner canula is removed, cuff deflated and decanulation plug inserted, air flows around tube, through fenestration in outer anula, and up over vocal cords. Patient then can speak.
Whose patient cannot used Fenestrated Tracheostomy Tube? Fenestrated Tracheostomy Tube cannot used to patient with swallowing dysfunction.
Nursing Management of Fenestration Trach Tube Procedure how to used it. Assess risk of aspiration b4 remving inner canula Deplate cuff Note coughing Have pt swallow sml amt of clear liquid (grape juice or 30 ml of h2o w/ drop of blue food coloring)
Continue Nursing management of Fenestration Trach Tube Procedure how to used it. Observe secretions after the patient cough or when suctioned for presence of colored secretion. If no aspiration is noted, a Fenestrated Trach Tube may be used.
What should the nurse do prior insertion of decanulation plug in pt with Fenestration Trach Tube? Never insert decanulation plug in Trach Tube until cuff is deflated and inner canula removed. Prior insertion will prevent from breathing (no air inflow). This may precipitate respiratory arrest.
What should the nurse do to the pt for first time use of Fenestration Trach Tube? Assess for signs of respiratory distress when a Fenestration Trach Tube canula is first used. If this occur, the cap should be removed, the inner canula replaced, and the cuff reinflated.
Speaking Tracheostomy Tube with cuff, two external Tubings Has 2 tubing, 1 leading to cuff and 2nd to opening above the cuff. When port is connected to air source, air flow out of opening & up over the vocal cord allowing speech with cuff inflated
Nursing Management of Speaking Trach Tube with cuff, 2 external tubings Once tube is inserted wait 2 days b4 use, so that the stoma can close around the tube and prevent leaks When the pt desire to speak, connect port to compressed air(or O2)Be certain to identify correct tubing
Continue Nursing Mgmt of Speaking Track Tube with cuff, 2 external tubings. If gas enters the cuff, it will overinflated and rupture, requiring an emergency tube change. Use lowest flow typically 4-6L/min that results speech. High flows dehydrate mucosa Cover port adapter. This will cause the air to flow upward.
Continue Nursing Mgmt of Speaking Track Tube with cuff, 2 external tubings Instruct pt to speak in short sentences bec voice becomes a whisper with long sentences Disconnect flow when pt does not want to speak to prevent mucosa dehydration
Tracheostomy Tube (Bivona Fome-Cuf)with Foam -Filled Cuff Cuff is filled with plastic foam. B4 insertion cuff is deflated. After insertion cuff is allowed to fill passively with air. Pilot tubing is not capped, and no cuff pressure monitoring is required.
Nursing Mgmt of Trach Tube with Foam Filled Cuff B4 insertion withdraw all air from the cuff using a 20ml syringe. Cap pilot balloon tubing to prevent reentry of air After trach is inserted remove cap from pilot tubing allowing cap to passively reenflate
Continue Nursing Mgmt of Trach Tube with Foam Filled Cuff Do not inject air into tubing or cap pilot balloon tubing while in pt Air will flow in and out in response to pressure changes (head Turning) Place tag on tubing alerting staff not to cap or inflate cuff
Continue Nursing Mgmt of Trach Tube with Foam Filled Cuff Deflate cuff daily via pilot balloon to evaluate integrity of cuff Also assess ability to easily deflate cuff. Difficulty deflating cuff a need for tube change. If aspirate return with air the cuff is no longer intact
How long can a pt use a tube with Trach Tube with Foam Filled Cuff on home mechanically ventilated? Tube can be used for up to 1 month in pt on home mechanically ventilated
What Trach Tube is good choice for pt who required inflated cuff at home? Trach Tube with Foam-Filled cuff is a good choice for pt who require inflated cuff at home since teaching about cuff pressure is simplified
What is obturator Obturator is used when inserting the tube. During surgical insertion of the tube, the obturator is placed inside the outer canula with its rounded tip protruding from the end of the tube to ease insertion.
After insertion of tube what should do with obturator? After insertion the obturator must be immediately remove so air can flow through the tube. Nurse should keep the obturator in an easily accessible place at the bedside (e g tape at wall) so that it can be used quickly in case of accidental decannulation
When is not safe to use MLT Do not use MLT when the trach was placed to bypass an upper airway obstruction such as with head and neck surgical patients
When is need to be careful not to dislodge Trach? Take care no to dislodge Trach during the first 5 to 7 days when the stoma is not mature (healed)
Because tube replacement is difficult what are several precautions are required? 1) Keep replacement tube of equal/smaller size in the bedside readily available for emergency reinsertion 2) Do not change Trach Tape for at least 24 hrs after the insertion procedure 3) PCP change the first tube change no sooner 7 days after the Trach
What should a nurse do if the tube accidentally dislodged? Immediately attempt to replace it. Grasp the retention sutures(if present) and spread the opening Use a hemostat to spread the opening to facilitate replacing the tube Insert the obturator in the replacement tube
Continue Procedure of replacing Tube if is accidentally dislodge Lubricated the tip of obturator with NS poured over the tip and insert the tube in the stoma at a 45 degree angle to the neck If insertion is successful remove the obturator immediately so that air can flow through the tube.
What are other method in replacing tube if is accidentally dislodge? Another method is to insert a suction catheter to allow passage of air and to serve as a guide for insertion. Thread the Trach tube over the catheter and remove the suction catheter.
What the nurse should do if the tube cannot be replaced? Assess the level of respiratory distress Can alleviate minor dyspnea by use of the semi Fowler's position until assistance arrives
What should the nurse do if Respiratory arrest occurs while replacing tube? Cover the stoma with a sterile dressing and ventilate the pt with bag -mask ventilation until help arrives
What is Trach Patient received initially? Initially Trach Pt received humidified air to compensate for the loss of upper airway to warm and moisturize secretion
Created by: negretagirl