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Lindsey Jones 3A4

Lindsey Jones 3A4 - Therapeutics : Airway Maintenance

What are the 6 airway maintenance? 1. Natural airway. 2. Artificial Airways. 3. General consideration of airways. 4. Nasal and oral (pharangeal airways). 5. Tracheostomy. 6. Airway clearance.
What are the causes/types of obstruction in a Natural airway? 1. soft/tissues (tongue) obstruction. 2 Foreign body 3. supra-glottic, sub-glottic swelling/edema. 4. Very thick secretions. (Often described as inspissated).
What are the 2 signs of obstruction in a Natural airway? 1. Partial obstruction 2. Complete obstruction.
What is a partial obstruction in a Natural airway? 1. Softened cough 2. Inspiratory stridor. 3. Paradoxical chest movement (chest moves inward upon inhalation) 4. General age of Resp. distress. (cyanosis, retraction etc.)
What is a complete obstruction in a Natural airway? 1. Paradoxical chest movement. 2. Inability to vocalize and no air movement sound at all. 3. Marked use of accessory muscles. 4. Marked nasal flaring, retraction etc. 5. Severe/marked anxiety, agitation.
How do you establish a patency in natural airway? 1. Modified Jaw thrust. 2. Head-tilt/chin-lift.
What is Modified jaw thrust in a natural airway? 1. It is modified to avoid head-extension-good for suspected neck trauma patients. 2. Done by pushing the mandbular process to extend the haw and open the airway.
What is a Head-tilt/chin-lift in natural airway? 1. Done by lifting up on the front edge of the jaw with one hand while pusing the forehead upward. 2. Do not use when suspecting neck fracture (no hyperextension of the head).
How do you establish an oral intubation in an artificial airway? 1. Use if patient is not alert, unconscious, not awake. 2. Use stylet (not magill forceps).3.Tube sizes should be (pt. wt. in kg/10). A. tube should be inserted to the markings in the low 20cm. Tube should be secured toa non-moving part of the face.
What is the procedure for an oral intubation? 1. Head in sniffing position. 2.Hyperinflation and hyper-oxygenation prior to procedure. 3. Guide blade along the right side of the oral cavity. Insert curved blade into the vallecula/straight blade under the epiglottis.
What happends after oral tube insertion? After tube insertion, inflate the cuff, auscultates the stomach first then the lungs, to determine position. If sounds over the stomach are pronounced, deflate cuff rand remove the tube.
How do you establish a nasal intubation in an artificial airway? Use nasal intubation if patient will remain awake, alert. Use Magill forceps (no stylet).
How do you establish an extubation procedure in an artificial airway? Extubation may be combined with the discontinuance of mechanical ventilation, but does not exclude it. Since someone can be ventilated with a mask the term, extubation, should never be substituted w/discontinuing mech.ventilation.
What are the qualifications to do an extubation procedure? 1. There must be little/no inflammation in the airway around the tube. 2. Pt. should be alert, oriented and able to follow commands.
What are the procedures for an extubation? 1. Clear airway by suctioning below&above airway. 2.Explain to the pt.3.Evacuate the cuff.Have pt. inhale&hold.Remove the tube while pt. holding max. inspiration.5.Instruct pt. to cough&expectorate-facilitate w/a tonsil suction device if needed.
What are the complications that would occur after an extubation? 1. Severe stridor - Immediately re-intubate the pt. 2. Moderate stridor - Consider racemic epinephrine aerosol treatment. 3. Mild-stridor- Cool mist and close observation.
What are some of the general consideration for an artificial airway? .
What are some of the reasons to establish an artificial airway? 1.Facilitates ventilation2.Protect airway(aspiration,inflammation)3.Profound,persistent hypoxemia 4.Facilitates bronchial hygine(marked secretion5.Sedate w/ativan(Iorazepam6.Deliver medications V-valium/versed,L-lidocaine,A-atropine,N-narcan,E-epinephrine
what is the assesment of positioning in an artificial airway? Determine the positions in an order: 1. Look@ the chest rise-visual(level1) 2. Auscultate for bilateral sounds - bedside(level2) 3. Chest X-ray-lab(level3).
What are the 4 potential problems during an artificial airway? Psycological implications- 1. Loss of dignity. 2.Cuff pressure necrosis. 3. Natural humidication is bypassed 4. Disables cough mechanisms. 5. Laryngospasm.
What is the loss of dignity problem in an artificial airway? cannot communicate.
What is the cuff problem in an artificial airway? Keep cuff pressure less than 20 mmHg. If it is high it causes necrosis,
What are the ways to minimize cuff problems in an artificial airway? Use the MLT and MOV tecniques. Use High-volume, low-pressure cuffs.
What does the natural humidification do when it is bypassed in an artificial airway? Provide heated humidity. Utilize a HME.
What is the disable cough mechanism-no glottic closure in an artificial airway? Suction-PRN. Teach ways to stimulate the cough. (forceful, explosive exhalation)
What is the Larngospasm problem in an artificial airway? This is worst of all the complications. Never extubate until this is resolved.
What is the purpose of suctioning during an artificial airway? To remove secretions. Promote expectoration of secretions(cough) Collect a specimen.
What is the suctioning procedure during an artificial airway? oxygenate the pt. 100% before and after suctioning for 1-3 m inutes. It should be sterile. Suction no longer than 15 second. Stop suctioning if any signs of distress are present.
What are hazards of suctioning during an artificial airway? Bleeding/trauma to the mucosa so be gentle and use lubricant. Cardiac changes can occur due to vagal reflex(bradycardia) and hypotension from vagal nerve stimulation. Tachycardia due to hypoxemia. Use sterile technique.
What should be done when a thick secretion situation occurs during an artificial airway? Increase the diameter of the catheter (higher french) but stay w/limits-no more than 1/2 the internal diameter of artificial airway. Increase suction pressure. Instill 5-10cc saline to hydrate secretions. Instill Mucomyst.Lower suction-prn& duration.
What is a Nasal pharyngeal airway in artificial airway? called as nasal trumphet. Helps in suctioning &remal of secretions.Opens airway for better ventilation. Not good for mech. ventilation.Used on consious pt. Less mucosal trauma. Use largest diameter possible to decrese RAW. Change often to prevent bleeding
What is a oral pharyngeal airway in an artificial airway? Used as a bite-block w/o ET tube in place. Insterted 180 degrees off then twisted inplace. Used on comatose/unconsious pt. Neer secure this airway to anything - no tape.
What are the genral considerations Tracheostomy in an artificial airway? Its used for long-term airway needed. Reduces RAW. Helpfulin difficult weaning situations. Indicated when an oral/nasal intubation is not possible. Can be cleaned by sterile water/hydrogenperoxide. Improves pt. life-style.
In tracheostomy what does it mean when Inflatable cuffs should be Inflated Only in an artificial airway? 1. During PPV support.2.During IPPB treatment.3.when pt. is eating.4.when there is an established risk for aspiration and if there is anything in the stomach.Inother cases deflate the cuff.When removing use sterile method.
What is Tracheostomy cleaned with during an artificial airway? it is cleaned with topical sterile dressing.
When is a tracheostomy done in an artificial airway? .
When removing or doing a tracheostomy care what all should be done in an artificial airway? Do not attempt to close the stoma w/a tape or gauze. All dressing should be lose and breathable and Do not suture stoma closed.
What are the 4 reasons to change a tracheostomy in an artificial airway? 1.when tube size is small. Unable to seal. Takes more than 20 cmH2O of cuff pressure to obtain a seal. 2. Obstruction in the tube- herniated cuff/dried secretions. 3. Tube is malfunctioning. Time-do not change frequently than once a week.
What are the 10 airway clearance procedures in natural and artificial airway? 1. Postural drainage 2. Chest precusson. 3. vibration 4. autogenic drainage 5. Positive expiratory pressure (PEP therapy) 6. Flutter valve. 7. External percussive device. 8. Intrapulmonary percussion vibration (IPV) 9. Teacing coughing. 10. Evalutation
What is Postural drainage in a patient during airway clearance? removal of secretions through gravity. Involves lowering the head down so that secretions drain downward towaed the upper airway and mouth, where they can be expectorated. Helpful in cystic fibrosis, bronchiectais and COPD patients.
What are the 4 general positions during airway clearance? 1.flat(supine/prone)-head down 0 degrees2.fowlers/reverse trendelenburg :45-90 degrees 3.Trendelenburg (head down 15 degrees)4.Trendelenburg(head down 30 degrees)trendelenburg is contraindicated for pt. w/incrased intracranial pressure(head trauma etc.)
What is the supine position during airway clearance? 1. Lying flat on back (looking @ the ceiling) 2. drains upper lobes, anterior segment. 3. Good for post neuro-surgical patients.
What Prone position during airway clearance? Lying flat - face down. Drains lower lobes, posterior basal segments-superior segments.
What is the Trendelenburg @ 15 degree head down during airway clearance? Manage hypotension (support blood perfusion in the brain). Contraindicated for head trauma/ brain surgery. Drain lingular, lateral and medial segments.
What is the Trendelenburg @ 30 degree head down during airway clearance? Used to drain the lower lobes basal segments anterior basal, lateral basal , posterior basal segment. May be dificult for dyspenic pt. to tolerate.
What are the contraindications during airway clearance? Untreated Tb. Poor/unstable cardiovascular system. Over incision sites.
What is chest percussion during airway clearance? often combined w/postural drainage. Facilitates mechanical mobilization of secretions.
What is chest percussion procedure during airway clearance? Use cupped-hands. Finger & thumb together. Relax wrist. Percuss over the area to be drained.
In using a chest mechanical device what all should we consider during airway clearance? watch for malfunctions. Stop using if any mechanical malfunction is manifested. Change to manual percussion / any other airway clearance technique.
What is vibration during airway clearance? 1. Facilitates mobilization of secretions. 2.Done by placing hand over the area to be drained while vibrating hands.3. Compression and vibration is done during exhalation.
What are the contraindications to vibration and percussion airway clearance? 1.Untreated pneumothorax. 2.Chest trauma (fractured ribs and bones) 3. TB and assosiated hemoptysis. 4.Pulmonary emboli.
What is autogenic drainage during airway clearance? 1. Multi-stage method of breathing. 2. Start w/breathing at ERV range. 3. Next,include VT range, but exhalating to ERV. 4. Finally, patient breathes at high lung volume (VT and IRV).
What is the Positive Expiratoury pressure (PEP) therapy during airway clearance? 1. Mask allows easy inhalation. 2. Restricts exhalation-causing expiratory airway pressure to exist. 3.Use 3-4 times per day. 4.Expiratory pressure from 10-20 cmH20. 5. Avoid during epitaxis,middle ear infection&sinus problems.
What is the flutter valve in airway clearance? 1. It is easy inhalation. 2. It is restricted exhalation. 3. Fluttering ball causes exhalation to oscillate expiratory flow rate, thereby stimulating a succession of small cough.
What is the External percusive device in airway clearance? 1. Also called High-frequency chest wall compression devive. 2. Eg. Device is VEST.
What is Intrapulmonary percussion ventilation (IPV) during airway clearance? 1. Done by delieviring inhalation w/oscillation.2. Causes vibration of the lungs. 3.Helps gases penetrate deeper levels of the pulmonary airway system.4.can be combined w/aerosol delivery.5. Good start Frequency is 30 PSI.
What is Teaching a cough during airway clearance? 1.Good Cough-deep inhalation&forceful exhalation 2.Multiple cough-closure of glottis & single exhalation done sitting 3.Splingting-support incision 4.Huff cough-w/o closure of glottis 5. Serial cough-cough w/low vol.then increase w/inhalation&exhalation.
After every therapy how do you evaluate the effectiveness to any airway clearance therapy ? 1. Visual inspection-chest excursion. 2. Better vital signs-BP,HR & RR. 3. Auscultaton-Improvement of breath sounds. 4.Cough-Forcefulness and sputum production. 5. WOB-decreased. 6.Chest X-ray-Not done after every treatment but periodically.
Created by: johnfaar