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N4117
Exam II Airways Management
| Question | Answer |
|---|---|
| What is invloved in airways management of Pts? | To ensure patency and ventilation |
| How do you maintain patent airway in Pts? | Reposition patient for optimal airway opening Head tilt-chin lift method, Jaw thrust method |
| How do clear airways? | Suctioning, TCDB |
| What eqiupments are needed in airway maintainance? | Suction equipment, Ambu if necessary, BMV or bag-mask-valve, Oropharyngeal airways, Nasopharyngeal Airway. |
| Oropharyngeal airway is used for what? | Prevention of tongue from obstructing airway |
| Oropharyngeal airway is used for ONLY what kind of Pts | Unconcious or semiconcious Pts. |
| Why can we not use Oropharyngeal airway on a consious Pt. | Can stimulate gag reflex |
| What do you do FIRST before placing an Oropharyngeal airway? | Measure for the appropriate size |
| Procedure for placing an Oropharyngeal airway? | Place the oropharyngeal airway along the outside of the jaw with one end of the airway at the bottom tip of the ear. Close the mouth and bring the other tip of the airway toward the corner of the mouth. |
| Procedure for placing an Oropharyngeal airway? Con't | The airway should reach from the bottom tip of the ear to the corner of the mouth. |
| In Proper Oropharyngeal airway placement, the tip should lies above where @ the base of the tongue? | Epiglottis |
| What can happen if an incorrect size of Oropharyngeal airways is used? | Airways obstruction |
| What does Nasopharyngeal Airways do? | Provides airways via the nostrils |
| What do you do FIRST be placing an Nasopharyngeal Airways? | Measure for correct size |
| Procedure for placing a Nasopharyngeal Airways? | Lubricate prior to placement, Hold the airway against the side of the face and ensuring it extends from the tip of the nose to the earlobe. |
| In proper placement of Nasopharyngeal Airways, the tip lies above where @ the base of the tongue? | Epiglottis |
| Types of Endotracheal tube (Short-Term)? | Oral and Nasal |
| Type of Endotracheal Tube (Long-Term)? | Tracheotomy >21 days |
| After placement of ETT, what do you document? | Size, Dept of tube, & balloon inflation |
| After the placement of Tracheotomy, what do you document? | Size of Trach., cuff balloon inflation |
| How do you verify proper tube placement? (Intubation) | By Chest X-Ray and by auscultating epigastric area, & abdomen, anterior & lateral. |
| What do you inspect after intubation? | Chest expansion |
| End-Tidal C02 detector tells the nurse what? | Tube placement is in the right place - the lungs. |
| How do End-Tidal C02 detector work? | Changes color due to C02 as pt breaths |
| Proper dept placement of ETT is? | 3 - 4 cm above carina |
| ETT assessment | Tube type (ETT - oral or nasal or Trach), Size of airway. Location @Teeth, Gums (Look at marking on tube), Pilot balloon (Cuff pressure), Check for mucosal damage (Know when scheduled change in location is due). Check for stability. |
| What do you do to ensure ETT stabilization? | Avoid unnecessary tube manipulation (Due to Excessive water collection in tubing. Monitor for skin and tongue breakdown, Avoid bite blocks. Keep tape secure (Watch for the saliva slide) |
| ETT & Trach monitoring. Cuff inflated too high...? | Will cause Tracheal damage |
| ETT & Trach monitoring. Cuff inflated too low...? | Will cause aspiration around cuff leak |
| ETT & Trach cuff is monitored by ? | Touch by RT q shift |
| Normal range of cuff inflation is? | 20-25mmHg or 24-30cm H2O |
| Proper procedure for suctioning? | Elevate HOB, Pre-oxygenate/Hyper-oxygenate, Support vent tubing when suctioning, Use correct suction withdrawal technique, Intermittent suction or continuous - 10-15 sec (Hold your breath as you suction), Use of saline controversial. |
| What are the complications of ETT.? | Tube obstruction, Tube displacement, Sinusitis, nasal injury, Tracheoesophageal fistula, Mucosal lesions, Laryngeal or tracheal stenosis. |
| What are the complications of Trach.? | Tracheoinnominate artery fistula, Subcutaneous emphysema. |
| What are Indications for Mechanical Ventilation | Acute impending Ventilatory failure, Refractory hypoxemia, Secretion/airway control, Apnea/respiratory arrest. |
| What is a Ventilator? | Automatic mechanical device designed to provide all or part of the work the body must do to move gas into and out of the lungs. |
| What is a circute? | Sets of apparatus or tubings through which a ventilator delivers 02 to a Pt. |
| What do you monitor in a Pt on mechanical ventilator? | Monitor what is provided for the Pt: MD orders, Settings that are keyed into the machine. Monitor the patient’s response: Variable, Look for trends. |
| What is the acronym AC & CMV? | Assist Control. Continuos Mandatory Ventilation |
| What is the function of AC or CMV? | Delivers preset number of breaths at preset tidal volume. |
| How does AC or CMV? work | If pt initiates breath, machine delivers preset tidal volume for every breath. |
| What is the acronym PRVC? | Pressure-Regulated Volume Control |
| What is PRVC a variation of? | CMV (Continuation mandatory Ventilation) |
| In whom is PRVC used for? | Patients with airway resistance or decreased lung compliance such as ARDS. |
| PRVC is a combination of what features? | Volume and pressure |
| How does PRVC work? | Delivers a preset tidal volume using the lowest possible airway pressure. Airway pressure will not exceed preset maximum pressure limit. |
| What is the acronym SIMV | Synchronous Intermittent Mandatory Ventilation. |
| What is the function of SIMV | Delivers preset number of breaths at preset tidal volume |
| How does SIMV work? (Tip: Sync of Pt. breath) | If pt initiates breath, machine allows Pt to breath in own TV (Tidal Vol.) |
| What is the acronym CPAP | Continuous Positive Airway Pressure |
| How does it work? | Patient initiates own breath, and Machine delivers constant positive pressure. |
| What is the acronym Fi02 | Percent of inspired O2 |
| Explain Fi02? | This is the Percent or fraction of oxygen delivered by the ventilator. |
| What is I:E ratio? | Inspiration to expiration ratio. |
| What is normal I:E? | starts at 1:2 |
| What is normal I:E for COPD Pts. | 1:4 |
| What is the reason I:E is longer in COPD Pts | To prevent "breath stacking." |
| What is done FIRST before deciding to intubate a Pt. | Use of CPAP |
| What is a Tidal Volume | Amount of air it takes to inflate the lungs with each breath. |
| *Normal TV is? | 10 - 15 ml/kg |
| What is the respiratory rate? | Rate set by physician as the number of delivered breaths. |
| Define pressure support? | A set amount of pressure delivered when patient initiates own breath. Assists movement of air through ventilator tubing in order to augment patient’s own tidal volume. |
| *When does pressure support work? | *Works at the beginning of Inspiration |
| What does the acronym PEEP stand for? | Positive end expiratory pressure. |
| Explain PEEP? | Positive airway pressure applied at end of expiration. to keep alveoli open and facilitate oxygen transport. |
| *When does PEEP work? | *Works at the end of Expiration |
| PIP stand for what? | Peak Inspiratory Pressure |
| What is PIP? | Amount of pressure it takes for ventilator to deliver tidal volume or breath. |
| ARR stands for what? | Actual Respiratory Rate. |
| How do you calculate ARR | Count the amount of breath delivered by machine as well as Pt's initiated breaths. |
| ETV stands for what? | Exhaled Tidal Volume |
| What is ETV | Amount of air detected by machine during exhalation |
| MV stands for what? | Minute Ventilation |
| What is MV | Amount of gas moved in or out of lungs per minute |
| How do you calculate MV? | RR x TV = MV |
| *Example of MV calculation? | 12 bpm x .600 (or 600 TV) = 7.2 L/min |
| *Normal MV is? | 5 - 8 L/min |
| What could be reasons for High pressure alarm? | Circuit tubing kinked, Water collecting in dependent tubing, Fighting vent (Breath stacking), Airway secretions, coughing, ETT in Right mainstem bronchus (in too far), Decreased lung compliance, ARDS, tension pneumothorax, Pulmonary HTN. |
| What could be reasons for low pressure alarm? | Tubing disconnected, Circut leak, Cuff deflated. |
| What could be reasons for low exhaled *VT? (I think she meant TV) | Leak in the system, poor cuff inflation, and leak through chest tube |
| What could be reasons for temperature alarm? | Sensor malfunction, sensor pickin up outside airflow |
| What could be reasons for Apnea alarm? | Sedation, neurologic and metabolic problems |
| What could be reasons for High respiratory rate alarm? | Pt not tolerating weaning, neurogenic/metabolic problems, anxiety, and pain. |
| What could be reasons for mechanical ventilator failure? | Electrical outlet damage, needs replacement |
| What are the complications of mechanical ventilation? | Ventilator Induced lung injury (e.g. Excessive pressure in the alveoli (barotrauma), Excessive volume in the alveoli (volutrauma), Shearing due to repeated opening and closing of the alveoli (atelectrauma), |
| Other complications of mechanical ventilation? | Inflammatory immune response (biotrauma) EX: pneumothorax, subcutaneous emphysema - air under the skin. Oxygen toxicity. |
| Prevention of mechanical ventilation complications? | Plateau pressure kept < 32 cm H2O, PEEP should be used, TV set at 6-10 ml/kg. |
| Mechanical ventilation complications on the cardiovascular system? | Increase intrathoracic pressure, ↓ Venous return; ↓ preload; ↓ CO & ↓ BP. Tachycardia to compensate, Hepatic & renal dysfunction, Impairment of cerebral venous return, ↑ ICP |
| Mechanical ventilation complications on the GI system? | Gastric distention, Hypomotility, Constipation |
| Nosocomial pneumonia accounts for...? | 15% of all hospital associated infections. & 27% of all MICU acquired infections |
| Primary risk factor for nosocomial pneumonia is? | Mechanical ventilation |
| VAPP stands for what? | Ventilator Associated Pneumonia Prevention |
| The most critical period for VAP Pts | First 24 hours |
| VAPP bundl includes whay? | HOB elevated 30° - 45°, ETT with a dorsal lumen provides continuous SX above the cuff, Oral care, Handwashing. |
| VAP stands for what? | Ventilator Assisted Pneumonia |
| How do Pts aquire VAP? | Micro or macro aspiration of oropharyngeal pathogens. Leakage of secretions containing bacteria around the ET cuff. |
| How do you prevent VAP? | Avoid Micro or macro aspiration of oropharyngeal pathogens. Avoid Leakage of secretions containing bacteria around the ET cuff. |
| How do you perform oral care in a Pt on ventilator? | Follow protocol of institution. Use “BRUSH” once a shift with chlorahexadine solution. Use soft “swab” for oral airway q2hrs. |
| What is a ventilator bundle? | “Bundle” of orders for nursing, respiratory therapy in caring for a patient on the ventilator |
| Examples of ventilator bundle? | VAP precautions, DVT precautions, Gastric reflux prevention, Sedation vacations, Evaluation of readiness to wean from the ventilator. |
| Excessive pressure in the alveoli is known as what? | Barotrauma |
| Excessive volime in the alveoli is known as what? | Volutrauma |
| Shearing due to repeated opening & closing of the alveoli is known as what? | Atelectrauma |
| Inflammatory immune response of the lungs is known as what? | Biotrauma. |
| Give examples of a biotrauma | Pneumothorax, Subcutaneous emphysema (air under skin) |
Created by:
nze
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