Airways, Suctioning and Trach's Flashcards Preview

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Flashcards in Airways, Suctioning and Trach's Deck (20)
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1

Why might a nasopharyngeal be used over an oropharyngeal airway?

Easier to gag out the oro type, but naso is much more secure since it does not irritate gag reflex

2

What sizes do oropharyngeal airways come in?

- Size 000 to 10, OR small, medium or large
- Babies and small children = 000-3
- Bigger children = 3-4
- Adults usually 4+
- Measure is based on age and size of person

3

Why do we do oral suctioning?

- Yaunker suctioning common
- Removes secretions from the mouth (but will also remove O2; be mindful of pre-oxygenating)

4

Where do we insert an oropharyngeal tube?

Inserted through the mouth to pharynx

5

Where do we insert a nasopharyngeal tube?

Inserted through the nares to the pharynx

6

What are complications of airway suctoning?

- Hypoxia
- Trauma to the airway
- Increased HR (remove O2, heart pumps harder) OR decreased HR if vagus nerve irritated
- Laryngo spasm

7

Describe the anatomy of the trachea:

- The trachea is the first part of the airway not shared by GI tract
- Trachea stretches between the larynx and the carina
- In the average adult it is 10-12cm long and 2.5cm in diameter (determines size of tracheostomy)
- The trachea is protected by 16-20 hyaline cartilage rings which help to maintain patency

8

What is a tracheostomy?

- An artificial opening (or stoma) in the trachea
- Surgically created between 2nd and 3rd cartilaginous ring
- Temporary or permanent
- Kept open by the insertion of a tracheostomy tube
- Shortens the length of the upper airway
- Decreases the work of breathing for the patient since dead space in nose/mouth eliminated, much easier for patients with labored work of breathing

9

Why might someone have a permanent trach?

- Cancer (esp. head and neck)
- Quadriplegic
- Muscular dystrophy
- Myasthenia gravis
- ALS
- May or may not be ventilator dependent

10

What are some general indications for trachs?

- Not usually a first line procedure, typically intubation done in other ways
- Fractures
- Traumas/burns
- Foreign bodies
- Infections
- Inability to protect own airway
- Respiratory insufficiency
- Upper airway obstruction and bleeding
- Inability to clear secretions effectively

11

What are some complications of tracheostomy?

- Airway occlusion
- Tissue damage (necrosis, ulceration)
- Infection
- Pooling of food in airway d/t decreased functioning of epiglottis
- Communication difficulties
- Tube displacement/dislodgement (e.g. by coughing)
- Bleeding
- Tracheo-oesophageal fistula
- Inability to maintain nutrition/hydration needs
- Air leaks
- Loss of normal airway function
- Secretion accumulation in upper airways, requiring suctioning
- Dehydration of airway
- Poor oxygenation of tissues leading to atelectasis possible

12

What are the different types of trach tubes?

- Vary in length, size, composition and number of parts
- Cuffed vs. uncuffed
- Fenestrated vs. non-fenestrated
- Fenestrated means there is a small hole in the tube, used to help promote speech; trachs with no trachs = no sound
- Downside of fenestration is accumulation of secretions/food in the tube, occluding the airway

13

Describe the composition of trach tubes:

- Consists of an outer cannula with flange [the outer wings], inner cannula (changed q12h) and obturator (mostly for insertion and new trachs at risk of stoma closing; is NOT left in there since it would occlude)
- May have a speaking valve attached (but tube must be fenestrated)

14

Describe nursing implications for trachs:

- Preparation (equip at bedside, pt assessment, discussed with patient, correct positioning, 2nd nurse to help with procedures)
- Assessment (airway, breathing, o2 sats, energy to breath, chest expansion, coughing, assessment of secretions, are they tolerating o2 or humidification)
- Education (family may want to learn how to suction)
- Communication/body image changes
- Procedures
- Emergencies
- Guidelines and documentation

15

Describe patient assessment:

- Why does the patient have a tracheostomy?
- How long have they had a tracheostomy?
- Type/size of tube (think of size like straw and how appropriate it would be to easily breath through for the person)
- Level of respiratory support needed
- Respirations/breath sounds
- Cuffed?/inflated?
- Humidification method?
- Suction required?/how often?
- Thickness, colour, amount of sputum
- Cleaning of inner tube?
- Wound assessment/dressing changes (once a shift)
- Can the patient swallow?
- Assessment done?
- Weaning progress
- When does the outer tube need changing?
- What does the patient look like?
- Patient education
- Mouth care

16

Describe patient education:

- Explain all procedures
- Pre-op education
- Communication limitations/alternatives
- Involve family
- Utilize other experts as appropriate

17

Describe the use of humidification:

- Humidification of air occurs in upper airway
- When a tracheostomy is formed, the upper airway is bypassed
- Humidification warms and moistens air
- Potential for fluid build-up in corrugated tubing
- Insufficient/excessive humidification

18

Describe dressing and cannula change basic principles:

- Positioning (semi or high fowlers); may want to be lower, but can aspirate when secretions pool
- Preparation
- Asceptic/clean technique
- Patient education
- Wound assessment
- Documentation
- Likely to use NS to clean reusable cannula's
- Typically two nurses for drsg in case of emergency and to keep trach secure (pt likely to cough during change)

19

What are the indications for suction?

- Visible or audible secretions
- Suspected aspiration
- Dropping peripheral O2 sats
- Increased coughing
- Reduced airflow

20

What is a trach emergency?

- Trach coming out (new trach should be at bedside, along with suction supplies)
- Trach oxygen masks should be in emergency supplies, 2 spare trach tubes (different sizes), securement devices, syringe, stitch cutters, scissors, etc.