EXAM1, SPRING07, AIRWAY, SUCTIONING, CHEST TUBES Dee Flashcards

Oropharyngeal airway
Terms Definitions
An __________ airway is a semicircular, minimally flexible, curved piece of hard plastic that extends from just outside the ___, over the tongue, & to the ____. Purpose is to ________ hold the airway open & prevent ____ from obstructing the ____.
Oropharyngeallipspharynxmechanicallytonguepharynxnon sterile
DO NOT insert oropharyngeal airway into a _____ or _____ patient because it can cause vomiting & ___. An airway that is too ___ can dislodge, stimulate _____, or obstruct breathing by depressing the _____into laryngeal opening. **Size is CORRECT if,
conscious or semi-consciouslaryngospasmlonggaggingepiglottisteethagainstjaw
DO NOT _____ oropharyngeal airway device in place because when patient becomes ____ he wouldnt be able to ____ device which increases risk of gagging & ______.
tapealertexpelaspiration
Insertion of an oropharyngeal airway is a ___ ___. Size is determined by measuring from corner of patients ____ to the angle of his jaw below the ___. Explain procedure to _______ though not alert. Wash ___, wear ___, mask & ______ or shield. Remove
non sterile techniquemouthearhandsglovesgogglesbackhyperextended
Oropharyngeal airway should be inserted ___ ___ to avoid pushing tongue towards ____. Slide over tongue to back of mouth & ____ 180 degrees as it passes the ____. ______ lungs to ensure _____ & position patient on ____ to facilitate secretion dra
upside downpharynxrotateuvulaAuculateventilationsideaspiration4hrs irritationsecretions
Need for insertion of oral airway: ____ airway gurgling, no __ __, increased oral secretions/excretions, excessive ____, grinding or clenching teeth, ____ oral tracheal or gastric tube, labored ____, _____ respiratory rate.
uppergag reflexdroolingteethbitingrespirationsincreasedincreased
ONLY use an oropharyngeal airway when patient doesnt have a ___ ___. When sizing, device should be ____ one that fits.Premi's & neonates 000newborns 00newborn - 1yr 01-2 yrs 12-6 yrs 26-18 yrs 318 + 4-10
gag reflexsmallest
Use of _______ airways in pediatric patients are ____ often used because their airways are so _______ that the device may be more _____ than helpful.Premi's & neonates 000newborns ?newborn - 1yr ? 1-2 yrs ?2-6 yrs
oropharyngeal NOTPremi's & neonates 000newborns 00newborn - 1yr 01-2 yrs 12-6 yrs 26-18 yrs 3narrowobstructive
Documentation for oropharyngeal airway includes assessment findings for inserting airway, size, placement, tolerance, presence of ____ distress, vomiting, quality of ____, & pain.
respiratorysecretions
If continual coughing & ____ occurs during oro airway insertion, ___ b/c patient may begin to vomit & risk ____. Try using a ____ airway, or reassess if patient really needs it. If airway obstruction is not relieved w/device obtain ____ ___, atte
gaggingstopaspirationsmallerimmediate assistanceclearing
Nasal pharyngeal airwaysaka "nasal trumpets" are preferred in ____ patients because it is better tolerated & less likely to ___ ___.
responsiveinduce vomiting
These airways are preferred in the responsive patient b/c it is better tolerated & less likely to induce vomiting. This airway is also known as called “nasal trumpets”. because of their shape
Nasal pharyngeal airways
Indications for Nasal Pharyngeal Airways: ____ Pt's & preferred for infants & ___ due to small mouths & ____ tongues. Nasal Airways are usually tolerated better than oral airways. Indications for use are ____ surgery's, wired ___, ___ breathi
responsivepediatricslargeoraljawsirregulardroolingmaintenancecan be sterile jellyCLEANsemi fowlers q4h
Assessing Pt for insertion of Nasal pharyngeal airway is inspecting nasal ___ for ____ such as polyps, fractures, or _____. Rn then selects ____ possible tube measured from external ___ to ___. RN should always _____ procedure to Pt.
passagesobstructionshemorrhagelargestnares to earEXPLAIN
Nursing implementation of Nasal Pharyngeal Airway: ____ use & procedure to Pt. Measure tube from external ___ to ___& use ____ possible tubing diameter. Place Pt in ____ position & lubricate tubing w/____. Using ___ technique, insert tube in
EXPLAINnares to the ear largestsemi-fowlerssterile jellyCLEANposteriorly earoropharynxrotatingnostriltape
Nasal Pharyngeal Airway can be used in conjunction w/ ______, & nasal tubing can be inserted into ______.
oropharyngeal airwaysboth nares
If insertion of oral or nasal airway does not improve _____ status, assist ventilations w/a ___-___-___ unit, also known as an ____. This procedure is most effective w/__ __ of which 1 person obtains an ____ mask seal after inserting an ___ or ___ airway
ventilatorybag-valve-mask (BVM)Ambu bagtwo peopleairtightoral or nasopharyngealboth hands rise
When using a bag-valve-mask (BVM) unit (Ambu bag), apply the APEX of mask over bridge of the ___ & lower mask over face & mouth. Apply pressure behind ____ with fingers & seal mask against the face w/ ____. If cervical injury is possible, mai
nosemandiblethumbsneutral
When 2 people are assisting ventilations using a Ambu bag, while 1 person obtains airtight ___ ___ the other person ____ bag w/___ ___ for ventilations & watches ____ rise. When squeezing Ambu bag remember it should be fully ____ & allowed to ful
mask sealsqueezesboth handschestdeflatedinflateCPR
When only 1 person is providing ventilations with n Ambo bag, form a ____ around the ventilation port w/the thumb & index finger & then use the middle figer, ring finger, & little fingers to ____& form a seal w/the mask. Use the other han
“C”lift jaw squeeze
Asisting ventilations is indicated if patient is breathing, but not w/ sufficient ____ to maintain adequate ___ ____. Give assisted breaths with ___ oxygen at the same time the patient _____
depthgas exchange100%breaths
What is a semicircular shaped flexible hard plastic curve that when inserted, extends from just outside the lips, over the tongue and to the pharynx?
oropharyngeal airway
What is a flexible piece of curved plastic with a wide or trumpet like end flange that when inserted, extends from the nares past the sinus to the pharynx?
Nasal pharyngeal airway
What other term is given to a is a Air Mask Bag Unit
Ambu Bag
The amount of oxygen entering the lungs is?
ventilation
The blood flow to the lungs and the body tissues?
perfusion
Suctioning is using ____ pressure to remove secretions such as ____ & ____. Suctioning is done in surgery, oral procedures & often performed at bedside in ICU, ER.
negativepulmonary gastric secretions
Indications for Pulmonary suctioning are patients who are ____ ventilated, tracheostomy, anyone unable to maintain a patent ___ &/or ____ airway independently, sedated patients, post-operative, post-ictal, drug ___, inability to cough ____, & Pt'
mechanicallyupperloweroverdoseeffectivelyrespiratory
Types of suction for Endotracheal intubation are:1- ________suctioning mouth & pharynx 2- ________suctioning through noseinto naso-pharynx & trachea 3- _________suctioning Endotracheal t
oropharyngeal suctioningNasotracheal suctioningArtificial Airway suctioning
Oral Pharyngeal Suctioning uses _____ suction catheter (tonsil tip), ____ technique w/______ precautions & ____ delegated. It is effective on copious, ____ , upper airway secretions, for Pt's w/oral & ____ surgery, impaired ___ or for performing
YankauerCLEANuniversalmay be thickfacialswallowinghygiene
Nasopharyngeal/Nasotracheal Suctioning uses ____ plastic or rubber suction catheter, requires ____ technique, is invasive & ____ tolerated by the awake patient but necessary when ____ airway requires suctioning, & patient is ___ mechanically vent
flexibleSTERILEpoorlylowerNOTsputum
When patient is not mechanically ventilated & lower airway requires suctioning _________ is indicated.
Nasopharyngeal/Nasotracheal
Nasopharyngeal/Nasotracheal is used to collect ____ _____.
sputum specimens
Endotracheal (ET) tubes are used on Pt's to provide _____ ventilation, protect airway from ___ & are a ___ solution used only for __-__. They are placed by trained professnl. Adult ET tubes have a ___ molded around tube at distal end. ET tubes preven
mechanicalaspirationtemporary2-4 weekscuff aspirationairwayescapeNOT
A temporary solution solution used only for 2-4 weeks to provide for mechanical ventilation & to protect airway from aspiration are ________.
Endotracheal (ET) tubes
Tubes used on clients to provide for mechanical ventilation, protect airway from aspiration that have a cuff molded around the distal end to prevent aspiration & seal airway to prevent escape during mechanical ventilation are ________.• ET tu
Endotracheal (ET) tubes
Suctioning ET Tubes are ___ delegated to AP's & only performed __ ____ depending on Pt's status rather than on a routine schedule. ET suctioning is ______ to perform than nasotracheal because there is direct ____. A flexible plastic or rubber suction
NOTas neededeasieraccessincreased
Two methods for performing ET suctioning are ____ & ____ (in-line). Both methods are considered equally effective in removing secretions.
Open suctioningClosed suctioning
Closed ET suctioning allows ____ circuit to stay closed ____ chances of contamination for both Pt/nurse, & chances of splashing & spraying are minimized. Closed suctioning is more easily performed by one person & is performed using ____ techn
respiratorydecreasingCLEAN
Tracheostomy tubes may be ____ or ____ & are used for ___-__ mechanical venilation, ____ neck surgery, &___ upper airway. Trachs are placed ____ & tubes may be ____ or ____, plastic, silicone, or ____. Suctioning methods are ___ or ___. Close
temporary or permanentlong-termradicalobstructedsurgicallycuffed or uncuffedmetalOpen & Closedon ventilator.
With Tracheostomy Suctioning it is necessary to ____ the amount of ____ pressure to prevent ____ damage. Therefore, always use the least amount of suction necessary.
adjustnegativemucosal
With , if _____ is felt after inserting catheter the recommended amount, you have probably hit the ____. This stimulates severe ____ & usually causes discomfort. In this event, pull back ____ then apply ____.
resistancecarinacoughing1-2 cmsuction
To determine suction catheter size for Tracheostomy Suctioning, – ____ the ET tube ____ X __, then use the next size ____ suction catheterFrench sizes are only even numbers!
multiplydiameter2smallerExample:8.0 ET tube X 2= 16Use 14 Fr suction catheterFrench sizes are only even numbers!
Guidelines for Trach Suction are: always assess Pt __ & __ suctioning & only apply suction when ____ cath, NOT on ____. Recommendations are to ____ Pt & give additional 02 ____ & ____procedure. If mouth & throat contain lrg amounts of
before & afterWITHDRAWINGinsertionhyperventilatebefore & afterfirstyankauerlowerSTERILEmouth10 seconds
Complications of Tracheostomy Suctioning are: irritation & bleeding of ____ ____, stimulation of gag reflex, Cardiac ___, Hypoxia & hypoxemia, caregiver exp., ______ infectn, ____ of secretions, bronchospasm or ____, elevated ____ pressure.
mucous membranesdysrhythmiasnosocomialaspirationbronchoconstrictionintracranial20bpm40bpm90%paraxysmalcyanosis
After Trach Suctioning, ____ Pt & dispose of equip by wrapping ____ around gloved hand & rolling glove off & over it to decrease contamination. _____ your findings, Pre & post ____ c___, a___, & consis___ of sputum, & Pt's toleran
reassesscatheterDocumentassesscolor, amount & consistency before, during, & after
Water seal drainage – 3 Bottle System (Pleur-evac Water Seal system - fxns same as three bottle system)Intermittent ____ in water seal chamber is seen during ____ or when Pt ____ sneezes.Tidaling in water seal chamber occurs w/___ &am
bubblingexhalationcoughsinspiration & expirationre-expanded or chestobstructed
Nursing Management of Chest Tubes is keep chest drainage tubing ____ from bed to container & coiled loosely ____ chest level. Instruct Pt not to lay on or compress tube & tape/secure all ____ between chest tube, drainage tubing & drainage col
straightbelowconnectionssuction & watertime & level colorbubblingfluctuationsinspirationexpirationoppositemechanical ventilationrespiratory distressdeepstripping
ONLY Clamp chest tubes for short periods of time & ONLY when accidentally ____, changing ____ bottles, checking for ____ in drainage system, checking for resolution of ____ (sometimes)Clamping for even short periods can create _____ press
disconnecteddrainageleakspneumothoraxintrathoracictension
Nursing Intervention & Eval of Chest tubes is maintain ____, patent, functioning, chest drainage system & ____ all connections & chest tube ____ as needed. Keep tubing unobstructed & place a rolled towel ____ chest tube to prevent compres
airtightre-tapedressingsundercoughdeep breathechange positionsobstructionclampdrainage
NDX:chest tubesAnxiety r/t ____risk of chest tube ____, system ____ & inability to breatheBreathing pattern ____ r/t ____ lung expansion, painRisk for ____ r/t ____ of chest tubePain r/t ____ inju
perceived dislodgmentdisruptionineffectiveasymmetricalinjurypresencetissue
Chest Tube Nursing Interventions & Eval include providing Pt w/inf about chest tube & ____ ____ & stress ____ of avoiding chest tube compression as well as maintaining tubing ____ level of ___. Explain ___ & ___ of drainage expected &
drainage systemimportancebelowbedtype and amountbubbling and fluid questionsbell
Chest Tube Removal are removed when the lungs are ___ & fluid drainage has ___, tidaling w/______ decreased or absent, ____confirmation, decreasing amount of ____ applied, chest tube may be placed to ____ drainage or ____ per physicians orders w/ clo
re-expandedceasedrespirationChest x-ray suctiongravityclampedremoval
With Chest Tube Removal you ____ supplies, ____ procedure to Pt & medicate if ordered. You will assist physician, Advanced Practice Nurse or PA to ____ chest tube. They will prepare a sterile dsg., clip ___, place occlusive dsg. over site; ask Pt to
prepareexplainremovesuturesdeep breathbear downrespiratorydressingcolor, amount, & odorpulse oxbreath sounds16 - 20/minute-ray
Suction tubes are typically ____ for adults & ____re-used for a 2nd pass if not contaminated.
12-14frcan be
The problem w/ cuffs is they can ___ & ___ the trachea. Suctioning an ET tube is ___ delegated.
erodeirritate NOT
Mini ____ State Exam Gauges mental state w/a maximum score of ___. Score of 24-30 may indicate ____, less than 20 may indicate ____/____. MMSE is important assessment every ____ for persons ___ & up.
Mental30depressiondementia/delirium6 months65 years
MMSE - Areas assessed are Orientation, ____, Attention & ____, Recall, Language & Level of ____ Continuum
RegistrationCalculationConsciousness
A Neuro asessment includes Cranial Nerve ___, ___, ___, & ____ strength such as hands strength & the ____ drift, as well as ____ strength, & Vital Signs ____ ____. The Romberg test assess balance
III, IV, VIMotorpalmarLowerCushing’s triad
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