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26 Cards in this Set

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List 7 steps of suctioning
1. hyperoxygenate, before during and after -- 100% for 3 minutes or 3 deep breaths
2. explain procedure
3. semi-fowlers
4. lubricate with sterile saline
5. advance
6. apply suction and withdraw with rotating motion -- no more than 10 seconds
7. repeat after patient rested
What order to you suction et or trach tube and mouth?
ET or trach first and the mouth
How often trach care performed?
q 8 hours
List 14 steps of trach care
1. explain procedure
2. hyperoxygenate
3. suction tube
4. remove old dressing (clean gloves)
5. open sterile trach kit
6. sterile gloves
7. remove inner cannula
8. clean with hydrogen peroxide
9. rinse with sterile water, dry (nonlint)
10. reinsert
11. clean stoma site (hydrogen peroxide - rinse sterile water)
12. change ties
13. apply new dressing
14. document site ot trach, secretions, patient tolerance
What is purpose of trach cuff?

When is it inflated?
prevents aspiration of fluids

inflated during mech ventilation - during and after eating, tube feeding and 1 hour after, aspiration risk
How often do you check cuff pressure?

What shoud it be maintained at?
every 8

maintained at 24 cm/h20
Nasal cannula deliver how much oxygen?
20-40 at 1-6L/min
Face mask delivers how much oxygen?

How often should you remove?

Skin care?
40-60% at 5-8 L/min (minimum of 5 L/min)

remove every 1-2 hours

lotion to skin
Partial rebreather mask

What are parameters for oxygen flow?
50-75 at 8-11 L/min

Keep bag 2/3 full during inspiration
Nonrebreather
80-100% --

keep bag 2/3 full
Venturi mask

What does this type of deliver provide?
24-55 at 4-10 L/min

high humidity and fixed concentrations
Trach collar or t-piece

special care
24-100% at 10 L/min

keep water container full
Croupette care
up to 40%

check 02 q 4

refill humidity jar -- clean daily

cap for head

change linens frequently
Name components of chest tubes?
collection chamber
water seal chamber
suction control chamber
How much drainage is expected in the collection chamber?

What does drainage look like?

Mark how often?
no more than 100 ml per hour

serosanguinous -- not bright red

mark in 1 to 4 hour intervals
What is the water seal chambers purpose?
tip is underwater to allow fluid and air to drain from lungs without air entering into pleural space
What should you see with water seal chamber?

What should you not see?
water moves up as client inhales and down as client exhales

constant bubling means air leak in system -- intermittent bubbling is okay
What is purpose of suction control chamber?

What should you see with suction control chamber?
provide specific amount of suction

Should see continuous bubbling
Should patients move about with chest tube in place?
Yes -- patients should change positions frequently.
What should you do if tube becomes disconnected from drainage system?
either insert a sterile connected and reattach or immerse in 2 cm of sterile water
Describe levin tube and how used?
single lumen -- used to remove gastric contents with intermittent suction and provide tube feedings
Describe Salem sump and how used?
double-lumen ng with airvent -- used for decompression with continuous suction -- don't clamp airvent and keep above stomach level
What do you do if a leak occurs in air vent?
instil 30 ml of air and irrigate main lumen with ns
What are steps of insertion of levin/salem sump?
1. measure
2. mark distance with tape
3. lubricate
4. insert
5. offer sips of water-- bend head forward
What should you watch for when inserting ng tube?
respiratory distress -- means tube is in lungs
How do you verify placement initially and before feedings?
x-ray only sure way to verify placement

aspirate gastric contents --