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30 Cards in this Set
- Front
- Back
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What medical conditions require mechanical ventilation?
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-spinal cord injury
-acute respiratory distress syndrome -progressive neuromuscular disease -chronic obstructive pulmonary disease -cardiopulmonary illness (congestive heart failure, cardiac failure, pulmonary edema) |
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What are examples of artificial airways?
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-endotracheal tubes
-nasotracheal tube -tracheotomy tubes |
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Describe endotracheal tubes.
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-artificial airway
-thru the mouth -short-term (1-7 days) -used for surgery -risk of laryngeal injury -risk of aspiration -sore throat |
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Describe nasotracheal tube.
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-artificial airway
-thru nose |
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Describe tracheotomy tubes.
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-artificial airways
-long-term (>7 days) -bypass upper airway -greater comfort -effective means of secretion removal -improved options for oral comm and swallowing -improved oral hygiene |
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What is a stoma?
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opening in neck
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What is a tracheotomy?
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name of surgical procedure for trach input
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What is a tracheostomy?
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resulting hole and placement of tube (incision between 2nd and 3rd tracheal ring; tube has cuff if used for mechanical ventilation)
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What is the outer flange?
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-part of tracheostomy
-rests on patient's neck and keeps the tube from falling through the tracheostomy |
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What is the outer cannula?
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-part of tracheostomy
-main part of trach, goes into airway |
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What is the inner cannula?
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-part of tracheostomy
-smaller tube which can be inserted in to outer cannula, easier to clean |
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What is the obturatory?
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-part of tracheostomy
-fits inside outer cannula to make insertion easier, then taken out as it blocks airway |
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What is the universal hub?
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-part of tracheostomy
-regardless the size of trach, a 15mm hub extends from the tube to attach to vent tubing or a speaking valve |
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What is the cuff?
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-part of tracheostomy
-surrounds lower part of outer cannula, connected to a small tube which travel to the pilot pushed in by the vent to reach the lungs -the cuff is the TVFs |
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What is the fenestrations?
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-part of tracheostomy
-some trach tubes have a hole or multiple holes in the outer cannula -these fenestrations allow air to travel through the TVFs above while the cuff is still inflated |
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What physiological impacts does a tracheostomy have?
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-absence of airflow thru glottic, nose, and mouth
-loss of taste and smell -decreased laryngeal sensation -decreased subglottal pressure (decreased closure) -loss of phonation -reduced true vocal fold closure and coordination -esophageal compression -increased secretions (body produces more as a result of the foreign object) |
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What are potential problems associated with tracheostomy tubes?
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-ineffective cough
-impaired reflex cough (bypass glottis) -obstructed cervical esophagus (cuff over-inflation) -tracheomalacia (persistent cuff pressure--can develop into a hole between trachea and esophagus) -increased aspiration risk (decreased laryngeal elevation, anchoring) |
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What are the different ventilator settings?
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-tidal volume (amount of air in a breath)
-respiratory rate (number of breath in a min) -inspiratory flow rate (how much gas is given per min) -inspiratory time: expiratory time (I:E ratio) (how long it takes to breathe in and out) -sensitivity (how much pressure the patient has to generate in order to trigger the vent to give a breath) -fractional inspired oxygen concentration (FIO2) (portion or percentage of 100% oxygen given with each inspiration) |
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What alarms are on ventilators?
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-high-pressure: too much pressure to take air in, coughing, water in tube
-low-pressure: disconnections, leaks, cuff not inflated properly |
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When can a PMV be used?
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-with a cuffless trach or when cuff is deflated
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What does the Passy-Muir Valve do?
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allows inhalation via the trach, but exhalation occurs via the nose and mouth (so patient can speak)
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What physiological impacts does the PMV have?
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-airflow
-oxygenation -sensation -cough, secretion management -subglottic air pressure |
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What changes in cough and secretion management are there with the PMV?
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-improved sensitivity to cough
-with more forceful, effective cough, less suctioning may be required -sensing/clearing secretions in upper airway -able to blow nose -increased sub-glottal air pressure -expedites vent and trach weaning |
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True or false: Re-education of breath patterns and voice production may be necessary when adjusting to a one-way valve (aka PMV).
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True: patient may have "forgotten" how to breathe thru nose and mouth.
-may incorporate "distractions" such as recreation therapy when pt's experience anxiety with PMV/cap trials |
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What things will your assessment include?
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-feeding tube type (NG, PEG, J-tube)
-oxygen saturation -suction frequency/secretion management -sleep-wake cycle -presence of trach tube (reason, length of time) -type, size -tolerating cuff deflation? -tolerating PMV? -lung sounds -how frequently suctioned -location, amount, type of secretions -cough strength -any material around trach site? -ventilator settings, weaning? |
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What does the RT initial eval include?
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-trach tube size and type
-cuff status -vital signs -trach cuff pressure/volumes |
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What does the SLP initial eval include?
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-cognition
-swallow -voice -language |
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What are examples of "stop criteria"?
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-heart rate: >20 BPM
-respiratory rate: >35 breaths/min -SpO2: <90% |
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What is the MEBD?
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-Modified Evans Blue Dye Test
-assessment tool used w/ trachs -presented food/liquids dyed blue -varying bolus sizes -immediate and delayed suctioning |
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What conclusion is made about the MEBD?
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-not sensitive to detect micro-aspiration, only sensitive to detect gross aspiration (compared to FEES/MBS)
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