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39 Cards in this Set

  • Front
  • Back
Types of Respiratory Problems
COPD Chronic Obstructive Pulmonary Disease, Emphysema, Asthma, Cystic Fibrosis, Chronic Bronchitis, **Cant get air OUT
Types of Respiratory Problems
Restrictive, Pneumonia, Neuromuscular, **Can't get air IN
Artificial Airways Function:
Maintain airway patency (clear), Facilitate removal of secretions, Facilitate mechanical ventilation
Types of Respiratory Problems
Types of Endotracheal Tubes
Orotracheal intubations (in mouth into trachea), Naso tracheal intubations (nose), Tracheostomy (straight into trachea)
Orotracheal Intubations - Pros
More common than naso, Less traumatic, Larger diameter tube (facilitates secretion removal, decreases airway resistance), Placement is temporary (10-15 days)
Orotracheal Intubations - cons
Discomfort and gagging, accidental extubation, Oral hygiene is difficult, P.O (by mouth) nutrition impossible, Damage to lips, teeth, gums, oropharynx, and vocal folds
Nasotracheal Intubations - pros
More comfortable - not in mouth, Oral hygiene can be facilitated, Smaller diameter tube necessary, Better tube stability, Better toleration of tube, **Used in cases of oral trauma/surgery
Nasotracheal Intubations - cons
Less common, More complications, Increased airway resistance, Sinusitis - infection of sinuses, tutus media, Suctioning is difficult, Frequent tube changes are required
Subclinical Problems of intubations
Vocal fold damage: Granulomas - growth of epithelia layer of v.f., contact ulcers, Laryngeal webs - chords fuse together
Anoxia
Complete/total lack of oxygen
Hypoxia
Reduction in oxygen
Respiratory failure
Exchange of O2 &/or CO2 between the alveoli & pulmonary capillaries is inadequate.
Intubations
Placement of endotracheal tube
Extubation
Removal of endotracheal tube
Tracheotomy
Surgical procedure to place a trach tube
Tracheostomy
Actual hole in neck as a result of a tracheotomy
Tracheotomee
Actual patient with a trach tube
Tracheostomy Tubes - Why
1. Upper airway obstruction at or above the level of the true vocal folds 2. Potential upper airway obstruction (i.e. edema following oral, pharyngeal, or laryngeal surgery) 3. Provision of respiratory care
Placement of trach tube
Generally inserted into the tracheal through a surgical incision thought the 3rd & 4th tracheal ring. Placed well below VF to avoid damage to the larynx. If emergency, may be placed at the. 2nd tracheal right and cause laryngeal scarring. Left in place until the airway obstruction is past & respiratory care is completed. Occasionally, may remain permanently
Trach Tubes - Pros
Decreased resistance (larger tube than oral or nasal tube). Efficient secretion removal/cleaning. Minimizes damage to larynx, vocal cords. Oral nutrition is possible. More comfortable
Trach Tubes - Cons (complications)
Hemorrhage, Thyroid injury, Injury to laryngeal nerves, Air leaks (pnemothorax) puncture of thoracic cavity, Tracheoesophagea fistula (hole between esophagus and trachea), Cardiac arrest, Tracheostomy too high or low
Trach Tubes - Physiological changes:
Phonation lost, Humidification/filtration/warming - become very dry, Secretions - very difficult to manage, No valsalva maneuver - bare down & close v.f., difficult going to bathroom and lifting heavy things, blowing nose, Decreased ciliary activity, Increased airflow resistance - breathing different, Decreased back pressure within lungs, Bathing/showering - must cover or drowned, Swallowing, Psychological changes
Trach tube parts
1. Outer cannula 2. Inner cannula 3. Obturator
Outer cannula
(always stays in place to hold the trach site open until it can be allowed to close)
Inner cannula
(remains in the tube except for cleaning)
Obtrurator
(inserted only to provide a smooth, rounded tip for the initial insertion of the trach tube)
Trach tube variations - cuffed vs. uncuffed
A cuff surrounds the lower portion of the trach tube like a balloon Cuffed trach is used when there is need for respiratory treatment of potential for patient to aspirate material If deflate the cuff, then same as uncuffed trach allowing air to pass upward
Cuffed Trachs
"Suction right away after deflating cuff. Fully inflated cuffs are usually not left in place for long periods of time due to the pressure of the cuff contacting the tracheal wall which can cause irritation. May cause ischemia (change in blood flow) and lead to stenosis (narrowing of trachea). To prevent the above, may fully inflate then take 1-2 cc of air out of the cuff so some decrease pressure on tracheal wall. Sometimes, fully inflated cuffs will still allow air leakage and aspiratation due to ill-fitting tube &/or trachea wall deviations
Trach Tube Variation
Fenestrated vs. Unfenestrated trach tubes. Fenestrated tubes have a window cut into tube to allow for greater airflow. Usually made only to the outer cannula. So, need to remove the inner cannula if you want them to talk. Used for patients having difficulty producing voice with a normal tube or close to being weaned off trach tube. Rare for cuffed trachs to be fenestrated (negates what cuff does).
Weaning off a trach tube
Usually done by decreasing the size of the trach tube. May use a plug or cap to see how functioning with normal respiration
Speaking Valves
Caps/Plugs. Inserted onto/into trach tube to force normal respiration and voicing. One-way speaking valves: Common type (brand) passy-muir valve - Allows air to come in through the trach tube but not out… forcing it up through the VF
Speaking Valves: How they're used and when they're appropriate
Cuffed must be deflated. As part of the weaning process. To create closed pressure system. As tolerated by patient
Trachs & Swallowing - Blue Dye Test
Deflate cuff. If not able to deflate due to medical stability then question if swallowing is appropriate yet. Check voicing and speech using finger occlusion. Use finger occlusion or valve during swallowing. Ideally should have RT and RN present. CA just recently gave SLP the okay to do deep suctioning
Blue Dye Test
Only about 40-50% accurate. No false positives.. May have false negatives though. Do your bedside swallowing evaluation as usual but add blue coloring to all consistencies. You'll want to suction immediately, 10 minutes later, 20-3- minutes late. Nursing or RT will continue to monitor throughout day. IF MEDICALLY/PHYSICALLY ABLE, DO AN MBS OR FEES!!!!
Ventilator Dependence - aka
Mechanical ventilation
Ventilator Dependence - Goals
Maintain alveolar ventilation appropriate to patient's metabolic requirements. To correct hypoxemia (decreased O2 in arterial blood causing hypoxia)
Ventilator Dependence - problems with speech & swallowing
1. Difficulties coordinating speech or swallowing with breathing cycle for ventilation 2. Difficulty with short exhalation cycle of ventilator. Cuff is usually inflated.
Ventilator Dependence - Assessment Process
1. Best to focus on speech before swallowing. 2. Present food at beginning of exhalation,