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18 Cards in this Set
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Assignment 6 |
white clinical lab competencies Chapter 18 page 380 to 392, questions |
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Nasotracheal intubation |
More difficult than orotracheal intubation Performed either blindly or with visualization (can use magill forcepts and laryngoscope) :direct visualization requires either standard or fiberoptic laryngoscope Steps for nasotracheal intubation are similar to those of orotracheal intubation |
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Extubation decannulation |
Extubation: process of removing oral or nasal endotracheal airway Decannulation: process of removing trachesotomy tube Assess patients readiness for extubation or decannulation :original problem is no longer present :quantity and thickness of secretions :upper airway patency :presence of intact gag reflex :Ability to clear airway secretions |
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Extubation Procedure |
Assemble equipment Towel, scissors, gloves, suction, O2 device, syringe explain procedure to patient Pre oxygenate patient, remove ETT tape Suction oropharynx |
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Extubation procedure |
Insert catheter :instruct patient to "take a deep breath" when instructed (count to 3 etc) Deflate the cuff and remove the tube swiftly :applying suction throughout withdrawal Apply O2 auscultate lungs and neck for stridor Check SpO2, instruct patient to deep breath and cough |
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Steps of extubation |
Step 1 assemble needed equipment Step 2 suction endotracheal tube and pharynx above cuff Step 3 oxygenate patient Step 4 deflate cuff Step 5 remove tube while applying suction as you withdrawl Step 6 apply appropriate oxygen and humidity therapy :O2 with cool mist which is usually about 2 to 10 micros coming out of LVN Step 7: assess/reassess patient :Check for good air movement by auscultation |
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Laryngectomy tube |
If larynx removed due to cancer, this tube can be inserted into the permanent stoma |
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Tracheotomy |
Procedure of establishing access to trachea via neck incision :either traditional surgical tracheotomy or percutaneous dilatational tracheotomy can be performed Opening in neck is called "tracheostomy" Tracheotomy Procedure is best performed by physician or surgeon after patients airway is stabilized(which means patent and secured by an endotracheal tube) Selection of trachesotomy tubes depend on :patients age :height :weight :airway anatomy |
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Tracheotomy |
If patient is doing fine on ETT tube and will be able to be extubated within 14 days, continue with ETT tube and extubate after. If patient needs more than that, then tracheotomy is suggested |
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the primary indications for an artificial tracheal airway include all the following, except |
Provide negative pressure ventilation |
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Types of trach tubes |
Cuffed trach tubes Double cannula trach tubes Single cannula trach tues Fenestrated trach tubes |
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Cuffed trach tube |
Cuffed :provide seal between upper and lower airway to prevent aspiration of food or secretions :Maintain a seal during mechanical ventilation
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Double cannula trach tube |
Outer cannula Inner cannula Obturator aids insertion of the outter cannula Cuff Pilot balloon
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Single Cannula trach tube |
Single cannula :appropriate for permanent trach :patients with minimal secretions Pediatric patients
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Airway maintenance |
Role of RTs :secure tube and maintain placement :provide for patient communication :for the patient to be able to speak, the cuff must be deflated when using a trachestomy tube :ensure adequate humidification :minimize possibility of infection (sterile and asepsis) :Aide in secretion clearance :Provide appropriate cuff care :Troubleshoot airway related problems
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Airway maintenance |
Tracheostomy care :Step 1: assemble and check equipment :Step 2 explain procedure to patient :Step 3 suction patient :Step 4 remove and replace inner cannula(not clean its disposable) :Step 5 clean and examine the stoma site (saline or hydrogen peroxide)
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Fenestrated tracheostomy tube |
Has holes prior to the cuff then the tip(end of the tube) |
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Parts of the tracheostomy tube |
1. Out cannula: keeps stoma open 2. Inner cannula: can be removed for cleaning 3. obturator: used to insert outer cannula 4. Cuff seals airway 5. Plug (button) keeps air from OC(outter cannula) when fenestration is used |
