EXAM1, SPRING07, AIRWAY, SUCTIONING, CHEST TUBES Dee
Terms
undefined, object
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- 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 ____.
-
Oropharyngeal
lips
pharynx
mechanically
tongue
pharynx
non 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-conscious
laryngospasm
long
gagging
epiglottis
teeth
against
jaw - DO NOT _____ oropharyngeal airway device in place because when patient becomes ____ he wouldnt be able to ____ device which increases risk of gagging & ______.
-
tape
alert
expel
aspiration - 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 technique
mouth
ear
hands
gloves
goggles
back
hyperextended - 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 down
pharynx
rotate
uvula
Auculate
ventilation
side
aspiration
4hrs
irritation
secretions - 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.
-
upper
gag reflex
drooling
teeth
biting
respirations
increased
increased -
ONLY use an oropharyngeal airway when patient doesnt have a ___ ___. When sizing, device should be ____ one that fits.
Premi's & neonates 000
newborns 00
newborn - 1yr 0
1-2 yrs 1
2-6 yrs 2
6-18 yrs 3
18 + 4-10 -
gag reflex
smallest -
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 000
newborns ?
newborn - 1yr ?
1-2 yrs ?
2-6 yrs -
oropharyngeal
NOT
Premi's & neonates 000
newborns 00
newborn - 1yr 0
1-2 yrs 1
2-6 yrs 2
6-18 yrs 3
narrow
obstructive - Documentation for oropharyngeal airway includes assessment findings for inserting airway, size, placement, tolerance, presence of ____ distress, vomiting, quality of ____, & pain.
-
respiratory
secretions - 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
-
gagging
stop
aspiration
smaller
immediate assistance
clearing -
Nasal pharyngeal airways
aka "nasal trumpets" are preferred in ____ patients because it is better tolerated & less likely to ___ ___. -
responsive
induce 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 trumpetsâ€. 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
-
responsive
pediatrics
large
oral
jaws
irregular
drooling
maintenance
can be
sterile jelly
CLEAN
semi 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.
-
passages
obstructions
hemorrhage
largest
nares to ear
EXPLAIN - 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
-
EXPLAIN
nares to the ear
largest
semi-fowlers
sterile jelly
CLEAN
posteriorly
ear
oropharynx
rotating
nostril
tape - Nasal Pharyngeal Airway can be used in conjunction w/ ______, & nasal tubing can be inserted into ______.
-
oropharyngeal airways
both 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
-
ventilatory
bag-valve-mask (BVM)
Ambu bag
two people
airtight
oral or nasopharyngeal
both 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
-
nose
mandible
thumbs
neutral - 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 seal
squeezes
both hands
chest
deflated
inflate
CPR - 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
-
“Câ€
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 _____
-
depth
gas exchange
100%
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.
-
negative
pulmonary
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'
-
mechanically
upper
lower
overdose
effectively
respiratory -
Types of suction for Endotracheal intubation are:
1- ________
suctioning mouth & pharynx
2- ________
suctioning through nose
into naso-pharynx & trachea
3- _________
suctioning Endotracheal t -
oropharyngeal suctioning
Nasotracheal suctioning
Artificial 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
-
Yankauer
CLEAN
universal
may be
thick
facial
swallowing
hygiene - 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
-
flexible
STERILE
poorly
lower
NOT
sputum - 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
-
mechanical
aspiration
temporary
2-4 weeks
cuff
aspiration
airway
escape
NOT - 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
-
NOT
as needed
easier
access
increased - Two methods for performing ET suctioning are ____ & ____ (in-line). Both methods are considered equally effective in removing secretions.
-
Open suctioning
Closed 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
-
respiratory
decreasing
CLEAN - 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 permanent
long-term
radical
obstructed
surgically
cuffed or uncuffed
metal
Open & Closed
on ventilator. - With Tracheostomy Suctioning it is necessary to ____ the amount of ____ pressure to prevent ____ damage. Therefore, always use the least amount of suction necessary.
-
adjust
negative
mucosal - 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 ____.
-
resistance
carina
coughing
1-2 cm
suction -
To determine suction catheter size for Tracheostomy Suctioning, – ____ the ET tube ____ X __, then use the next size ____ suction catheter
French sizes are only even numbers! -
multiply
diameter
2
smaller
Example:
8.0 ET tube X 2= 16
Use 14 Fr suction catheter
French 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 & after
WITHDRAWING
insertion
hyperventilate
before & after
first
yankauer
lower
STERILE
mouth
10 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 membranes
dysrhythmias
nosocomial
aspiration
bronchoconstriction
intracranial
20bpm
40bpm
90%
paraxysmal
cyanosis - 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
-
reassess
catheter
Document
assess
color, 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 -
bubbling
exhalation
coughs
inspiration & expiration
re-expanded or chest
obstructed - 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
-
straight
below
connections
suction & water
time & level
color
bubbling
fluctuations
inspiration
expiration
opposite
mechanical ventilation
respiratory distress
deep
stripping -
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 -
disconnected
drainage
leaks
pneumothorax
intrathoracic
tension - 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
-
airtight
re-tape
dressings
under
cough
deep breathe
change positions
obstruction
clamp
drainage -
NDX:
chest tubes
Anxiety r/t ____risk of chest tube ____, system ____ & inability to breathe
Breathing pattern ____ r/t ____ lung expansion, pain
Risk for ____ r/t ____ of chest tube
Pain r/t ____ inju -
perceived
dislodgment
disruption
ineffective
asymmetrical
injury
presence
tissue - 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 system
importance
below
bed
type and amount
bubbling and fluid
questions
bell - 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-expanded
ceased
respiration
Chest x-ray
suction
gravity
clamped
removal - 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
-
prepare
explain
remove
sutures
deep breath
bear down
respiratory
dressing
color, amount, & odor
pulse ox
breath sounds
16 - 20/minute
-ray - Suction tubes are typically ____ for adults & ____re-used for a 2nd pass if not contaminated.
-
12-14fr
can be - The problem w/ cuffs is they can ___ & ___ the trachea. Suctioning an ET tube is ___ delegated.
-
erode
irritate
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.
-
Mental
30
depression
dementia/delirium
6 months
65 years - MMSE - Areas assessed are Orientation, ____, Attention & ____, Recall, Language & Level of ____ Continuum
-
Registration
Calculation
Consciousness -
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, VI
Motor
palmar
Lower
Cushing’s triad