EXAM1, SPRING07, AIRWAY, SUCTIONING, CHEST TUBES Dee

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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 â€œnasal 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: â€œCâ€

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, â€“ ____ 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 â€“ 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

Cushingâ€™s triad

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