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Causes:
Food particles
Vomitus
Blood clots
Other particles that enters & obstruct the
larynx & trachea
Patient w/ altered LOC (loss of protective
reflexes)
ORAL AIRWAYS
Are stiff plastic tubes inserted into the
patients mouth to prevent the tongue from
sliding back into the pharynx and blocking
the airway.
Nursing Responsibilities
Choose the proper size for the patient
(measures from the corner of the patients
mouth to the tip of the earlobe).
Explains the procedure to the patient or to
the relatives.
Suction equipment available at bedside.
Check the patency
Copyright 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
9
NASAL AIRWAYS
-referred to as nasal trumpets
- are soft, flexible tubes that are inserted
into the nasal passage to maintain an
open airway
-commonly used for patients who require
frequent nasotracheal suctioning.
Nursing responsibilities
Choose the appropriate size for the
patient-measure the oral airway from the
nares to the tip of the earlobe and then
adding 1 inch.
Nasal airway should be lubricated with
water soluble lubricant.
Explain the procedure
Equipments:
Crash cart
Suction equipment with tonsil tip suction
catheter.
ETT tray should include;
Laryngeal scope (curved/straight)
ETT
lubricant
Stylet
Syringe for balloon inflation
Oral airway
Magill forceps
Personal protective eyewear & gloves
Tape
Nursing Responsibilities
ETT is lubricated and stylet is placed in
center of the tube to ease insertion.
Check patency by auscultation
CXR after the procedure to verify
appropriate placement.
Secures tube with tape.
Document the centimeter marking at the
lip of the patient to monitor for tube
movement
Copyright 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
19
TRACHEOSTOMY
Is placed by surgical incision in the
trachea, either in the operating room or in
the bedside.
Is placed and is secured by sutures.
Is required for all patients who require
long-term ventilator support
1.
2.
3.
4.
5.
Vocal folds
Thyroid cartilage
Cricoid cartilage
Tracheal ring
Balloon cuff
MECHANICAL VENTILATION
INDICATIONS FOR MECHANICAL
VENTILATION:
Decreased oxygen saturation or oxygen
deficit
Increased work of breathing and respiratory
rate with impending respiratory failure.
Apnea
Continuous Mandatory
Ventilation (CMV)
Is a mode of ventilation that delivers a
minimum preset respiratory rate to a
patient
This mode is frequently used for patients
who have underlying chronic respiratory
problems and come into the ICU with an
acute exacerbation.
Synchronized Intermittent
Mandatory Ventilation (SIMV)
Will deliver a preset tidal volume or
pressure for every preset breath.
This mode is frequently used for patients
being weaned from mechanical ventilation
or for patients who require short term
ventilatory support and have no underlying
lung disease.
Ventilator Settings
Patients who are being mechanically
ventilated have prescribed ventilator
settings that are adjusted according to
patient condition.
FiO2 may be set anywhere from 21-100
percent.
Tidal volume- is the amount of air
exchanged or delivered with each
inspiration and expiration.
Copyright 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.
39
Mechanical Ventilation
Pressure-control versus volume-control
Ventilator settings
Fraction of inspired oxygen (FiO2)
Tidal volume (Vt)
Nursing Management of
Mechanically-Ventilated Patients
Indications for ventilator weaning
Resolution or marked improvement of illness
Adequate nutritional status
Normal electrolytes
Hemodynamically stable
Ventilatory muscle strength
Nursing Management of
Mechanically-Ventilated Patients
Nursing care during weaning
Psychological support-should be provided
during the process of weaning
Education/information- the process should
be explained to the family and patient and
both should be kept informed of the
patient progress.
Nursing Management of
Mechanically-Ventilated Patients
Withdrawal of life support
Patient request
Health care team
Ethics committee