Airway Management and Mechanical Ventilation (ENDOTRACHEAL TUBES ETT)

Question 1

Cranial nerve for cough and gag reflex is

Answer 1

9 and 10

Question 2

Indications for an Artificial Airway

Answer 2

1. upper airway obstructions
2. apnea
3. high risk for aspiration
4. ineffective clearanc of secretions
5. respiratory distress

Question 3

Equipment needed for a Endotracheal Intubation

Answer 3

1. Self inflating BVM/ ambu bag and mask and oxygen
2. ET tube, guide wire, lubricant, securement device, End Tidal CO2 detector
3. Suctioning equipment
4. IV access and medications as indicated

Question 4

Preparation for intubating

Answer 4

1. consent/ resuscitation status
2. client teaching
3. position client
4. preoxygenate

Question 5

Things nurses do during intubation

Answer 5

1.Limit each intubation attempt to less than 30 seconds
2.Ventilate client between successive attempts
3. Rapid sequence intubation (RSI) (administer sedative and Paralytic agents)
4. Monitor oxygenation status
5. Assess for signs of hypoxia, dysrhythmias, aspiration

Question 6

After intubation you..

Answer 6

1. confirm placement of et tube
   (a) End-tidal CO2 detector (Gold is good)
   (b) Auscultate lung bilaterally
   (c) Observe chest wall movement
   (d) Check O2 saturation

Question 7

After placement verification you..

Answer 7

(a) Inflate cuff
(b) Secure airway
(c) Suction oropharynx and ET tube as needed
(d) Obtain chest x-ray (2-6 cm above carina)
(e) Record and mark position of tube in cm at teeth or gums
(f) Monitor oxygen saturation continuously, may monitor end-tidal CO2 continuously
(g) Obtain ABGs as ordered

Question 8

Mechanical Ventilator Modes

Answer 8

1. Assist-control ventilation (A/C)
2. Synchronized intermittent mandatory ventilation (SIMV)
3. Continuous positive airway pressure (CPAP)

Question 9

Used for clients who have weak respiratory muscles and may be
unable to maintain adequate ventilation

Answer 9

Assist-control ventilation (A/C)

Question 10

Ventilator synchronizes the mandatory breaths with the client’s own inspirations

Answer 10

Synchronized intermittent mandatory ventilation (SIMV)

Question 11

Provides continuous positive airway pressure during spontaneous breathing

Answer 11

Continuous positive airway pressure (CPAP)

Question 12

fever, increased WBC, purulent sputum, crackles or wheezes, pulmonary infiltrates are signs of

Answer 12

Ventilator-associated pneumonia

Question 13

How to prevent Ventilator-associated pneumonia

Answer 13

1) Minimize sedation and spontaneous breathing trials
2) Early exercise and mobilization (turn q 2hrs)
3) Subglottic secretion drainage port
4) Elevate HOB 30-45 degrees
5) Oral care with chlorhexidine
6) No routine changes of ventilator circuit tubing
7) Good hand hygiene

Question 14

Assessment on ETT

Answer 14

1- tube type: oral or nasal
2- size of airway
3- location at teeth, gums (marking on tubing)

Question 15

Procedure for suctioning

Answer 15

1. hyperoxygenate before and after
2. limit suctioning time to 10 sec or less
3. monitor Sp02 and ECG
4. Limit suction pressure <120mmHg
5. Insert until client coughs or meets resistance, whichever comes first

Question 16

Complications of suctioning (LOOK AT ALL VITALS BEFORE SUCTIONING)

Answer 16

(a) Hypoxemia (that’s why you always hyper oxygenate first)
(b) Bronchospasm (might develop wheezing, high pressure alarm might go off) (Give albuterol for bronchospasms but if HR is high ibutropem)
(c) Increased intracranial pressure
(d) Dysrhythmias
(e) ↑ or ↓ BP
(f) Mucosal damage (excessive suctioning can cause trauma and make it bleed)
(g) Pulmonary bleeding
(h) Pain
(i) Infection
(j) ALWAYS TELL PATIENT YOU ARE GONNA SUCTION BEOFRE YOU DO.

Question 17

Manage thick secretions

Answer 17

(1) Adequate hydration
(2) Supplemental humidification
(3) No saline instillation (DO not use saline UNLESS patient has a mucus plug)
(4) Mobilize and turn client
(5) Antibiotics as needed (if have pneumonia, yellow secretions, fever, high WBC, has smell.)

Question 18

Provide oral care and maintain skin integrity q2-4 hrs

Answer 18

(1) Brush teeth BID
(2) Oral swabs with 1.5% hydrogen peroxide and/or
mouthwash
(3) Chlorhexidine (an antiseptic and disinfectant) oral rinse twice/day. Every 12 hours or every shift.
(4) Moisturizer- lips, tongue, gums
(5) Oropharyngeal suctioning
(6) Reposition and retape ET tube every 24 hours. Try to prevent skin breakdown