rcp 330 week 1

Question 1

bronchospasm

Answer 1

abnormal contraction of the smooth muscle of the bronchi, resulting in acute narrowing and obstruction.

Question 2

bronchospasm stimulated by

Answer 2

catheter in the lower airway
patients with hyperactive airway disease

*stop suctioning and administer aerosolized bronchodilator

Question 3

preventing hypoxemia when suctioning

Answer 3

preoxygenate the patient
not disconnecting the ventilator
closed suction technique
steady FiO2/ PEEP - lung decruitment

Question 4

Maxillary trauma

Answer 4

NPA (nasopharyngeal)

• direct visualization
• blind passage

Question 5

size of artificial airway adapter

Answer 5

15mm

Question 6

purpose of pilot balloon

Answer 6

used to measure cuff status and pressure when the tube is in place

Question 7

Complications associated with suctioning

Answer 7

hypoxemia 
cardiac dysrhythmias 
hypotension / hypertension
atelectasis
mucosal trauma
ICP
bacterial colonization of lower airway

Question 8

hypoxemia

Answer 8

not pre oxygenating enough, use closed suction technique and maintain FiO2 levels and PEEP

Question 9

cardiac dysrhythmias

Answer 9

vagal nerve stimulation, agitation, hypoxemia, stop suctioning, keep a pulse ox on during admistering and apply O2/ ventilation

Question 10

hypotension / hypertension

Answer 10

cardiac dysrhythmia, hypoxemia, anxiety, stress, pain, coughing, stop suctioning, apply O2 / ventilation, explain procedure, be calm, pre oxygenate

Question 11

atelectasis

Answer 11

too much negative pressure and not appropriate catheter size, use closed-system technique and do not disconnect patient, pre oxygenate

Question 12

mucosal trauma

Answer 12

too much negative suction pressure, shallow suction method and use NPA

Question 13

ICP

Answer 13

cough, discomfort, previous injury, administer lidocaine 15 min before suctioning to minimize ICP to prevent

Question 14

bacterial colonization of lower airway

Answer 14

using normal saline, open-system technique, and disconnecting vent. ETT patients, sterile technique should be used with a closed-system. Only use normal saline when necessary

Question 15

steps for intubation

Answer 15

assemble and check equipment 
position patient
pre oxygenate / ventilate
insert laryngoscope 
visualize glottis
displace glottis
insert tube
assess tube position
stabilize tube and confirm placement

Question 16

position patient

Answer 16

align mouth, pharynx, and larynx

moderate cervical flexion
extension of atlantooccipital joint
placement of pillows under shoulders
flexes neck and tilts head backward
sniffing position

Question 17

features on ETT that indicate placement

Answer 17

tube markings in cm

radiopaque

Question 18

assess tube position

Answer 18

auscultation of chest and abdomen
observation of chest movement
tube length 
light wand
capnometry 
colorimetry
flexible laryngoscopy / bronchoscopy 
videolaryngoscopy 
ultrasound

Question 19

miller blade

Answer 19

straight blade and directly displaces epiglottis

Question 20

mcintosh

Answer 20

curved blade and indirectly displaces epiglottis

Question 21

ETT depth

Answer 21

men 21-23

women 19-21

Question 22

indications for tracheostomy tube

Answer 22

overcoming upper airway obstruction or trauma
people with poor protective reflexes
prolong period of intubation

Question 23

cuff pressures

Answer 23

normal 20-30cmH2O

high = cuts off mucosal blood flow

• tissue damage
• tracheal wall injury

low = aspiration of oral secretions

Question 24

how often are patients suctioned

Answer 24

only when indicated

Question 25

suctioning adults pressures

Answer 25

-120 to -150

Question 26

suction time vs total time

Answer 26

suction time = 10 seconds | total time = 15 seconds

Question 27

when a patient does not tolerate suctioning

Answer 27

discontinue treatment

Question 28

equipment needed for intubation

Answer 28

``` oxygen flowmeter and tubing suction apparatus flexible sterile suction catheters sterile gloves for endotracheal suctioning yankauer tip suction manual resuscitation bag and mask colorimetric carbon dioxide detector oropharyngeal airways laryngoscope (two) with assorted blades endotracheal tubes (three appropriate sizes) tongue depressor stylet stethoscope tape or endotracheal tube holder 10-mL or 12-mL syringe water-soluble lubricating gel magil forceps local anesthetic towels barrier precautions ```

Question 29

equipment needed for nasotracheal suctioning

Answer 29

vacuum source calibrated, adjustable regulator collection bottle and connecting tube disposable, sterile gloves sterile suction catheter standard precautions, goggle, masks oxygen source with calibrated flow meter or ventilator pulse oximeter manual resuscitation bag equipment with O2 enrichment device for emergency use stethoscope **sterile water-soluble lubricating jelly

Question 30

nosopharyngeal airway

Answer 30

patients who require nasotracheal suctioning - minimizes damage to mucosa facial surgery helps maintain patency of upper airway

Question 31

artificial airway inserted into larynx

Answer 31

endotracheal tube

Question 32

murphys eye

Answer 32

side port | ensures gas flow if the main port should become obstructed

Question 33

purpose of artificial airway cuff

Answer 33

prevent tracheal mucosal injury minimize aspiration seal to prevent air leaks during ventilation

Question 34

advantages of tracheostomy with inner cannula versus without

Answer 34

can be cleaned or replaced if obstructed or occluded instead of changing a whole trache prevents emergency changing of whole device recommended for patients going home with a TT or in situations in which humidity delivered to the airway is less than optimal

Question 35

tracheostomy inserted

Answer 35

traditional - over second or third ring | percutaneous - circoid and first ring or between first and second ring

Question 36

symptom of vocal cord inflammation and glottic edema

Answer 36

stridor retractions inability to feel airflow in upper airway

Question 37

complications with intubation / rare and serious

Answer 37

``` laryngeal lesions glottis edema vocal cord inflammation laryngeal / vocal cord ulcerations vocal cord paralysis vocal cord stenosis ```

Question 38

steps to wean a patient off a tracheostomy tube

Answer 38

- fenestrated tubes - progressively smaller tubes - tracheostomy buttons - patient should have sufficient muscle strength to generate cough ( peak expiratory pressure > 40 cmH2O) - ideally there should be no active pulmonary infection, and the volume and thickness of secretions should be acceptable - patency of upper airway assessed via bronchoscopy - adequate swallow must be present to decrease risk of aspiration

Question 39

device commonly used to suction secretions or fluids from the oropharynx

Answer 39

rigid tonsillar | yankauer suction tip

Question 40

special catheter used to facilitate entry into the left mainstem bronchus

Answer 40

curved-tip catheter

Question 41

emergency tracheal airway

Answer 41

orotracheal (oral passage)

Question 42

why is suction equipment needed for intubation

Answer 42

vomitus or secretions may obscure the pharynx or glottis

Question 43

disadvantage os using colorimetric / capnography

Answer 43

patients who recently consumed carbonated fluids | cardiac arrest patients that get a false-negative due to poor pulmonary blood flow

Question 44

final step to confirm ETT placement

Answer 44

bronchoscope

Question 45

advantages of LMA

Answer 45

``` ease and speed someone who is inexperienced you dont need equipment greater amount of ventilation emergency use ```

Question 46

disadvantage of LMA

Answer 46

doesnt protect against aspiration | cannot be used in conscious or semicomatose patients bc of the stimulation of gag reflex

Question 47

8 basic steps of trach care

Answer 47

``` assemble and check equipment explain procedure suction patient clean inner cannula clean and examine stoma site change tie and holder replace clean inner cannula reassess patient ```

Question 48

3 airway emergency

Answer 48

tube obstruction cuff leaks unplanned extubation

Question 49

tubing becomming obstructed

Answer 49

kinking of tube or patient biting tube herniation of the cuff over the tube tip obstruction of the tube orifice against the tracheal wall mucous plugging

Question 50

patients that might need to remain intubated even after the ventilator is removed

Answer 50

surgically treated throat and laryngeal cancer | patients with respiratory failure

Question 51

when a patient does not tolerate endotracheal suctioning

Answer 51

patient becomes bradycardic from vasovagal reflex, STOP and provide 100% FiO2

Question 52

when a patient does not tolerate nasotracheal suctioning

Answer 52

patient may gag or regurgitate ... avoid suctioning after meals if gagging or regurgitating occurs, reposition patient and suction oropharynx