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Peds Nurse > skills > Flashcards

skills Flashcards

1
Q

Where does a tracheostomy tube sit?

A

A tracheostomy tube fits through and keeps the surgically made hole (stoma) in your windpipe (trachea) open.

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2
Q

When should you suction a tracheostomy?

A

A moist cough.
Inability to clear secretions from your throat.
Difficulty breathing or feeling like you can’t get enough air.
Visible mucus (secretions or bubbles at the trach opening).
Rattling sounds.
Flaring nostrils.
Gasping or fast breathing.
A whistling noise coming from the trach tube.
Sinking in of your chest (retractions).
A bluish color around your mouth (cyanosis).
Clammy skin.
Irritability or restlessness

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3
Q

What do you need for trach suctioning?

A

Tracheostomy suction machine.
A clean suction catheter.
Connection tubing.
A cup of clean, distilled water.
Gloves.
Bowl or basin.

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4
Q

How do you clean suction equipment?

A

Fill the bowl or basin with clean, distilled water.
Use the suction catheter to flush the water through the connection tubing.
Turn off the suction machine.
Disconnect the suction catheter from the tubing. If it’s disposable, throw it in the wastebasket. If it’s not disposable, rinse it and set it aside for disinfection later.
Hang the tubing on the suction machine with the tip pointing up.
Wash the bowl or basin with antibacterial soap and warm running water.
Take your gloves off and throw them away.
Wash your hands thoroughly with antibacterial soap and running water. Dry your hands with a clean towel.

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5
Q

What are the possible complications of suctioning?

A

Bleeding.
Infection (foul-smelling mucus or mucus that’s yellow, green, red or brown)
Vagal nerve stimulation, which can lower your heart rate and oxygen levels.
Pain or discomfort.

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6
Q

How often should a trach be suctioned?

A

once weekly and PRN

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7
Q

What are the steps for trach suctioning?

A

Wash your hands thoroughly.
Turn on the tracheostomy suction machine and set the pressure to low or medium
Put on your gloves
Connect the clean suction catheter to the end of the tubing
Gently place the suction catheter into the trach tube as far as instructed
Pull the catheter back just a little bit before you begin suctioning.
Begin suctioning but do not suction for more than 10 seconds at a time
Remove the catheter from the trach tube

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8
Q

Baclofen pump

A

system consisting of a pump and a catheter that brings the medication from the pump into the spinal fluid.

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9
Q

sputum culture

A

used to find and diagnose bacteria or fungi that may be causing an infection in the lungs or airways.

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10
Q

urinalysis

A

used to detect uti’s, kidney disease, and diabetes

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11
Q

culture and sensitivity

A

sample is taken and tested to see if germs will grown in it. Any germs that will grow will be tested against a variety of medications.

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12
Q

ferral bag

A

designed to help with poor gastric motility, pain, and bloating

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13
Q

GJ tube

A

lo

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14
Q

Examples of PRN trach changes?

A

difficulty passing suction catheter
cuff integrity compromised
unexplained respiratory distress
broken components

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15
Q

What can you do to allow a full view of the trach stoma?

A

hyperextend the neck by placing a roll under the shoudlar blades

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16
Q

describe an uncuffed trach

A

air will flow through the trach tube as well as around trach tube and through upper airway

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17
Q

describe a cuffed trach

A

maintains air being delivered from vent to lungs and back to vent
(protects against aspiration)

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18
Q

What should you remember when removing a trach tube?

A

it is curved and follow the curve out

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19
Q

When inserting the trach tube…

A

Follow the curve in
Immediately remove obturator after insertion
Auscultate for BBS
( a misplaced tube should be suspected if there are absent breathe sounds)

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20
Q

You are inserting a trach tube and auscultate for breathe sounds. What should you suspect if there are absent breathe sounds?

A

A misplaced tube

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21
Q

What is a obturator?

A

tool to guide trach

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22
Q

When cleaning the tracheostomy tube…

A

It must be cleaned and sterilized after every trach change.
bagged and stored in the emergency bag.
outside of bag is labeled date, name of child, type, and size as well as your initials.
ensure there is a brand-new trach and backup trach every 3rd month after ensuring the availability of two new trach tubes.

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23
Q

Auscultation of bilateral breathe sounds

A

BBS
anterior and posterior chest
Must be done before and after treatments
must also be done w/ s&s of respiratory distress

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24
Q

List the breathe sounds

A

Clear
Rhonchi
Fine crackles
Coarse crackles
Wheezes
Stridor

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25
Q

When is rhonchi present

A

with airway secretions

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26
Q

Describe Fine Crackles

A

“popping” sound

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27
Q

Describe Coarse Crackles

A

Loud and low pitched
usually present with increased fluid or mucous

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28
Q

Describe wheezing

A

High pitched musical quality
present in conditions that narrow the airway such as obstructions, aspiration, pneumonia, and asthma.

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29
Q

Describe Stridor

A

high pitched crowing sound heard with upper airway obstruction..

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30
Q

Does a trach collar require a physicians order?

A

No

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31
Q

How often are trach collars changed ?

A

daily and PRN

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32
Q

How do you ensure a collar fits?

A

one finger between the collar and the neck
trach tube is midline in the trachea

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33
Q

SpO2

A

amount of oxygen in the red blood cells

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34
Q

Characteristic of sputum

A

amount, color, odor, and consistency

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35
Q

Tracheitis

A

infection of the trachea that makes breathing difficult.

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36
Q

EtCO2 Monitoring

A

for respiratory distress

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37
Q

S&S of respiratory distress

A

accessory muscle use/retractions
cyanosis and decreased oxygen saturation
nasal flaring
tachypnea
bradypnea
abnormal breathe sounds
productive/Non-productive cough
abnormal EtCO2

38
Q

Standard low setting for SPO2 is…

A

92%

39
Q

Pulse ox alarm is going off and tracheostomy is dislodged. What do you do?

A

reinsert tracheostomy tube

40
Q

Troubleshooting a pulse ox alarm

A

check airway first!
assess for cyanosis and/or a distressed look.
check for ventilator dis-connection.
look for a unattached pulse ox probe.

41
Q

Prior to administering a respiratory treatment…

A

assess breathe sounds.
respiratory rate
heart rate
SPO2

42
Q

What are nebulizer treatments?

A

turns liquid medication into mist (small microns) to be deposited into airways

43
Q

Placement of ventilator dependent nebulizer

A

nebulizer in line proximal to the trach on the inspiratory flow side of tubing

44
Q

Placement of a non-vent dependent nebulizer

A

attach nebulizer to the trach using an adapter and a 6-inch piece of corrugated tubing on the distal end of nebulizer

45
Q

ETCO2 Monitoring

A

end tidal Co2
allows exhaled CO@ to be measured non-invasively.

46
Q

What is the partial pressure or maximal concentration of carbon dioxide at the end of an exhaled breath, which is expressed as mmHg?

A

ETC02

47
Q

Where does gas exchange occur?

A

between alveolar air and blood of pulmonary capillaries (ventilation and perfusion)

48
Q

Normal ETCO2 values

A

35-45 mmHg

49
Q

What should you do if ETCO2 values are outside normal values?

A

recheck.
verify baseline for that child.
airway inflammation, bronchospasm, sputum production.

50
Q

Metered dose inhalers are…

A

short burst of a specific amount of medication propelled into lungs

51
Q

What is chest physiotherapy?

A

cupping your hand or using percussion cups to produce a hollow sound in rapid Rythm over the lung segment to be drained.

52
Q

Where should you never percuss?

A

rib edges, below rib cage, over vertebrae, and sternum

53
Q

what is cofflator machine?

A

it assist with coughing for clients who are unable to cough or self clear secretions

54
Q

trans-tracheal suctioning

A

Clean procedure
Catheter size is physicians order.
A suction catheter should only be inserted 1 cm past the tracheostomy tube.

55
Q

oxygen tank sizes

A

size E, Size, D, and Size M6

56
Q

oxygen delivery via ventilator

A

green bubble tubing between oxygen source and ventilator

57
Q

oxygen delivery via Thermovent

A

Thermovent T
White adaptor with green bubble tubing

58
Q

What should be in a non-trached e-bag?

A

o2 mask
oxygen tubing
nasal cannula
ambubag
02 tank key

59
Q

what should be in a trached e-bag

A

2 trach tubes
back up trach
step down trach
obturator
syring for cuffed trach
ambu bag with face mask and peep valve(if needed)
o2 tank key
tracheostomy wedge
scissors
small baggie containing the following (plastic vials of nss, 2 gloves, and 2 suction catheters)

60
Q

Uses for manual ventilation with resuscitator bag

A

During cpr.
Ventilator dependent patient removed from the ventilator .
As needed for respiratory distress.

61
Q

for manual ventilation for a pt. with a trach attach resuscitation bag to…

A

trach tube

62
Q

for a non trached pt. or if artificial airway is lost attach…

A

Face mask to resuscitation bag
Position head to open airway
Place face mask over mouth and nose, Maintain proper seal

63
Q

Manual ventilation with resuscitator bag (ambu bag)

A

Ventilate rhythmically compressing the bag for inspiration-allow ample time for passive expiration and bag re-expansion.
Manual breaths should be delivered minimally at the patients normal respiration rate.
Observe chest to ensure that it rises and falls with each ventilation.

64
Q

Most effective way to provide humididication

A

heated humidity

65
Q

heated humidity

A

humidifier reservoir bag filled with distilled water.
ensure the water chamber is filled to the fill line with water.
heater temperature between 37-39 C
Trouble shooting ( too much rain out or circuit too dry)

66
Q

Passy -Muir valve

A

it allows increase air flow through the vocal cords. it improve swallowing. it may worn with or without ventilator.

67
Q

Trach cap

A

allows patient to breathe through the upper airway. wear time is increase as tolerated.

68
Q

List ventilators

A

LTV, TRILOGY, ASTRAL

69
Q

circuits

A

the tubing that delivers the breath to the patient, and allows the patient to exhale after breath is delivered.
single or double limb
change weekly

70
Q

Bacteria Circuits

A

removes small particles from inhale air. it connects to patient air outlet.
change weekly.

71
Q

pressure support

A

provides the patient with spontaneous breaths with some support pressure.

72
Q

tidal volume

A

size or volume of gas delivered by the vent.

73
Q

Pressure control

A

a set pressure delivered to patient.

74
Q

(PEEP) Positive and expiratory pressure

A

amount of positive pressure maintained in the lungs during the expiratory phase.

75
Q

Inspiratory time

A

amount of time it takes to deliver the ventilator breath.

76
Q

Sensitivity

A

determents how easy or difficult it would be for a patient to trigger a breath.

77
Q

oxygen percentage

A

FiO2, room air is 21% and the other 79% of air we breath is made up of nitrogen and carbon dioxide.

78
Q

peak inspiratory pressure (PIP)

A

amount of pressure it takes to deliver the breath.

79
Q

raspatory rate actual

A

Mandatory breath + spontaneous breath

80
Q

Exhaled volume (VTE)

A

Vent monitor exhale tidal volume
monitor both machine and spontaneous breath.
leaks can cause inaccurate values.

81
Q

synchronized intermittent mechanical ventilation. (SIMV)

A

provides mandatory breath witch are synchronized with patients spontaneous efforts.
combination of mandatory, assisted, and spontaneous breath

82
Q

CPAP

A

No mechanical breath, patient breath spontaneously.
provides positive pressure for patient to breath off of.

83
Q

BiPAP

A

breath are taken by patient (spontaneous breath)
vent supports the breathing with added pressure support.
2 levels of pressure VS CPAP witch is one consistence pressure.

84
Q

Pressure Support With Safety tidal volume (PSSV)

A

delivers a pressure targeted breath with a volume guarantee.
Similar to AVAPS mode in Trilogy Vent

85
Q

Mandatory or controlled breath.

A

initiated by vent and delivery of air is controlled by the vent.

86
Q

assisted breath

A

triggered by patient or by vent and delivery of air is then controlled by vent

87
Q

spontaneous/ supported breath type

A

triggered and controlled by patient
some support from vent- not full support like assisted

88
Q

High pressure alarm

A

if PIP rises to meet the set high pressure alarm the vent will alarm.
may be due to change within patient lungs or trach tube
(Usually set 10 to 15 cm H20 above the patients normal PIP)

89
Q

Low pressure alarm

A

if the patients PIP drops bellow the set, low pressure alarm. the vent will alarm
anything that causes a large leak in the ventilator system with cause a low pressure alarm. ( 5-10cm H20 Bellow the patients normal PIP)

90
Q

low minute alarm (MV)

A

The product of raspatory rate and tidal. if the patient MV drops bellow the set low minute volume the vent will alarm
( Minute volume litters = RR X Vt)

91
Q

Vent alarms due to…

A

power loss
circus disconnection
low circus leak (check whisper valve)
using internal battery
apnea
low battery

92
Q

Pulmonary Hypotension

A

high blood pressure in the arteries of the lungs .

Peds Nurse (3 decks)

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