AH: Module 1

What is the purpose of an endotracheal (ET) tube?

To provide a short-term artificial airway for ventilation.

What are the two types of ET tube insertion routes?

Orotracheal (through the mouth) and nasotracheal (through the nose).

What is the function of the inflated cuff on an ET tube?

It prevents air leakage and allows for positive-pressure ventilation.

What are the patient limitations associated with ET tubes?

Patients cannot speak or eat.

What are the nursing priorities when managing an ET tube?

Confirm placement with bilateral breath sounds and chest x-ray, maintain airway patency, prevent self-extubation, and provide oral care frequently.

What complications can arise from ET tube insertion?

Damage to teeth/vocal cords, aspiration during insertion, esophageal intubation, and mainstem bronchus intubation.

What indicates esophageal intubation during ET tube placement?

No breath sounds and no chest rise.

What is cricoid pressure and when is it used?

Cricoid pressure compresses the esophagus to reduce aspiration risk, used during rapid sequence induction.

What is the recommended force for cricoid pressure before and during induction?

Before induction: 10 N (1 kg); during induction: 30-40 N (3-4 kg).

What is a tracheostomy?

A surgically created opening into the trachea for airway access.

What are the indications for performing a tracheostomy?

Long-term ventilator support, airway obstruction, swelling/injury, and pulmonary disorders.

What are the main parts of a tracheostomy tube?

Outer cannula, inner cannula, obturator, flange/neck plate, trach ties, and pilot balloon.

What is the difference between cuffed and cuffless tracheostomy tubes?

Cuffed tubes prevent air leak and are used for ventilated patients; cuffless tubes allow airflow through the upper airway.

What is the purpose of humidification for tracheostomy patients?

To prevent thick secretions due to bypassing normal humidification.

What is the function of the Passy-Muir valve?

It allows air to enter the tracheostomy but exits through the vocal cords, enabling speech.

What are common complications associated with tracheostomy?

Bleeding, pneumothorax, subcutaneous emphysema, and esophageal injury.

What is the priority intervention for accidental decannulation of a tracheostomy?

Perform mouth-to-stoma respirations and keep a same-size trach tube at the bedside.

What are the signs that indicate the need for suctioning in a tracheostomy patient?

Gurgling, crackles, dyspnea, visible secretions, and decreased oxygen saturation.

What are the safety precautions to take during suctioning?

Wear PPE, hyperoxygenate before suctioning, limit suction pass to ≤10 seconds, and reoxygenate between passes.

What is a tension pneumothorax?

A condition where air is trapped in the pleural space and cannot escape, causing mediastinal shift and compressing the heart/lung.

What are the assessment findings for pneumothorax?

Sudden chest pain, dyspnea, decreased breath sounds, hyperresonance, and asymmetric chest movement.

What is hemothorax?

Blood in the pleural space, often caused by trauma or lung cancer.

What are the common manifestations of lung cancer?

Cough, hemoptysis, wheezing, dyspnea, chest pain, and pneumonia.

What are the risk factors for lung cancer?

Smoking, passive smoke exposure, asbestos, radon, and air pollution.

What is the purpose of thoracentesis?

To remove air or fluid from the pleural space, often guided by ultrasound.

What are the signs of mucus plugs in tracheostomy patients?

Strong resistance, dyspnea, and falling oxygen saturation.

What nursing diagnoses are associated with airway management?

Ineffective airway clearance, altered mobility, and sleep pattern disturbance.

What age range is primarily affected by lung cancer?

Ages 50-80.

What is the minimum smoking history (pack-years) associated with lung cancer?

≥20 pack-years.

What imaging technique is used to detect metastases in lung cancer patients?

PET scan.

What imaging techniques are used to evaluate the spread of lung cancer?

MRI, CT, and bone scan.

What is the purpose of pulmonary function tests in lung cancer patients?

To evaluate lung volumes and airflow, important before lung surgery.

What procedure removes air or fluid from the pleural space?

Thoracentesis.

What is the maximum amount of fluid that can be removed during thoracentesis?

1000-1200 mL.

What are the potential complications prevented by thoracentesis?

Pulmonary edema, hypoxia, and hypotension.

What is monitored post-thoracentesis to check for pneumothorax?

A chest x-ray.

What is the primary use of radiation therapy in lung cancer treatment?

To relieve bone pain, dyspnea, and treat brain/liver metastases.

What type of radiation therapy is more targeted and delivers a higher dose?

Stereotactic radiation.

What should patients not do regarding skin markings during radiation therapy?

Do not remove skin markings.

What dietary recommendations are given to patients undergoing radiation therapy?

Eat a high-calorie/high-protein diet.

What are common side effects of radiation therapy?

Fatigue, esophagitis, trouble swallowing, skin changes, pulmonary fibrosis, and cardiac toxicity.

What are the nursing interventions for chemotherapy?

Monitor CBC, prevent infection, encourage nutrition/hydration, and administer antiemetics.

What is a lobectomy?

The surgical removal of one lobe of the lung.

What is a pneumonectomy?

The surgical removal of an entire lung.

What is a wedge resection?

The surgical removal of a small section of the lung.

What is a thoracotomy?

A surgical incision into the chest.

What are the key components of postoperative nursing care for thoracic surgery?

Pain control, pulmonary hygiene, and monitoring chest tubes/drainage.

What are common postoperative concerns for thoracic surgery patients?

Impaired gas exchange, blood loss, dysrhythmias, atelectasis, pneumonia, and respiratory failure.

What is monitored continuously to assess oxygenation status post-surgery?

Oxygen saturation.

What does increased end tidal CO₂ (EtCO₂) indicate?

Impaired gas exchange or impending respiratory failure.

What are signs of respiratory compromise?

Dyspnea, tachypnea, restlessness, hypoxia, and increased work of breathing.

What should be assessed regularly in chest tube monitoring?

Drainage amount, color, air leaks, and tidaling.

What does continuous bubbling in the water seal chamber indicate?

An air leak.

What is the purpose of the water seal chamber in a chest tube system?

To allow air to leave the pleural space while preventing air from reentering.

What should be done if a chest tube disconnects?

Place the tube end in sterile water and reconnect the system as soon as possible.

What are the nursing responsibilities for maintaining chest tube safety?

Keep the system below chest level, avoid kinks, and secure all connections.

What are the expected findings in a normal chest tube system?

Tidaling, gentle bubbling in the suction chamber, and intermittent bubbling with coughing.

What should never be done with a chest tube?

Do not clamp routinely, raise the system above chest level, or strip tubing aggressively.