Airway Management

airway management

maintaining patency of the nose, upper airway, trachea, and. lower airway of the respiratory tract

Types of Obstructions

• Mucus

• Mechanical Obstruction

• Foreign Body

Assessment

a) Obtain patient’s baseline

b) Medical Hx

c) Assess rx for airway obstruction/aspiration

• enteral feeding tubes

• LOC

• Dysphagia

d) Respiratory assessment

e) Medications

Inventions for airway management

• setting a patient up

• encourage them

• suction

• change diet

• flutter value

• increasing fluids

• removal of obstructions

Indications for airway suctioning: upper airway

Oropharyngeal:

may cough, not clearing

• Gurgling on insp/exp

• Restlessness

• Excessive oral secretion/ drooling

• Emesis in mouth

Indications fir airway suctioning: lower/ artificial airway

• Assess for any signs of hypoxia

• SpO2 below 90%

• Productive cough

• Ineffective cough

• Coarse crackles

• Acute distress

(must be sterile)

Oropharyngeal

Clean technique

Yankauer- kept at bedside

• clear the line with NS after suctioning

• No more than 150mmHg

• Unconscious patients- side-lying

  • 2 ppl, one to help position/hold mouth open, one to suction

Sterile technique

1. Endotracheal Tube

2. Tracheostomy Tubes

Artificial Airway Suctioning

• narrower than normal airway

• hyperoxygenate prior, 30-60 sec 100% O2

• suction 10 seconds intermittently

Risk Associated with Suctioning

• Hypoxia

• Cardiac Dysrhythmias

• Laryngeal spasm

• Bradycardia

• Nasal Trauma and Bleeding

Suctioning Procedure Overview

1. Place in Semi- or High Fowler’s position

2. Take baseline vitals, assess, & put Pulse Ox in place

3. Preoxygenate/hyperoxygenate client

4. Maintain sterility

5. Do NOT apply suction on the way in

6. Suction is applied intermittently durning REMOVAL of catheter

7. Rotate catheter with thumb and index finger

8. Reassess VS & lung sounds

9. Allow at least one full minute & clear the line with NS between suction passes

NEVER

Suction longer than 10 seconds

Stop

If pulse decreases by 20 BPM

If pulse increases by 40 BPM

If O2 Sat falls below 90% or 5% below baseline

Nursing Consideration

keep at bedside

• Obturator

• Sterile saline- for clearing line between passes

• Suction supplies

• Extra Trach Care set

• New, sterile inner cannula

• O2 equipment

ET Tube Care

must occur at least q shift, or sooner as needed

• help will be needed to hold tube in place while care is being completed

Sputum Collection

• Manuel expectoration

  • oro/Nasopharyngeal suctioning if needed

• Make sure it is mucus, not saliva

• Morning is best time to obtain

• Purpose: cytology, C&S

Mrs. Pitman is a 89 yo female patient admitted for a ulnar fx s/p fall at home. When you go in to assess Mrs. Pitman, you find her in slumped over in the chair, and she has vomited on her covers and gown. She appears to be trying to spit out the rest, but she is having difficulty. What would you do FIRST and why?

• lay her on her side

• check airways

• vital signs

• suction if needed

The nurse is assessing a patient with a respiratory problems. Which is most reflective of an early symptom of hypoxia?

Restlessness

A patient has thick, tenacious respiratory secretions. To best help thin patient’s secretions, the nurse should:

Encourage the patient to drink more fluids

A patient hospitalized for acute pneumonia has a 10 year history of chronic lung disease and cannot clear her respiratory secretions from the posterior pharynx with coughing. Which suctioning intervention is appropriate?

oropharyngeal