Airway Management & Obstructive Respiratory Disorders

obstruction

air can NOT get in or out; something is blocking the airway

unable to breath or speak, agitated and distressed, grips the throat, cyanosis, LOC

s/sx of complete airway obstruction (5)

• mechanical (tongue, secretions, blood, foreign body)

• inflammation (anaphylaxis, epiglottitis)

• neurological (stroke, sedation, opioids)

• structural (tumor, sleep apnea)

causes of airway obstruction (4 bullets)

soft tissues relax, airway closes, no airflow, oxygen fails, brain wakes pt

how does obstructive sleep apnea work? (5 main points)

BMI, large neck, male, age, alcohol, sedatives, smoking

what are the risk factors for OSA? (7)

snoring, morning headache, daytime fatigue, observed apnea, hypertension, poor concentration

what are the signs and symptoms of OSA? (6)

sleep study

how do they diagnose OSA?

CPAP, weight loss, avoid alcohol, oral applications, surgery

what are some treatments for OSA? (5)

ventilation problem

is OSA a ventilation or perfusion problem?

assess, CPAP use at home, bring machine to hospital, avoid oversedation, continuous pulse ox when appropriate, elevate HOB

what are some nursing considerations for OSA? (6)

trigger, inflammation, bronchospasm, mucus production, airway narrowing

what is the pathophys for asthma (5 steps)

allergens, exercise, cold air, respiratory infection, smoke, stress, medication triggers (aspirin, NSAIDs, beta blockers)

what are common triggers of asthma? (7)

ventilation issue

is asthma a ventilation or perfusion issue?

wheezing, chest tightness, dyspnea, accessory muscles, difficulty speaking, cough, peak flow

things to assess for with asthma patients (7)

silent chest, unable to speak, low SpO2, fatigue, accessory muscles, sudden disappearance of wheezing

things to look for as a sign of an exacerbation/flair (6)

airway, oxygen, steroids (IV or PO), bronchodilators, monitor response

nursing priorities for asthma (5)

albuterol and ipatropium

what are two quick relief/rescue medications for asthma?

inhaled corticosteroids, salmeterol (LABA), leukotriene modifiers

what are 3 long-term control/maintenance drugs for asthma?

chronic bronchitis and emphysema

what are the 2 main problems with COPD?

COPD

chronic, progressive, and usually caused by smoking/inhaling chemicals

ventilation problem

is COPD a ventilation or perfusion problem?

chronic bronchitis

excess mucus, chronic productive cough, inflammation, airway narrowing, hypoxemia describe what condition?

emphysema

destroyed alveoli, air trapping, loss of elastic recoil, hyperinflation describe what condition?

airflow obstruction, air trapping, poor gas exchange, hypoxia, hypercapnia

both chronic bronchitis and emphysema lead to: (5)

barrel chest, pursed-lip breathing, tripod position, chronic cough, sputum, fatigue, weight loss

when assessing someone with COPD some things you might notice are: (7)

chronic

is COPD chronic or acute?

True

True or False: COPD has exacerbations

smoking cessation, bronchodilators, inhaled corticosteroids, pulmonary rehabilitation, vaccinations, nutrition, home oxygen (when indicated)

COPD treatment includes: (7)

88-92%

what is the target oxygen saturation for COPDers?

True

True or False: oxygen requires a provider order

False

True or False: weaning someone off oxygen requires a provider order

pulse ox, skin, humidity

things to monitor while someone is on oxygen therapy? (3)

do they normally use O2 (baseline vs acute), can we wean the person off it?

things to evaluate about someone on oxygen (2)

1-6 L

list the liter flow for the device: nasal cannula

5-10 L

list the liter flow for the device: simple mask

variable

list the liter flow for the device: venturi mask

10-15 L

list the liter flow for the device: nonrebreather

6 L +

list the liter flow for the device: high flow NC

simple mask

this oxygen device is best for mouth breathers

venti mask

this oxygen device provides precise O2 delivery

nonrebreather

this oxygen device provides a high concentration in emergency situations; you should crank the O2 all the way up to 15 L to start and make sure the bag is inflated

risky

Right or Risky? Turning a non-rebreather down to 2 L because the patient’s oxygen is improving

prolonged mechanical ventilation (over 2 wks), airway obstruction, cancer, neuromuscular disease, trauma

why do patients need a tracheostomy? (5)

Take a minute to review the components of a tracheostomy

assess, secretions/suction, skin, ties, trach care Q8, humidification

what are included in nursing care of tracheostomies? (6)

obturator, same-size trach, suction, ambu bag, trach collar

things that should always be at the bedside of someone with a trach (5)

whenever needed

when should you suction a trach?

visible secretions, coarse crackles, low oxygen, ineffective cough, respiratory distress

what are some signs we should suction a trach? (5)

hypoxia, dysrhythmias, mucosal trauma, bleeding, increased ICP

what are some risks of suctioning (5)

assess (do we need to suction), insert catheter until meet resistance, suction ONLY while withdrawing, no more than 10-15 seconds of suctioning per pass, reoxygenate, reassess (lungs, VS, do you need to suction again?)

how to suction a trach (6)

sterile

is suctioning a trach sterile or clean?

breath sounds, SpO2, work of breath, secretions, patient tolerance

when suctioning, make sure to assess before, during, and after; what type of things are we assessing? (5)

passy muir valve

this valve allows people with a trach to speak

nasal cannula

Which O2 device should you use? post-op patient with SpO2 91%

venti mask

Which O2 device should you use? COPD exacerbation needing precise oxygen delivery

non rebreather

Which O2 device should you use? trauma patient with severe hypoxemia

trach collar

Which O2 device should you use? patient with a tracheostomy and a SpO2 of 91%

right

Right or Risky? apply oxygen before calling the provider for a hypoxic patient

risky

Right or Risky? patient with COPD should never receive more than 2 L/min of oxygen

risky

Right or Risky? suction every four hours to prevent mucus plugs

right

Right or Risky? a trach patient should always have an obturator and spare trach tubes available at the bedside

right

Right or Risky? the nurse should suction for no longer than 10-15 seconds per pass

albuterol

give an example of a short acting beta 2 agonist

salmeterol

give an example of a long acting beta 2 agonist

bronchodilators

med that opens the airway

beclomethasone

example of a corticosteroid (aerosol)

bronchodilator

which should you use first? bronchodilator or steroid?

right

Right or Risky? albuterol is a rescue medication

risky

Right or Risky? a patient should stop using inhaled corticosteroids once symptoms improve

right

Right or Risky? smoking cessation is the single most effective intervention to slow COPD progression

risky

Right or Risky? patients with COPD should never receive supplemental oxygen

risky

Right or Risky? a silent chest during a severe asthma attack is reassuring