Airways & Vents Notes week 2

Page 1: Airways & Vents CBN IV

Page 2: Artificial Airways

  • Indications for Artificial Airways:

    • Upper airway obstruction

    • Apnea

    • High risk of aspiration

    • Ineffective clearance of secretions

    • Respiratory distress

Page 3: Types of Artificial Airways

  • Endotracheal Tube (ET):

    • Oral: Passed through mouth and vocal cords into the trachea.

    • Nasal: Passed through nose, nasopharynx, and vocal cords.

    • Tracheostomy: Surgical incision placing artificial airway directly into the trachea via the neck.

Page 4: Oral ET Intubation

  • Procedure of choice:

    • Can be secured rapidly.

    • Larger-diameter tube used.

    • Decreases work of breathing (WOB).

    • Easier to remove secretions and perform bronchoscopy.

    • Associated Risks: Includes possibility of complications during intubation.

Page 5: Nasal ET Intubation

  • Procedure:

    • Tube placed blindly.

    • Used when head and neck manipulation is risky.

    • Contraindicated in: Facial and basilar skull fractures, cranial surgery.

    • Associated Risks: Similar to oral intubation risks.

Page 6: Endotracheal Tubes

  • Intubation:

    • Tube passes into trachea.

    • Uses by Diameter:

      • Females: 7.5-8 mm

      • Males: 8-9 mm

    • Depth markings on side.

    • Pilot balloon with one-way valve.

    • Tracheal cuff.

Page 7: Preparing for Intubation

  • Ready Equipment:

    • ET tube

    • Laryngoscope with blade (Miller – straight & Macintosh – curved; check light)

    • Suction kit with tonsil tip (Yankeur)

    • 10 ml syringe

    • Water soluble lubricant

    • Bag-valve-mask (BVM) with O2 source (Ambu bag)

    • Oral airway

    • IV access

    • CO2 detector

    • Stethoscope

Page 8: Intubation Procedure

  • Consent if non-emergent.

  • Explain procedure.

  • Position patient in sniffing position.

  • Pre-oxygenate for 3-5 minutes.

  • Prepare ordered medications:

    • Sedatives: Midazolam or Etomidate

    • Rapid onset opioid: Fentanyl

    • Paralytic: Succinylcholine (only used in RSI intubated by MD)

Page 9: Monitoring During Intubation

  • Monitor SpO2 during procedure.

  • Assist with suction as needed.

  • Limit intubation attempt to <30 seconds.

  • Inflate cuff and secure placement.

  • Confirm tube placement using:

    • End-tidal CO2 detector

    • Auscultate bilateral breath sounds

    • Observe for symmetrical chest wall movement

    • Obtain CXR (2-6 cm above the carina)

    • Mark and chart position of tube at lip/teeth.

Page 10: Tracheostomy Overview

  • Indication: When the need for the airway is expected to be longer than 10-14 days.

  • Advantages:

    • Decreased incidence of pressure ulcers

    • Enhanced patient comfort

    • Decreased work of breathing (WOB)

    • Allows for eating and speaking eventually.

  • Precaution: New stoma (48-72 hrs) will close if tube is removed; ties are not changed during first 2-3 days.

  • Check tube tie tension – one finger between anchor and neck.

Page 11: Types of Tracheostomies

  • Cuffed Tracheostomy:

    • For positive pressure ventilation and prevention of aspiration.

  • Uncuffed Tracheostomy:

    • For patients needing no mechanical ventilation and low aspiration risk.

  • Fenestrated Tube:

    • Outer cannula is fenestrated; inner cannula is not.

    • Used for weaning to decannulation; permits speech.

  • Single or Double Lumen: Inner cannula may vary.

Page 12: Speaking Valve - Passy-Muir Valve

  • Valve connected to trach.

  • Cuff on trach is deflated.

  • A one-way valve allows inhalation through it but not exhalation.

  • Can be mechanically ventilated with the trach but not with the ET tube.

Page 13: Nursing Responsibilities for Artificial Airway

  • Maintain Correct Tube Placement: Regular checks on tube position.

  • Maintain Proper Cuff Inflation:

    • Ensure cuff pressure is within safe limits.

  • Monitor Oxygen & Ventilation: Keep track of SpO2 and ventilation.

  • Maintain Tube Patency: Regular suctioning as needed.

  • Provide Oral Care & Maintain Skin Integrity: Prevent breakdown.

  • Foster Comfort & Communication: Address patient needs.

  • Assess for Complications: Monitor for issues like OET too deep, misplacement, etc.

Page 14: Correct Tube Placement

  • Document placement & continuously monitor.

  • Mark position of the tube at the teeth or lip (approximately 21 cm for females, 23 cm for males).

  • Airway Emergency Protocol:

    • Stay with patient.

    • Maintain airway using BVM with 100% O2.

    • Call for help to reposition the tube.

Page 15: Proper Cuff Inflation

  • Cuff Purpose: Serves as a seal in the trachea to prevent escape of ventilating gases.

  • Monitoring: Maintain cuff pressure of 20-25 cm H2O.

  • Measure & record cuff pressure after intubation and periodically as per policy.

  • Techniques: Minimal occluding technique (MOV) or minimal leak technique (MLT).

  • If inadequate pressure can’t be maintained, consider cuff leak management.

Page 16: Monitor Oxygenation & Ventilation

  • Check ABG, SpO2, and clinical signs of hypoxemia:

    • Mental status changes

    • Anxiety

    • Dusky skin

    • Dysrhythmias

Page 17: Maintaining Tube Patency

  • Do NOT routinely suction: Only suction when necessary.

  • Indications for Suctioning:

    • Visible secretions in ET tube

    • Respiratory distress

    • Sudden decrease in SpO2

  • Prevent hypoxemia and dysrhythmias during suctioning: Hyper-oxygenate before and after suctioning and limit suction pass to <10 seconds.

Page 18: Suctioning Techniques

  • Open Suction Technique: Requires sterile gloves.

  • Closed-Suction Technique (CST): Enclosed in a plastic sleeve connected directly to patient-ventilator circuit.

    • Maintains oxygenation and ventilation.

    • Decreases exposure to secretions.

Page 19: Suctioning Procedure

  • Gather Equipment:

  • Hand Hygiene: Essential before procedure.

  • Monitor Patient: Check vitals and ECG before starting.

  • Set suction vacuum to 100-120 mm Hg:

    • Don gloves, hyper-oxygenate for 30 seconds.

    • Insert catheter until resistance met, then apply suction on withdrawal.

    • All steps should not exceed 10 seconds.

    • Rinse catheter with sterile saline after use.

Page 20: Complications Associated with Suction

  • Possible Complications:

    • Hypoxemia

    • Bronchospasm

    • Increased ICP

    • Dysrhythmias

    • HTN, Hypotension

    • Mucosal damage

    • Infection

  • Management Strategies:

    • Limit suction pressures to <120 mm Hg, manage thick secretions, hydrate, provide humidification, avoid saline instillation, use antibiotics as needed.

Page 21: Oral Care & Skin Integrity

  • Routine Oral Care:

    • Brush teeth BID, use 1.5% hydrogen peroxide swabs every 2-4 hours, perform chlorhexidine oral rinse BID.

    • Moisturizer to oral mucosa and lips with each cleaning.

    • Frequent suctioning of the oropharynx and change oral suction equipment daily.

    • Assess areas for breakdown; reposition and re-tape ET tube every 24 hours.

Page 22: Fostering Comfort & Communication

  • Addressing Patient Needs:

    • Manage fear and anxiety linked to inability to speak, eat, or move.

    • Build trust, involve patients and caregivers in decision-making.

    • Use various methods for communication, including relaxation therapies and sedatives if necessary.

    • Monitor for physiologic signs of pain or anxiety.

Page 23: ET Intubation Complications

  • Common Issues:

    • Unplanned Extubation (accidental or self-induced)

    • Prevention: Stay with the patient, call for help, maintain airway with BVM, monitor for signs like patient talking, low-pressure ventilator alarm, or breathing difficulty.

Page 24: ET Tube Complications

  • Aspiration Risk:

    • Cuff does not completely prevent secretions from entering trachea.

    • If cuff is deflated, secretions may move into lungs.

  • Prevention of Ventilator-Associated Pneumonia (VAP):

    • Use NG/OG for suction, maintain HOB at 30-45 degrees.

Page 25: Mechanical Ventilation Weaning & Extubation

  • Process Overview:

    • Decrease ventilator support and resume spontaneous ventilation.

  • Differences in Process: Short-term versus long-term ventilated patients vary in weaning approach.

  • Preparing for Extubation: Hyperoxygenate, suction, deflate cuff and remove tube at peak deep inspiration, encourage deep breathing and monitor cautiously post-extubation.

Page 26: Mechanical Ventilation Description

  • Definition: Moving fraction of inspired oxygen (FIO2) at ≥ 21% (room air) in and out of lungs using mechanical ventilator; not curative, supportive therapy.

Page 27: Indications for Mechanical Ventilation

  • When to Consider Ventilation:

    • Apnea or impending inability to breathe.

    • Acute respiratory failure

    • Severe hypoxia

    • Respiratory muscle fatigue

    • May involve ethical decisions on use.

Page 28: Types of Mechanical Ventilation

  • Negative Pressure Ventilation:

    • Encases body to pull chest outward for air intake.

    • Non-invasive, similar to normal breathing.

    • Example: Iron Lung.

  • Positive Pressure Ventilation:

    • Primary method for acutely ill patients, pushes air into lungs under positive pressure.

    • Can be volume or pressure-controlled.

Page 29: Invasive vs Non Invasive Ventilation

  • Invasive Ventilation: Full ventilatory support required.

  • Non-Invasive Ventilation:

    • Face Mask Vent, BiPAP, CPAP available, suitable for specific conditions.

Page 30: Types of Positive Pressure Ventilation

  • Volume Ventilation:

    • Predetermined tidal volume delivered with variation in pressure needed.

  • Pressure Ventilation:

    • Tidal volume varies with set peak inspiratory pressure.

    • Careful monitoring required.

Page 31: Mechanical Ventilator Settings

  • Key Settings:

    • Mode: Determines WOB performed by patient.

      • Controlled: Ventilator does all WOB.

      • Assisted: Patient-triggered breaths with ventilator-supplied support.

    • Tidal Volume: 6-10 mL/kg of ideal body weight, adjusted per patient needs.

    • Frequency: Breaths vent delivers per minute, normal range varies.

    • PEEP: Pressure applied at end of expiration.

    • FiO2: Adjusted to maintain adequate oxygen levels.

Page 32: Additional Ventilator Settings

  • Pressure Support (PS):

    • Pressure support during inspiration, ranges between 6-18 cm H2O.

  • Rapid Shallow Breathing Index (RSBI):

    • Spontaneous rate divided by tidal volume in liters; <105/L indicates a successful wean.

Page 33: Ventilator Alarms and Settings

  • Monitoring Systems:

    • Ensure accurate settings for patient safety

    • Frequent checks on WOB and alarms status.

Page 34: Personal Vent Settings Example

  • My Vent Settings:

    • Mode: AC

    • Tidal Volume: 350 mL or 0.35 L

    • Frequency: 16 breaths/min

    • PEEP: 5

    • FiO2: 40%

    • Ideal Body Weight: 120 lbs (54.5 kg); Tidal Volume range calculated.

Page 35: Modes of Ventilation Detailed

  • Assist-Control (A/C): Delivers preset VT and frequency with options for patient spontaneous breathing.

  • Synchronized Intermittent Mandatory Ventilation (SIMV): Allows spontaneous breath with added benefits for muscle atrophy prevention and improved synchrony.

Page 36: Non Invasive Positive Pressure Ventilation (NiPPV)

  • Settings:

    • FMV & BiPAP: Offers pressure support for oxygenation and ventilation.

    • CPAP: Delivers continuous airway pressure, beneficial for sleep apnea and acute conditions.

Page 37: NiPPV Indications and Settings

  • Must be able to breathe independently.

  • Uses:

    • Acute settings for hypercapnia or during post-extubation.

    • Non-acute for conditions like obstructive sleep apnea.

Page 38: NiPPV Contraindications

  • Do not use in:

    • Status asthmaticus

    • Hemodynamic instability

    • Poor airway fit or fit intolerance

    • Excessive secretions

    • Severe agitation

    • High FiO2 requirements

Page 39: Other Options for Ventilation

  • Advanced Techniques:

    • High-frequency oscillatory ventilation

    • Extracorporeal Membrane Oxygenation (ECMO) with oxygenation and venous access.

Page 40: Complications of Positive Pressure Ventilation

  • Risks Involved:

    • Barotrauma, pneumomediastinum, and volutrauma

    • Alveolar hyper/hypoventilation and cardiovascular effects.

Page 41: Ventilator Associated Pneumonia (VAP)

  • Causes:

    • Commonly occurs >48 hours post-intubation.

    • Risk Factors: Contaminated equipment, inadequate hygiene.

    • Prevention Strategies: HOB elevation, circuit maintenance, and strict hand hygiene.

Page 42: Cardiovascular Complications of PPV

  • Physiological Effects:

    • Increased airway pressure affecting venous return, leading to reduced cardiac output and blood pressure.

Page 43: Neurologic and Other System Effects

  • Systemic Complications:

    • Neurologic impacts include ICP increases.

    • Musculoskeletal risks from immobility necessitating intervention.

    • Gastrointestinal risks including stress ulcers.

Page 44: Mechanical Ventilator Management

  • Machine Disconnection: Common issue between tracheal tube and adapter; alarms should be active and monitored.

  • Ventilator Malfunction Management:

    • Disconnect from settings to manually ventilate with 100% O2 if needed.

Page 45: Nursing Management Responsibilities

  • Primary Assessment:

    • Focus on vital signs, respiratory status, and general condition.

    • Monitor alarm settings and troubleshoot issues immediately.

  • Care Protocols:

    • Ensure equipment is readily available and maintain routine assessments for complications.

Page 46: Common Nursing Diagnoses

  • Anticipated Diagnoses:

    • Fear, anxiety, powerlessness, ineffective breathing pattern and airway clearance, risk for aspiration, and communication barriers.

Page 47: Nutrition Therapy for Ventilated Patients

  • Challenges with Nutrition:

    • Hypermetabolism leading to inadequate intake.

    • Nutritional assessments should occur within 24-48 hours; prefer enteral feeding when possible.

    • Consult speech therapy for swallowing assessments when appropriate.


Airways & Vents SUMMARY

Artificial Airways

Indications for Artificial Airways:

  • Upper airway obstruction: This includes conditions that lead to blockages in the throat that prevent airflow into the lungs.

  • Apnea: Complete cessation of breathing for more than 20 seconds, potentially requiring intervention.

  • High risk of aspiration: Patients unable to protect their airways due to diminished consciousness or excessive secretions may require artificial airways to prevent aspiration into the lungs.

  • Ineffective clearance of secretions: Patients who cannot clear their own airways may need assistance to prevent infections or respiratory distress.

  • Respiratory distress: Severe difficulty in breathing necessitating immediate medical intervention and airway management.

Types of Artificial Airways

Endotracheal Tube (ET):

  • Oral ET: Passed through the mouth, facilitating access to the trachea and is the most common method of intubation. Ideal for emergency uses.

  • Nasal ET: Passed through the nasal passages; used when oral access is obstructed or challenging.

  • Tracheostomy: A surgical procedure creating an opening in the neck to place an artificial airway directly into the trachea.

Oral ET Intubation

Procedure of choice:

  • Rapid securing: Can be performed quickly in emergencies.

  • Larger-diameter tube used: This facilitates better airflow and reduces the work of breathing (WOB).

  • Advantages: Allows for easier removal of secretions and provides access for bronchoscopy, aiding diagnostic efforts.

  • Associated Risks: The procedure carries risks including esophageal intubation, laryngospasm, and potential injury to the teeth or airway.

Nasal ET Intubation

Procedure:

  • Tube placed blindly: Requires skill and experience, as the tube is inserted without direct visualization.

  • Used when head and neck manipulation is risky: Patients with certain injuries may benefit from this method.

  • Contraindications: Should not be performed if there are facial or basilar skull fractures or if cranial surgery has been conducted.

  • Associated Risks: Similar to oral intubation risks, but may include bleeding and trauma to the nasal passages.

Endotracheal Tubes

  • Intubation: Involves passing a tube into the trachea; careful attention to the diameter size based on patient gender (Females: 7.5-8 mm; Males: 8-9 mm) is critical for proper placement.

  • Depth markings: Allow for verification of appropriate tube insertion depth.

  • Pilot balloon: Indicates cuff inflation status to maintain an adequate seal in the trachea.

  • Tracheal cuff: Prevents aspiration and allows for positive pressure ventilation.

Preparing for Intubation

Ready Equipment:

  • Ensure all necessary equipment is prepared and checked prior to intubation, including:

    • ET tube

    • Laryngoscope (Miller – straight & Macintosh – curved)

    • Suction kit (Yankeur);

    • 10 ml syringe for cuff inflation;

    • Water soluble lubricant and a bag-valve-mask (BVM) with O2 source.

    • Oral airway for airway maintenance and IV access to administer medications.

    • CO2 detector and stethoscope for confirmation of placement and monitoring.

Intubation Procedure

  • Consent: Obtain if the procedure is non-emergent.

  • Patient positioning: Place in the sniffing position to optimize airway access.

  • Pre-oxygenation: This step is crucial; patients should be pre-oxygenated for 3-5 minutes to improve oxygen reserves.

  • Medications: Prepare ordered medications for sedation (Midazolam or Etomidate), a rapid onset opioid (Fentanyl), and a paralytic (Succinylcholine) specifically for Rapid Sequence Intubation (RSI) performed by an MD.

Monitoring During Intubation

  • Monitor SpO2: Continuous monitoring of oxygen saturation throughout the procedure is vital.

  • Assist with suctioning: Be prepared to suction as indicated to maintain airway patency.

  • Intubation attempts: Limit attempts to <30 seconds to prevent hypoxia.

  • Confirm placement: Confirm tube placement using tools such as an End-tidal CO2 detector, auscultating breath sounds, and observing for symmetrical chest wall movement. Obtain a chest X-ray within 2-6 cm above the carina to ensure proper placement.

  • Charting: Document the tube position comprehensively for ongoing patient safety.

Tracheostomy Overview

Indication:

  • Chronic airway maintenance: When the expected need for airway support exceeds 10-14 days.

Advantages:

  • Comfort and Complications: Reduced risk of pressure ulcers, improved patient comfort, and decreased work of breathing.

  • Daily Living: Allows for patient engagement in normal activities like eating and speaking once patient is stable.

Precaution:

  • Monitor new stoma post-placement, as it can close rapidly if the tube is removed (especially within the first 48-72 hours).

Types of Tracheostomies

  • Cuffed Tracheostomy: Essential for patients requiring mechanical ventilation, providing a secure seal.

  • Uncuffed Tracheostomy: Suitable for those needing no mechanical ventilation with low aspiration risks.

  • Fenestrated Tube: Permits speaking and weaning, where the outer cannula is perforated while retaining an inner cannula.

  • Lumen Variability: Single or double lumen options may be available based on patient needs and ventilation requirements.

Speaking Valve - Passy-Muir Valve

  • Functionality: Enables patients with tracheostomies to speak by allowing air in for inhalation through the valve while preventing exhalation through the trachea until it naturally escapes through the upper airway.

  • Compatibility: Can be used while the patient is mechanically ventilated but not with the endotracheal tube.

Nursing Responsibilities for Artificial Airway

  • Tube position checks: Regularly verify the tube's placement in the airway to ensure patency and efficacy.

  • Cuff inflation management: Maintain cuff pressure within safe limits to prevent airway damage or aspiration risks.

  • Monitoring oxygen levels: Consistent assessments of SpO2 to respond to changes in respiratory status.

  • Oral care: Implement strategies to maintain oral hygiene and prevent skin breakdown around the airway entry point.

  • Fostering comfort: Address psychological needs of the patient to promote overall wellbeing and communication.

  • Assessing for complications: Be vigilant for signs of misplacement or over-inflation and intervene as necessary.

Correct Tube Placement

  • Regular documentation is crucial, marking the tube's position for reference.

  • In an airway emergency, ensure the patient is supported and oxygenated using a BVM with 100% O2 while calling for additional help.


The difference between invasive and non-invasive ventilation primarily lies in the way the air is delivered to the lungs:

  • Invasive Ventilation: This type requires the insertion of an artificial airway, such as an endotracheal tube or a tracheostomy. It is typically used in critical care settings for patients who cannot maintain their own airway or need mechanical assistance for breathing. Invasive ventilation provides full ventilatory support and is often employed in situations like acute respiratory failure or severe hypoxia.

  • Non-Invasive Ventilation (NiPPV): This method does not require an artificial airway; instead, it uses face masks or nasal interfaces to deliver positive pressure to the airway. It is suitable for patients who are able to breathe independently but need support, such as those with chronic obstructive pulmonary disease (COPD) or in situations post-extubation. Non-invasive methods reduce the risk of complications associated with invasive techniques, such as infections or injury to the airway.


Airways & Vents CBN IV

Artificial Airways

Indications for Artificial Airways:

  • Upper airway obstruction

  • Apnea

  • High risk of aspiration

  • Ineffective clearance of secretions

  • Respiratory distress

Types of Artificial Airways:

  1. Endotracheal Tube (ET):

    • Oral ET: Inserted through the mouth into the trachea.

    • Nasal ET: Inserted through the nose into the trachea.

    • Tracheostomy: Surgical opening in the neck to place an airway directly into the trachea.

  2. Oral ET Intubation:

    • Rapid securing, allows for larger tubes, good for secretions and bronchoscopy, but has associated risks like laryngospasm.

  3. Nasal ET Intubation:

    • Blind placement for patients with head and neck risks; contraindicated in certain skull fractures.

  4. Endotracheal Tubes:

    • Size varies by gender. Uses depth markings and cuff technology to ensure proper placement.

Preparing for Intubation

  • Assemble equipment: ET tube, laryngoscope, suction kit, syringes, lubricant, and BVM.

  • Position patient in "sniffing" position and pre-oxygenate. Administer medications as needed.

Monitoring During Intubation

  • Monitor SpO2, assist with suctioning, confirm tube placement with various methods, and document tube position.

Tracheostomy Overview

  • Indicated for prolonged airway needs (10-14 days), offering comfort and reduced work of breathing. Needs close monitoring to prevent stoma closure.

Types of Tracheostomies:

  • Cuffed: For ventilation and aspiration prevention.

  • Uncuffed: For patients not on mechanical ventilation.

  • Fenestrated: Allows speaking and weaning from ventilation.

Nursing Responsibilities for Artificial Airway

  • Ensure tube placement, cuff inflation, monitor oxygen levels, and provide oral care.

  • Facilitate patient comfort and assess for complications.

Ventilation Techniques

  1. Invasive Ventilation: Requires artificial airway for critical cases.

  2. Non-Invasive Ventilation (NiPPV): Delivers support via masks, suited for patients who can breathe independently.

Ventilator Management:

  • Monitor settings and alarms, and assess patient condition regularly to prevent complications such as pneumonia and cardiovascular effects.

  • Address nutritional needs of ventilated patients and assess for swallowing capabilities if necessary.


Additional Study Questions


  1. What are the indications for artificial airways?Answer: Upper airway obstruction, apnea, high risk of aspiration, ineffective clearance of secretions, respiratory distress.


  2. What are the types of artificial airways?Answer: Endotracheal Tube (ET), Oral ET, Nasal ET, Tracheostomy.


  3. What is the procedure of choice for Oral ET Intubation?Answer: Rapid securing, larger-diameter tube, decreases work of breathing, easier to remove secretions and perform bronchoscopy.


  4. What are the risks associated with Oral ET Intubation?Answer: Potential complications include esophageal intubation, laryngospasm, and injury to the teeth or airway.


  5. What is the procedure for Nasal ET Intubation?Answer: Tube placed blindly; contraindicated in cases of facial/basilar skull fractures or cranial surgery.


  6. What is the size range for Endotracheal Tubes by gender?Answer: Females: 7.5-8 mm; Males: 8-9 mm.


  7. What preparations are needed for intubation?Answer: Necessary equipment includes ET tube, laryngoscope, suction kit, 10 ml syringe, and BVM with O2.


  8. How should a patient be positioned for intubation?Answer: Patient should be placed in 'sniffing' position to optimize airway access.


  9. What can happen if inadequate cuff pressure is maintained?Answer: Can lead to aspiration and prevents a proper seal in the trachea.


  10. What are the indications for a tracheostomy?Answer: Needed when airway maintenance is expected for longer than 10-14 days.


  11. What are the advantages of a tracheostomy?Answer: Decreased incidence of pressure ulcers, enhanced comfort, decreased work of breathing, allows for eating and speaking.


  12. What is the difference between Cuffed and Uncuffed Tracheostomy?Answer: Cuffed: for positive pressure ventilation; Uncuffed: for low aspiration risk patients.


  13. What is the functionality of the Passy-Muir Valve?Answer: Allows patients to speak by enabling inhalation while preventing exhalation through the trach.


  14. What are the nursing responsibilities for an artificial airway?Answer: Maintain tube position, cuff pressure, monitor oxygen levels, and provide oral care.


  15. What are the complications of suctioning?Answer: Hypoxemia, bronchospasm, increased ICP, dysrhythmias, mucosal damage.


  16. What are the signs of respiratory distress?Answer: Mental status changes, anxiety, dusky skin, dysrhythmias.


  17. What is the Open Suction Technique?Answer: Requires sterile gloves and is performed via direct suctioning of the airway.


  18. What is the difference between invasive and non-invasive ventilation?Answer: Invasive: requires artificial airway; Non-invasive: uses masks or nasal interfaces.


  19. What are the challenges in nutrition therapy for ventilated patients?Answer: Challenges include hypermetabolism and the importance of early nutritional assessment.


  20. What are the indicators of successful weaning from mechanical ventilation?Answer: RSBI <105, indicating readiness for weaning from mechanical ventilation.