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When is a trach used with people on mechanical ventilation?
If they are going to be vented for over 7-10 days.
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What are two reasons to trach someone w/o a vent?
Emergent situations: epiglottitis, severe anaphylaxis
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Indications of when to suction
- Dyspnea
- decreased saO2
- ronchi with bubbling or rattling breath sounds
- cyanosis
- restlessness
- changes in pulse rate or rhythm
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Sizes of suction catheters to use on adults, children, and infants.
- adults - 12-18F
- children - 8-10F
- infants - 5-8F
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Suction pressure ranges from ____ to ____ for adults.
100-150mmHg
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Do not apply ____ during nasopharyngeal insertion.
suction
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Always ______ before and between suctioning.
- preoxygenate
- Give 100% O2 for 1 min to hyperoxygenate, then suction, reoxygenate and suction again.
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Suction should not be applied for longer than ______ seconds.
5-10 seconds
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Pts with an endotracheal tube should be ____ & ____ prior to suctioning.
hyperventilated and hyperoxygenated
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A sputum collection trap is called a ____
Luki or Lukens tube
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Complications of suctioning
- Hypoxia
- Tissue trauma
- Infection
- Vagal stimulation (bradycardia) and bronchospasm (continuous coughing)
- ***stop if pt becomes bradycardic
- ***continuous sat monior & watch heart rate
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Evaluation and documentation after suctioning.
- Reassssment of resp system-breath sounds, SaO2, rate and depth, skin color, changes in VS
- They should be able to breathe easier, lung sounds should be clearer.
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What is the chorina?
Where the trachea splits into the bronchi
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Which lung sounds indicate a need for suctioning?
Ronchi, not crackles or wheezes.
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How far do you advance the suction catheter for nasotracheal and trachs?
- nasotracheal 8 inches
- trachs 3-4 inches
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If trachea gest dislodged what is your immediate reaction?
Cover with occlusive dressing, vasoline gause. If you do not do this they are at risk for pneumothorax.
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What do you need to document with subQ emphysema?
Document the exact area you detect the subQ emphysema. Gives a baseline so you can tell if the problem is ongoing and spreading.
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Which types of tubes are pts able to talk?
- fenestrated tube
- talking tube
Allows air to flow up from the trach allowing pt to talk
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What needs to be done with a trach pt before they eat?
Make sure the cuff is inflated while eating to prevent aspiration.
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If effusion is <_____ there is usually no action taken.
<200mL
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Where are chest tubes placed?
Into the pleural cavity. This drains out air, blood, exudate, mixtures, and allows lung to fully inflate.
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What is a pleurodesis?
A procedure that creates scar tissue, which results in he closing of the pleural cavity (adheres pleura to lung surface)
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What potentially life threatening condition can take place following a rapid expansion of a collapsed lung?
Re-expansion pulmonary edema
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Nursing responsibilities during chest tube insertion?
- Pain control
- Consent
- pt teaching prior to procedure
- positioning - flat, supine
- Observe and assess pt during insertion: color, HR, RR, SaO2
- Attach chest tube drainage system
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How to you confirm tube placement?
CXR and assessment of lung expansion
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HOB _____ for chest tube pt.
15-45 degrees
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