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Airway obstruction
- this is a blockage in the airway. It may partially or totally prevent air from getting into your lungs.
- some airway obstructions are life threatening emergencies. they require immediate medical attention to prevent death
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Airway obstruction
- causes
- aspiration of foriegn body
- larynogospasm- low Ca after thyroidectomy causes tetany and laryngospasm
- laryngeal edema
- trauma
- excess secretion
- tongue relaxation
- ** results is hypoxemia which leads to hypoxia - untreated hypoxia leads to irreversible brain damage with in 4-6 mins.
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Airway obstruction
- signs
- hands to throat
- inability to speak, breath, cough
- central cyanosis
- accessory muscle use
- retractions
- look of panic
-
Airway obstruction
- other signs
- stridor, shallow breathing
- inc BP & P
- changes in MS
-
Airway obstruction
- patients at risk
- elderly, small children
- s/p cva
- dec LOC
- burns/trauma on head/face/neck
- smoke inhalation
- drug OD anaphylaxis
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Airway obstruction
- treatment
- heimlich maneuver
- artificial airways
- goals:
- - patent airway
- - route for ventilation
- - suctioning
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Artificial airways
- Nasopharyngeal
- prevents tongue from blocking the airway
- - sits above larynx
- ribber tube via nares
- easy to insert
- tolerate by pt with gag reflex; conscious pts
- contraindicated with nasal obstruction. epistaxis, prolonged PTT/INR
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nasopharyngeal airway sizes
- soft rubber catheter
- measure from pt tip of nose to bottom of earlobe
- also base on diameter of patient's nares
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Artificial airways
- oropharyngeal
- blocks the tongue from occluding the airway
- hard plastic device
- unconscious patients
- back of the tongue. lower posterios pharynx
- easy to insert
- prevents tongue from falling back
- *** should bot be taped***
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complications of oropharyngeal
- if too small, may not displace tongue or may cause tongue to obstruct airway
- it is too large, may cause epiglottis impaction
- roof of mouth my be lacerated upon insertion
- aspiration from intact gag reflex
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Artificial airways
- endotracheal tube
- large, firm plastic catheter through mouth or nose into trachea, 2-4 cm above carina
- can traumize mucosa and vocal cords
- placed by skilled personnel
- ** remove dentures, bridges, plates etc
- pt sedated, hyperoxygenated
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endotracheal tube
- CXR to confirm placement
- cuff inflated
- secured exteriorly also
- attached to ventilator
-
endotracheal tuve
- nursing care
- check cuff pressure q 8 h
- maintain tube patency- suction
- frequent oral hygiene
- adequate nutrition
- communication (can't talk)
- resp assessment
-
endotracheal tube
- complications
- tube displacement
- tube obstruction
- tissue trauma
- nosocomial infection
- tracheoesphageal fistula (TEF)
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Artificial airways
- tracheostomy
- surgical opening with stoma below vocal cords. b/w the 2nd and 3rd tracheal rings
- pt can eat and talk with some adjustments
- tracheostomy button- caps stoma, one way valve allows exhalation, pt can eat and talk
- indication:
- - bypass the upper airway obstruction
- - remove the tracheobronchial secretion
- - long term vent use
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tracheostomy
- complicationa
- tube displacement
- tracheal damage
- infection
- - lungs
- - stoma
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Artificial airways
- nursing dx
- ineffective airway clearance
- impaired gas exchange
- risk for infection
- risk for aspiration
- impaired verbal communication
- anxiety and fear
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Nursing intervention
- trach
- trach set at beside- for all trach pts
- promote airway clearance and aeration
- - freq position changes
- - sedation PRN
- - freq suctioning
- - O2 via trach mask not nasal cannula
-
nx intervention
- trach -
- tracheostomy care q shift/qd PRN
- - trach sponges
- - clean cannula- sterile
- - check cuff pressure
- usual resp assessment
- alternate communication means
- emotional support
-
laryngectomy
- surgical removal of all of parts of the larynx and surrounding structures- CA of the larynx
- Maintain airway- O2 mask of stoma NOT N/C,, HOB 30 degree or higher
- pain- compressions, med
- tracheotomy care
- nutrition, I&O- may take 5-7 days for oral food
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Laryngectomy 2
- speech therapist- other methods of communication
- support for pt and fam
- monitor for complications
- possibility of more- surgeries- tracheoesophageal puncture (TEP)- voice restoration procedure to pts with total laryngectomy
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Obstructive Sleep Apnea
- this is a sleep disorder that involves cessation or significant dec in airflow in the presence of breathing effort during sleep
- predisposing factor
- HTN
- cardiac issue
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OSA
- manifestations:
- Apnea >/= 10 sec, >/= 5x/hr d/t repetitive upper airway obstruction
- decreasing o2 and inc CO2 stimulate sympathetic response
- excessive day time sleepiness, freq night waking, insomnia, loud snoring, morning h/a, fatigue, personality/memorie changes, HTN
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Obstructive sleep apnea
- management
- W/t loss
- side position, pillows- moves tongue
- avoid sedatives
- ETOH 3-4 hours before bed
- quit smoking
- use nasal decongestant
- --makes things worst
-
Obstructive sleep apnea
- other management
- oral appliance- prevents the airway from collapsing by either holding the tongue or supporting the jaw in a forward position
- CPAP/BiPAP- always know the pt setting
- surgery
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