Respiratory disorders

  1. airway obstruction
    • blockage in airway. it may be partially or totally preventing air from getting into the lungs
    • some airway obstruction are life threatening emergencies/ they require immediate medical attention to prevent death
  2. airway obstruction
    • causes
    • aspiration of foriegn body
    • laryngospasm- low ca from thyroidectomy causes tetany, and laryngospasm
    • laryngeal edema
    • trauma
    • excess secretions
    • tongue relaxation
    • result is hypoxemia which leads to hypoxia, untreated hypoxia leads to irreversible brain damage with in 4-6 min
  3. airway obstruction
    • signs
    • hands over throat
    • inability to speak, cough, breath
    • central cyanosis
    • accessory muscle use
    • retractions
    • look of panic
  4. airway obstruction
    • signs more
    • stridor, shallow resp
    • inc BP and P
    • changes in MS
    • - lack of o2 to the brain
  5. airway obstruction
    • pt at risk
    • elders, younger children
    • s/p CVA
    • dec LOCburns/trauma head face, neck
    • smoke inhalation
    • drug OD
    • anaphylaxis
  6. airway obstruction
    • treatment
    • heimlich maneuver
    • artificial airway
    • goals
    • - patient airway
    • - route for ventilation
    • - suctioning
  7. Artificial Airways
    • Nasopharyngeal
    • prevents tongue from blocking the airway
    • sits above larynx
    • rubber tube via nares
    • east to insert
    • tolerate by pt with gag reflex/conscious pts
    • contraindicated with nasal obstruction, epistaxis, prolonged PTT/INR
  8. nasopharyngeal airway sizes
    • soft rubber catheter
    • measure from the tip of the nose to the bottom of the earlobe
    • also based on diameter of pts nares
  9. Artificial Airways
    • oropharyngeal
    • blocks tongue from occluding the airway
    • hard plastic device
    • unconscious pts
    • back of the tonque- lower posterios pharynx
    • easy to insert
    • prevents tongue from falling back
    • ** should not be taped**
  10. complication oropharyngeal
    • if too small, may not displace tongue or may cause tongue to obstruct airway
    • it too large, may cause epiglottis impaction
    • roof of mouth may be lacerated upon insertion
    • aspiration from intact gag reflex
  11. Artifical airways
    • endotracheal tube
    • large firm plastic catheter thru mouth or nose into trachea, 2-4cm above carina
    • can traumize muscosa and vocal cords
    • placed by skilled personnel
    • ** remove dentures, bridges, plates etc
    • pt sedated, hyperoxygenated
    • not comfortable
  12. endotracheal tubes
    • what you do
    • CXR to confirm placement
    • Cuff inflated
    • secured exteriorly also
    • attach to ventilator
  13. endotracheal tubes
    • nursing care
    • check cuff pressure q 8h
    • maintain tube patency- suction
    • freq oral hygiene
    • adequate nutrition
    • communication (can't talk)
    • resp assessment
  14. endotracheal tubes
    • complication
    • tube displacement
    • tube obstruction
    • tissue trauma
    • nosocomial infections
    • tracheoesophageal fistula (TEF)
  15. Artificial airway
    • tracheostomy
    • surgical opening with stoma below vocal cords, b/w the 2nd and 3rd tracheal ring
    • pt can eat and talk with some adjustments
    • tracheostomy button- caps toma, one way valve allows exhalation, pt can eat, talk
    • indiction
    • - bypass upper airway obstruction
    • - remove the tracheobronchial secretion
    • - long term vent use
  16. Artificial airway tracheostomy
    • complication
    • tube displacement
    • tracheal damage
    • infection
    • - lung
    • - stoma
  17. Artificial airway
    • nx dx
    • impaired gas exchanged
    • ineffective airway clearance
    • risk for infection
    • risk for aspiration
    • impaired verbal communication
    • anxiety and fear
  18. tach nx intervention
    • trach set at the bedside for all trach pts
    • promote airway clearance and aeration
    • - freq position changes
    • - humidication and hydration
    • - sedation as needs
    • - freq suctioning
    • - O2 via trach mask not nasal cannula
  19. nx interventions trach 2
    • trach care q shift/qd PRN
    • - trach sponges
    • - clean cannula- sterile
    • - check cuff pressures
    • usual resp assessment
    • alternate communication means
    • emotional support
  20. Laryngectomy
    surgical removal of all or part of the larynx and surrounding structure0 CA of the larynx

    • maintain airway- O2 mask on soma Not N/C, HOB 30 degree or higher
    • pain0 compression and meds
    • trach care
    • nutrition, I&O, may take 5-7 days for oral food
  21. Laryngectomy
    • more
    • 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
  22. Obstructive Sleep Apnea
    • this is sleep disorder that involves cessation or significant dec in airflow in the presence of breathing effort during sleep
    • predisposing factors
    • ┬áHTN, cardiac issues
  23. Obstructive Sleep Apnea
    • manifestations
    • Apnea >/= 10 sec, >/= 5x/hr d/t repetitive upper airway obstruction
    • dec O2 and incr CO2 stimulate sympathetic response
    • excessive daytime sleepiness, frequent night waking, insomnia, loud snoring, morning H/A fatigue, personality and memory changes, htn
  24. Obstructive Sleep Apnea
    • management
    • w/t loss
    • side position/pillow
    • avoid sedatives
    • ETOH 3-4 before bed
    • quit smoking
    • use nasal decongestant
  25. Obstructive Sleep Apnea
    • other management
    • oral appliances
    • prevents the airway from collapsing by either holding the tongue or supporting the jaw in a a forward position
    • CPAP, BiPAP- always know the patients setting
    • surgery
Author
Prittyrick
ID
327931
Card Set
Respiratory disorders
Description
pissed
Updated