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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
-
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
-
airway obstruction
- signs
- hands over throat
- inability to speak, cough, breath
- central cyanosis
- accessory muscle use
- retractions
- look of panic
-
airway obstruction
- signs more
- stridor, shallow resp
- inc BP and P
- changes in MS
- - lack of o2 to the brain
-
airway obstruction
- pt at risk
- elders, younger children
- s/p CVA
- dec LOCburns/trauma head face, neck
- smoke inhalation
- drug OD
- anaphylaxis
-
airway obstruction
- treatment
- heimlich maneuver
- artificial airway
- goals
- - patient airway
- - route for ventilation
- - suctioning
-
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
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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
-
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**
-
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
-
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
-
endotracheal tubes
- what you do
- CXR to confirm placement
- Cuff inflated
- secured exteriorly also
- attach to ventilator
-
endotracheal tubes
- nursing care
- check cuff pressure q 8h
- maintain tube patency- suction
- freq oral hygiene
- adequate nutrition
- communication (can't talk)
- resp assessment
-
endotracheal tubes
- complication
- tube displacement
- tube obstruction
- tissue trauma
- nosocomial infections
- tracheoesophageal fistula (TEF)
-
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
-
Artificial airway tracheostomy
- complication
- tube displacement
- tracheal damage
- infection
- - lung
- - stoma
-
Artificial airway
- nx dx
- impaired gas exchanged
- ineffective airway clearance
- risk for infection
- risk for aspiration
- impaired verbal communication
- anxiety and fear
-
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
-
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
-
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
-
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
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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
- HTN, cardiac issues
-
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
-
Obstructive Sleep Apnea
- management
- w/t loss
- side position/pillow
- avoid sedatives
- ETOH 3-4 before bed
- quit smoking
- use nasal decongestant
-
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
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