Studydroid is shutting down on January 1st, 2019



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Contamination vs infection
  • Contamination is colonization w/o evidence of infection
  • Infection has inflammation secondary to the micro organism
Common contaminates of lower airway (Gram +)
  • Gram + are most common
  • Staphyloccus
  • Streptococcus
Gram - (nosocomial infections)
  • Klebsiella (most common)
  • Pseudomonas
  • Escherichia coli
  • Enterobacter
  • Proteus (least common)
Gram - cause _______    ?
  • nectrotizing pneumonia (lung tissue destroyed)
  • sepsis
  • endotoxins released when bacteria destroyed
  • require toxic antibiotics
Recommended trach cuff pressure ?
20-25 mmHg
Tracheostomy Wound Care
  • Control bleeding
  • Keep wound dry and free from secretions
Tracheostomy Wound Care Procedures
  • Remove old dressing
  • Clean wound with 3% hydrogen peroxide
  • Rinse with normal saline
  • Apply new sterile dressing
  • Attach new ties
  • Remove old ties
Possible Short Answer: Pressures within Tracheal Mucosa
  • Arterial approx 30 mm HG
  • Venous approx 18 mm HG
  • Lymphatic approx 5 mm HG
Possible Short Answer: Complications  from exceeding Tracheal Mucosa pressures 






  • Exceeding lymphatic pressures will result in edema
  • Exceeding venous pressures will result in congestion.
  • Exceeding arterial pressures will result in ischemia which could result in necrosis
Possible Short Answer: Define Tracheal Stenosis (Tracheal narrowing)
  • Scarring of trachea caused by healing process. Results in narrowing of trachea
  • Occurs 1 week to 2 yrs post extubation
  • Indications are dyspnea, stridor, lowered tolerance to exercise, recurring infections
  • Treatment is surgical repair
Possible Short Answer: Factors that cause Tracheal Stenosis at cuff site
  • Cuff pressures
  • Length of time tube in place
  • Hypoperfusion (decreased blood flow)
  • Infection, not contamination
  • Movement of tube
  • Toxicity from chemical irritation
Possible Short Answer: Define Tracheal Malacia
  • Destruction of tracheal cartlage (sofening)
  • Without support trachea collapes on inspiration
  • Usually occurs together with stenosis
Possible Short Answer: Describe Lanz tube
Uses special valve that limits pressure to no greater than 18 mm Hg
Cuff inflation: Minimal Leak Technique
  • The diameter of trachea is maximal at peak inspiration during positive pressure breathing.
  • Cuff barely occludes trachea at peak inspiratory pressure, the pressure on the tracheal mucosa during expiration will be minimal
  • If peak inspiratory pressure changes procedure should be repeated
Describe humidification of gas to lower airway
Bypassing the upper airway eliminates the filtering/humidification function therefore we have to humidify gas for pt. 100% humidification at body temp indicated
Warm patient from core to __________.
  • Periphery
  • Pt spikes temp decrease temp of gas
  • Pt is hypothermic increase temp of gas
Artificial Airway: 5 Common Causes of Tube Obstruction
  • Kink in tube- Manipulate pts head, neck and tube
  • Herniated cuff- Deflate cuff
  • Mucus plug- Try suctin catheter
  • Tube may collapse- usually nasotracheal tube iminged by deviated septum
  • Bebel of tubr impinged- Usually on carina, tracheal wall or bronchus. Manipulate pt head, neck or tube.
Measures associated with minimizing complications w/endotracheal tube : Cuff leaks
  • Caused by wear/tear
  • maintain ventilation by increasing tidal volume while changing tube
Measures associated with minimizing complications w/endotracheal tube : Inadvertant extubation
  • Pt pulls out or works out with tongue
  • Deflate cuff try to re-intubate
Measures associated with minimizing complications w/endotracheal tube : Obstruction of tube
  • Manual ventilate. If you can problem is vent
  • If not problem is with pt
  • Cuff can become floppy impinging on carina, bronchus or anterior wall
Describe fenestrated tracheostomy tube
  • Hole in posterior wall
  • Allows pt trial at maintaining own airway
  • Not intended for long term use
  • holes increase airway resistance thereby increasing work of breathing
Rationale for subjecting pt to discontinuation of artificial airway: When indications for placement are no longer present
  • Obstruction- epiglottitis- swelling down
  • Protection- obtunded, coordinated swallow
  • Suction- adequate vital capacity, can cough effectively, secretions decreased
  • Ventilation- pathological reason no longer present, adequate vital capacity
Define vital capacity
Largest breath you can breath in and out t one time
List Post Extubation Complications
  • Laryngospasms
  • Sore throat and hoarse voice
  • Glottic edema
  • Subglottic edema
  • Laryngotracheal web
Procedure for correcting Laryngospasms
  • Provide as high as FiO2 as possible
  • Positive pressure vent
  • After 1 min should stop
  • If persists give neuromuscular blocking agent (succinylcholine)
  • Reintubate
 
Procedure for correcting Glottic edema
  • Cardinal sign is inspiratory stridor
  • Treatment is cool aerolsol
  • Racemic epiniphrine and Decadron
  • If no response reintubate
Procedure for correcting Subglottic edema
  • Cardinal sign is inspiratory stridor
  • Occurs below glottis
  • More serious may not respond to treatment 
  • Reintubation may be necessary
  • More common in infants and children (small airway) 
Appropriate pressures of suctioning
  • Adults -100 to -120 mm Hg
  • Children -80 to -100 mm Hg
  • Infants -50 to -80 mm Hg
Signs of hypoxia during suctioning
  • Tachycardia (HR increases)
  • Dysrhythmias
 
Procedure for dysrhythmia during suctioning
  • Reestablish oxygenation/ventilation
  • Usually normal vitals return
  • Remedy is proper technique
Why is Coude catheter used ?
  • Enhances chance of left main stem insertion
  • Rotate pts head to right in sniffing position
How do you determine ideal catheter size ?
  • Outside dia. should not exceed 1/2 of internal dia. size
  • Use as large as possible
  • Too large is hazardous, too small ineffective
Proper suctioning technique
  • Insert catheter w/o suction until obstruction is met then pull back slightly
  • Apply suction while rotating catheter between thumb and forefinger while removing
  • Do not leave in more longer than 10-15 sec. Total pt time w/o ventilation should not exceed 20 sec.
  • Observe ECG for any abnormalities
  • At onset of any abnormalities reestablish oxygenation and ventilation
 
Which route of suctioning is most hazardous ?
Nasotracheal because hypo pharynx and inferior aspect of epiglottis are highly innervated with branches of vagus nerve. When it gets stimulated can cause cardiac rate and/or rhythm abnormalilities.
What is purpose of fenestrations on suction catheter ?
Prevents catheter from grabbing the tracheal mucosa
Complications of suction
  • Hypoxemia
  • Dysrhythmia
  • Hypotension
  • Lung collapse
  • Tracheitis
  • Mucosal damage
  • Infection
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