Airway Management Karen Malt MSN RN Airway Management

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Airway Management Karen Malt, MSN, RN

Airway Management Karen Malt, MSN, RN

Airway Management � The Primary function of the respiratory system is to permit ventilation

Airway Management � The Primary function of the respiratory system is to permit ventilation (the movement of air in and out of the lungs) for an appropriate exchange of oxygen and carbon dioxide at the cellular level. � Factors that compromise airway patency: �Increased amount of mucus (a mixture of water, mucin, white blood cells, electrolytes, and cells that have been shed through the natural process of tissue replacement. ) �Thick mucus �Fatigue or weakness �A decreased level of consciousness �An ineffective cough �An impaired airway

Airway Management: Gerontologic Considerations � Conditions affecting the respiratory system are among the most

Airway Management: Gerontologic Considerations � Conditions affecting the respiratory system are among the most common life-threatening disorders that older adults experience. � Many older adults with pathologic lung disease have a history of cigarette smoking since their youth, occupations where they have inhaled pollutants, or living in an area with toxic emissions. � The nurse needs to inquire about the current history of coughing, determining how long the cough has been present, and observing and describing any sputum are important when assessing older adults. � If a cough is not resolved in a timely fashion, a cough, which is persistent, can consume the older adult’s energy and result in fatigue.

The Airway � The Upper airway consists of the: The Lower airway consists of

The Airway � The Upper airway consists of the: The Lower airway consists of � Nose Trachea � Pharynx Bronchi �Nasopharynx Bronchioles �Oropharynx Alveoli �Laryngopharynx �Gases travel through these structures to and from the blood.

The Airway � Structures that protect the airway from a wide variety of inhaled

The Airway � Structures that protect the airway from a wide variety of inhaled substances include: � Epiglottis- a lid that closes during swallowing. � Tracheal Cartilage – ensures that the trachea remains open. � Mucous membrane – a type of tissue which mucus is secreted, lines respiratory passages, and traps particles. � Cilia – hair-like projections that beat debris that collects in the lower airway. � Sneezing, and blowing the nose clears debris in nasal passages. Coughing, expectoration, or swallowing clears sputum (mucus raised to the upper airways).

Gerontologic Considerations � Elderly individuals lose the ability to clear their airway, due to

Gerontologic Considerations � Elderly individuals lose the ability to clear their airway, due to diminished strength of accessory muscles for respiration, increased rigidity of the chest wall, and diminished cough reflex make it difficult for older adults to cough effectively. � Older adults with dysphagia are more at risk for aspiration pneumonia. � Older adults are at increased risk of pneumonia. � Structures associated to the larynx tend to atrophy with age.

Natural Airway Management �Methods of maintaining the natural airway: �Keep secretions liquefied �Promote mobilization

Natural Airway Management �Methods of maintaining the natural airway: �Keep secretions liquefied �Promote mobilization and expectoration with chest physiotherapy �Mechanically clearing secretions with suction

Liquefying Secretions �The body produces mucus continually. The volume of water in the mucus

Liquefying Secretions �The body produces mucus continually. The volume of water in the mucus affects its viscosity (thickness). �Hydration- keeps mucus membranes moist and mucus thin. �An ESSENTIAL nursing activity is keeping clients hydrated. Also, nurses may assist with inhalation therapy.

Pharmacologic Considerations �Acute bronchospasm may cause airway constriction. Quick relief for this are inhaled

Pharmacologic Considerations �Acute bronchospasm may cause airway constriction. Quick relief for this are inhaled short-acting-beta-2 agonists (SABA) and oral steroids. �Albuterol, a rescue inhalant, is an example of a SABA. �Long-acting bronchodilators, such as salmetrol, a drug in many inhalers used daily for preventing asthma attacks or exercise-induced bronchospasm, are not used in an emergency situation.

Mobilizing Secretions � Chest Physiotherapy- Helps clients mobilize secretions from distal airway. Usually indicated

Mobilizing Secretions � Chest Physiotherapy- Helps clients mobilize secretions from distal airway. Usually indicated for clients with chronic respiratory disease who have difficulty coughing or raising mucus. � Postural Drainage – a positioning technique that promotes the drainage from various lobes or segments of the lungs with the use of gravity. Respiratory therapists are usually responsible for this in acute care. In long-term care nurses may be teaching this technique to the client/family. � https: //www. bing. com/videos/search? q=youtube+video+postural+drainage&view=detail& mid=29 FD 7 E 2 BAF 170 E 75 DB 3 F&FORM=VIRE � Percussion – Rhythmic striking of the chest wall. Helps to dislodge respiratory secretions that adhere to the bronchial wall. The nurse cups the hands, keeping the fingers and the thumb together as if carrying water. He or she then applies the cupped hands to the client’s chest as if trapping air between them and the thoracic wall. Percussion is performed for 3 -5 minutes in each postural drainage position. � https: //www. bing. com/videos/search? q=youtube+video+chest+percussion&view=detail& mid=52540029 EA 5 BBE 98 DB 4 C&FORM=VIRE � Vibration – The palms of the hands are used to shake underlying tissue and loosen retained secretions. Vibration is used as an alternative to percussion for frail clients.

Suctioning Secretions � Suctioning relies on negative (vacuum) pressure to remove liquid secretions with

Suctioning Secretions � Suctioning relies on negative (vacuum) pressure to remove liquid secretions with a catheter. The amount of negative pressure varies depending on the client and the type of suction equipment. Nurses may suction the upper airway, lower airway or both. � Nasopharyngeal suctioning – removes secretions from the throat through a nasally inserted catheter. � Nasotracheal Suctioning- Removing secretions from the upper portion of the lower airway through a nasally inserted catheter. A nasopharyngeal airway, sometimes called a trumpet, can be used to protect the nostril if frequent suctioning is necessary. � Oropharyngeal Suctioning – removing secretions from the throat through an orally inserted catheter. � Oral suctioning – removing secretions from the mouth with a catheter called a Yankauer-tip or tonsil tip catheter.

Variations in Suction Pressure � Age Wall Suction Portable Suction Adults 100 -140 10

Variations in Suction Pressure � Age Wall Suction Portable Suction Adults 100 -140 10 -15 Children 95 – 100 5 – 10 Infants 50 – 95 2– 5

Critical Thinking �In addition to an Sp. O 2 less than 90%, what signs

Critical Thinking �In addition to an Sp. O 2 less than 90%, what signs or symptoms does a person with hypoxia have?

Artificial Airway Management � Two common types of airway management: � Oral Airway- a

Artificial Airway Management � Two common types of airway management: � Oral Airway- a curved device that keeps a relaxed tongue positioned forward within the mouth, preventing the tongue from obstructing the airway. �Commonly used in unconscious clients and cannot protect their own airway, such as those recovering from anesthesia or a seizure. Nurses can insert oral airway, which are usually in place for a short time. https: //www. bing. com/videos/search? q=youtube+inserting+an+oral+airway &view=detail&mid=D 902 E 15 DCF 7 C 67 A 726 D 8 &FORM=VIRE � Tracheostomy- Clients who are less stable or have an upper airway obstruction or who require prolonged mechanical ventilation and oxygen are more likely to be a candidate for a tracheostomy (a surgical opening into the trachea. ) A tube is inserted through the opening to maintain the airway and provide a new route for ventilation.

Tracheostomy Tube � A tracheostomy tube is also called a cannula. Older tracheostomy tubes

Tracheostomy Tube � A tracheostomy tube is also called a cannula. Older tracheostomy tubes have larger been replaced with silicone or polyvinyl types that soften to body temperature. � Tracheostomy Tube Parts: � Inner Cannula – Cleaned periodically for cleaning � Outer Cannula – Remains in place until the entire tube is replaced. It has a flange that accommodates cloth ties that keep the tube in place as well as a locking mechanism that retains the inner cannula. � Obturator – a curved guide with a bullet- shaped tip. Used at the time of tube insertion to prevent the edge of the cannula from traumatizing tracheal tissue. Once the tube is in place, the obturator is left at the bedside for accidental extubation.

Tracheostomy Tube (cont. ) � The tracheostomy tube is below the level of the

Tracheostomy Tube (cont. ) � The tracheostomy tube is below the level of the larynx, so the client cannot speak. �One exception is if the client has a fenestrated tracheostomy tube (one with holes in the outer cannula) which allows air to pass through the vocal cords allowing speech. �Speaking Valve – a device that directs exhaled air through the upper airway. In the majority of cases, communication involves writing or reading the client’s lips. The nurse should check the client frequently do to the inability to vocalize.

Tracheostomy Suctioning � Most clients with a tracheostomy; �Require frequent suctioning due to: �The

Tracheostomy Suctioning � Most clients with a tracheostomy; �Require frequent suctioning due to: �The trach irritating the tracheal tissue �Inhaled air is not humidified as it is during normal breathing. � Catheter insertion is through the tracheostomy tube rather than the nose. � The nurse inserts the catheter a shorter distance (about 4 – 5 inches) or until resistance is felt because the tube already lies in the trachea. The resistance is caused by the contact between the catheter tip and the carina, the ridge at the lower end of the tracheal cartilage where the bronchi branch into each lung. The nurse then raises the catheter about ). 5 inch and applies suction.

Tracheostomy Care � Cleaning the skin around the stoma, changing the dressing, and cleaning

Tracheostomy Care � Cleaning the skin around the stoma, changing the dressing, and cleaning the inner cannula. Nurses perform trach care at least every eight hours or prn. They may do tracheal suctioning separately or simultaneously. � https: //www. youtube. com/watch? v=gt. Kc 9 pe 9 HCw � Nursing Implications; � Maintaining an open airway is priority. � Lack of oxygen for 4 – 6 minutes can result in permanent brain damage.

Critical Thinking �What suggestions would you offer an individual to discourage him/her from cigarette

Critical Thinking �What suggestions would you offer an individual to discourage him/her from cigarette smoking?

NCLEX Style Questions �Review the questions at the end of chapter 36 Airway Management.

NCLEX Style Questions �Review the questions at the end of chapter 36 Airway Management. Discuss rationale for answer.