Term
| Inspections of Lungs breathing |
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Definition
LOC and Skin Color
Quality of Respirations
Facial Expression, Nasal Flaring
Position Assumed
Use of Accessory Muscles
Symmetry
Midline Trachea
Nails for clubbing and digits
Shape and Configuration of Chest
Anteroposterior /Transverse Diameter |
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Term
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Definition
Mid line -Trachea
Palpate entire chest wall for lumps, masses, temperature, muscle development
Chest Expansion
Tactile Fremitus |
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Term
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Definition
| Anterior Chest Expansion should be equal and symmetrical Unequal when part of lung is obstructed, collapsed, guarding |
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Term
| Anterior tactile fremitus |
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Definition
Anterior Tactile Fremitus (palpatable vibration) Increases with lung density Decreases with obstructions
(5 spots) |
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Term
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Definition
resonance
hyperesonance
dull
tympany
flat |
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Term
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Definition
| resonance- low pitched clear hollow sound found over normal adult lung tissue |
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Term
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Definition
| hyperesonance- booming sound heard normally over child lung and adult lungs with increased air such as emphysema |
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Term
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Definition
| dull- soft thud sound over dense organs |
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Term
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Definition
| tympany-drumlike sound over areas with air such as stomach and intestines |
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Term
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Definition
| flat- very short soft sound heard over muscle or bone |
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Term
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Definition
Anterior Auscultation-
Anterior and lateral- Landmark area for Auscultation
Note Bronchial, bronchovesicular, vesicular lung sounds, and presence of adventitious
Have patient assume a sitting position, use diaphragm of stethoscope, place firmly on chest, have patient breathe slightly deeper than normal through their mouth |
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Term
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Definition
-Bronchial sounds are heard over the trachea, loud and high pitched, inspiration shorter than expiration
-Bronchiovesicular sounds are heard anterior between the first and second ICS and posterior between both scapula, moderate sound, inspiration equal to expiration.
-Vesicular sounds are heard in the peripheral lung fields, soft and breezy, inspiration longer than expiration |
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Term
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Definition
normal breath sounds are found in the area they are expected to be in, if they are heard in the wrong lung field it is abnormal.
-clear sounds bilaterally in anterior, posterior and lateral areas signify all sounds are in expected areas without adventitous sounds (crackles, wheezes etc) |
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Term
| Adventitious Breathing sounds |
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Definition
Adventitious breathing sounds:
-Crackles (fine, coarse)
-fine-short, high pitched, caused as airway pops open
-coarse- loud, low pitched, gurgles, caused as air collides with secretions
-Wheezes (sibilant, sonorous, rhonchi)
-Sibilant- high pitched, musical, caused by narrowed passageways
-Rhonchi- low pitched snoring, caused by air flow obstruction
-Pleural Friction Rub0 grating sounds, caused by inflamed pleurae
-Stridor- high pitched crowing caused by upper airway obstruction |
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Term
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Definition
inspections posterior:
Position Assumed
Skin condition and color
Shape and Configuration
Symmetry |
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Term
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Definition
Palpation posterior:
Entire chest wall for lumps, masses, temperature and muscle development
Chest expansion
Tactile fremitus (5 spots) |
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Term
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Definition
Percussion (posterior)
Landmark area for percussion
note percussion tone
(8 spots) |
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Term
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Definition
Auscultation (posterior)
Landmark areas for auscultation
Note bronchial, bronchovesicular, and vesicular sounds and presence of adventitious sounds
Same technique as anterior
(8 Spots) |
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Term
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Definition
12-20 B/M
exhalation usually takes twice as long as inhaling. usually a person breathes slightly faster when awake than sleeping.
-normally each breath is about teh same size, the chest of a person who is breathing quietly will be seen to rise and fall the amount from breathe to breathe.
-ppl who use their diaphragms effectively to breath make thei abdomens rise and fall. the average adult moves about 500 ml of air / breath.
-normal breathing is nearly effortless
-rate and deoth of ventilation increase during excursive to provide more oxygen to the tissues and to remove excess carbon dioxide.
-an athlete normally breathes more slowly and deeply while at rest than someone less fit. |
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Term
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Definition
| surfactant- decreases surface tension and permits aveolar expansion. |
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Term
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Definition
| Apnea- prolonged period of breathing cessation (20+ seconds) are abnormal |
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Term
| Newborns/ toddlers/ school age kid/adult breathing rates |
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Definition
newborns:30-60 b/m
toddlers: 20-30 b/m
school-age: 12-20 b/m
adult/older adults 12-20 |
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Term
| Factors effecting respiratory function |
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Definition
factors effecting respiratory function: body position, environment, level of general health, lifestyle.
Body position: upright posture (sitting erect or standing) allows for the greatest ease of lung expansion. breathing lying down requires more effort bc abdominal content push up against diaphragm.
environment: room air 21% oxygen |
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Term
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Definition
Bronchospasm: airways narrow and air exchange is limited. hallmarks of allergic asthma. severe and uncontrolled can be fatal.
when allergic responses take place in the lungs, breathing difficulties are far more severe. small airways become edematous, mucus production increases, and inflammatory chemical mediators cause bronchospasms. |
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Term
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Definition
Atelectasis: Stiffened lungs (or lungs not allowed to fully expand) tend to collapse, and their alveoli also collapse.
Atelectasis is common in patients after surgery. other factors that can restrict breathing include sever obesity, chest or abdominal binders, abdominal distention by gas or fluid, medications or anesthesia, rib injuries, musculoskeletal chest deformities and severe weakness or neuromuscular disorders
Certain conditions and diseases may cause the lungs to stiffen or restrict expansion of the chest. the amount of space available for gas exchange in the lungs decreases. some disease cause to swell and thicken. Pxygen has greater difficulty passing through thickened alveolar walls. bc stiff lungs require more work to expand, te respiratory muscles consume and increased amount of oxygen.
less oxygen is available to the blood for the tissues.
-stiffening can result form acute or chronic lung injuries. smoke inhalation, pulmonary fibrosis, respiratory distress syndrome, infections such as pneumonia all make lung tissues swell and stiffen. these types of problems are classified as restrictive lung disorders. |
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Term
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Definition
hemoptysis- coughing up blood. indices serious conditions such as lung cancer or TB. often bloody secretions originate in the nose. drainage from the nose or mouth can drip backward into the throat, mixing with the mucus of the lower airways.
-when cough is productive it is important to establish the source of the sputum and to assess its color, volume, consistency, and other noteworthy characteristics. |
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Term
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Definition
Dyspnea- labored breathing or breathlessness. a person who is unable to breathe sufficiently to meet the body;s oxygen and metabolic demands experiences comfort and breathlessness
-most common cause of dypsnea is increased work of breathing that occurs with lung disease. reduced lung capacity, alterations in oxygen and carbon dioxide levels, or stimulation of receptors on the intercostals or diaphragm can contribute to dyspnea.
-people with chronic congestive heart failure often experience shortness of breath bc excess fluid in the lungs and low blood oxygen levels.
-SOB is a subjective symptom of lung problems |
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Term
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Definition
Levels of Dyspnea:
Level I: patient can walk 1 mile at own pace before experiencing shortness of breath
Leve lI: Patient becomes short of breath after walking 100 yards on level ground or climbing a flight of stairs
Level III: patient becomes short of breath while talking or performing ADL's
Level IV: patient is short of breath during periods of no activity
Orthopnea: patient is short of breath lying down |
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Term
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Definition
| Hypoxemia- low oxygen levels in the blood, can be caused by very slow breathing |
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Term
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Definition
| hypercapnia- abnormally high carbon dioxide in the blood. |
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Term
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Definition
observe patients breathing effort by noting obvious sue of shoulder, neck or abdominal muscles, forward leaning position, tripod position. note any gasping, wheezing or panting.
in infant notice any flaring nostrils and retraction of ribs during inspiration are signs of air hunger |
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Term
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Definition
Cyanosis: is a bluish skin discoloration caused by desaturation of oxygen on the hemoglobin in the blood. cyanosis around teh lips and under the tongue indicates serious hypoxemia.
-central cyanosis, seen in mucous membranes of teh eyes and mouth, must never be ignored bc it indicates serious oxygenation problems |
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Term
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Definition
| Clubbing: seen in patients with respiratory or cardiac disease. the tips of the fingers and toes become rounded and enlarged. long term tissue hypoxia causes the release of a substance that causes dilation of the vessels of the fingertips. clubbing occurs in lung cancer, cystic fibrosis, and lung diseases such as lung abscess and COPD |
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Term
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Definition
| hypoxia- decreased amount of oxygen available in the tissues. |
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Term
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Definition
Pulse Oximetry: noninvasive means for approximating oxygenation. a sensor attached to the patients finger or earlobe allows assessment of heart rate and oxygen saturation, either intermittently or continuously.
-oximetry is an invaluable tool for determining the patients need for oxygen therapy and assessing the therapy's effectiveness.
-the oximeter registers arterial oxygen saturaiton (SaO2). the pulse oximeter uses infrared light to determinet eh % of HGB that combines with O2. an SaO2 of greater than 95% is considered normal, whereas values lower than 93% usually indicate the need for O2 therapy and further assessment.
-several factors affect accuracy and proper interpretation of oximetry. the patient must have adequate peripheral blood flow for the oximeter to detect a pulse. conditions such as room lighting, patient motion, cigarette smoking, or dark plush on teh patients fingernails can affect sensor accuracy. forehead reflectance oximetry is less susceptible to poor tissue perfusion and able to more accurately record oxygen saturation in patients with poor perfusion.
-carbon monoxide poisoning results in false high readings, edema at the sensor site produces false low readings.
relatively slight changes in SaO2 may actually reflect large changes in blood oxygenation. |
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Term
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Definition
Crackles (aka Rales) are discontinuous sounds heard on inspiration; they indicate fluid int eh lungs. heard in patients with obstructive disease or pneumonia. crackles range from soft, fine sounds to coarse rattling sounds.
-when they are coarse and loud and occur with severe dyspnea, crackles may be telling sign of pulmonary fibrosis, congestive heart failure and pulmonary edema.
-a coarse crackle is a low-pitched, rumbling sound that indicates sputum in teh airways. these sounds often called gurgles o rhonchi, ae common in patients with chronic bronchitis or CF or in any disorder that produces an excess of mucous secretions. Often rhonchi are clear with a strong cough. if the patient has a weak cough and cannot clear the secretions coarse wheezes can indicate the need for airway suctioning. |
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Term
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Definition
Wheezes: are continuous sounds created by air passing through narrowed airways. they differentiated by pitch and sound quality. high-pitched, musical sounds are caused by air traveling through bronchospastic or edematous airways. expiratory wheezes are common in the patient with asthma and COPD.
-Bronchodilators and corticosteroids are requires to open the patient's airways and ease breathing.
-Inspiratory wheezes can be heard when the upper airways are swollen and edematous.
Stridor: hte most severe type of inspiratory wheeze, heard most commonly in children with group or epiglottitis |
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Term
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Definition
Sputum Culture: sputum is cultured to identify the specific agent causing infection.
-Patient who has a productive cough, febrile, with signs of infection should have a sputum sample evaluated. Gram stain determines if infection is resent and classifies organism +or-
-sensitivity test will indicate best antibiotic to use
-patient may be treated with a broad spectrum antibiotic until culture report comes back (3 days), then changed to the sensitive drug. |
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Term
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Definition
| oxygen saturation is the amount of oxygen in the blood, measured by pulse oximetry |
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Term
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Definition
| orthopnea- patient is short of breath while lying down |
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Term
| Arterial Blood Gas Monitoring |
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Definition
ABG- levels of O2, CO2, and pH are teh msot reliabel indicators of gas exchange.
-PaO2 is one of the best indicators of how much O2 is available to tissues. when PsO2 is lower than normal, tissues may experience hypoxia. this is dangerous to all tissues and organs but especially to the heart and brain. PaO2 normal declines with age, but abnormally low PaO2 always indicated gas exchange problems. PaO2 decreases in direct proportion to the severity of lung impairment.
-arterial blood sampling also indicates how effectively lungs are removing CO2. regulation of waste products in essential for bloods normal acid-base balance. the CO2 level affects the drive to breathe, affinity of HGB for O2 and cardiac function. PaCO2 lower than 35 mmHg indicated hyperventilation |
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Term
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Definition
| Hyperventilation: PaCO2 lower than 35 mmHg indicates hyperventilation or breathing in excess of metabolic needs |
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Term
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Definition
Levels of Hypoxemia:
Mild: PaO2 60-80 mmHg & SpO2 91-95mmHg
Moderate: PaO2 40-60 mmHg & SpO2 74-91 mmHg
Severe: PaO2 less than 40 mmHg & SpO2 less than 74 mmHg |
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Term
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Definition
| Chest X-Ray: used t identify pathologic changes in teh lunch and chest that may explain the patient's breathing problems. detect abnormal fluid or air in the pleural space or collapsed lung. also show if portions of the lung are consolidated (pneumonia) or under inflated (atelectasis), detect tumors, determine position of catheters and tubes and to monitor patient's response to therapy |
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Term
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Definition
| Pulmonary Function Test: specialized breathing tests measure lung size and airway patency. spirometry produces graphic representation of lung volumes and flows, these graphs are essential in determining the severity of a patient's restrictive or obstructive lung disease. common measurements include tidal volume, vital capacity, and forced expiratory volume in 1 second (FEV-1) |
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Term
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Definition
| Bronchoscopy: allow the physician to visualize the airways directly. a flexible fiber-optic tube connected to a viewing screen is inserted through the patient's nose. a handheld control directs teh scope intot eh trachea and bronchi. the broncoscope can be used ot collect sterile sputum specimens or tissue samples for lab examination or to withdraw large sputum plugs or aspirated objects obstructing airways. nursing intervention for bronchoscopy include ensuring informed consent, teaching before procedure, and maintaining NPO status until gag reflex returns after procedure. monitoring after the procedure includes frequent assessment for dyspnea, hemoptysis or cardiac arrhythmias. |
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Term
| Normal Arterial Blood Gas Values |
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Definition
Normal Arterial Blood Gas Values:
PaO2: 80-100 mmHg
PaCO2: 35-45 mmHg
pH: 7.35-7.45
HCO3-: 22-26 mEq/L
Base excess: +/- 2 |
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Term
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Definition
Peak Flow: meter is a handheld device that measure the highest flow during maximal expiration. the meter indicates how rapidly the patient can breathe out air. changes in peak flow measurements reflect changes in airway diameter theyoccr before symptoms of respiratory distress,such as dyspnea, wheezing, or increased coughing. peak flow measurements can be used to individualize therapy and prevent the onset of a acute asthma attack.
instruct patient to perform and record peak flow measurement twice a day, once in the am and once in pm. before using any bronchodilators.
patient determines his personal best (highest peak flow measure that he obtains over 2 week period during which teh asthma was well controlled. once this value is obtained, the following zones can be determined.
Green Zone: 80-100% of personal best (asthma is well controlled)
Yellow zone: 50-80% of personal best (asthma is not well controlled, and treatment plan may need to be increased)
Red zone: below 50% of personal best (take fast-acting beta2agonist, and contact HCP immediately) |
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Term
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Definition
aerosol therapy: an aerosol is a suspension of microscopic liquid droplets in air or oxygen given to:
-adds moisture
-hydrates thick sputum and prevents mucus plugging
- to administer drugs to the airways
- a large volume nebulizer will deliver a moist fog continuously to the airways, while absorbing water, the mucous blanket loosens, facilitates removal and soothes inflamed airways. heating increases the amount of moisture delivered.
-check reservoir frequently to make sure it is filled with sterile water, must be screwed together tightly, tubing must be drained often to prevent build up of condensation. monitor the mist temperature to prevent possible injury.
-help paient remove loosened fried secretions by coughing or suctioning. |
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Term
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Definition
aerosol meds: drugs are admin by aeroso sucha s bronchodilators. closely monitor all patients with bronchodilators for signs of increase heart rate, nervous agitation and restlessness. in haled corticosteroids are used to fight lung inflammation. aerosol steroids are a safe alternative to oral steroids.
-ex: nedocromil (tidale) and Cromolyn (Intal) to prevent asthma attacks.
CF patients receive antibiotic aerosols |
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Term
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Definition
Oxygen administration: prescribed in terms of flow or concentration depending on patients needs and delivery device. O2 flow is expressed in L/m. concentration is expressed as a % or as a fraction of inspired oxygen.
*Maintain the PaO2 above 60 mmHg or the SaO2 above 93%*
-Use the lowest oxygen concentration or flow possible to acheive an acceptable blood O2 level.
-Assess response regularly to determine the need for continuation or adjustment of therapy.
-Color, alertness, heart rate, and breathing effort are general indicators of effectiveness of O2 therapy
-Arterial gas monitoring and pulse oximetry provide more specific information concerning patient response to O2 therapy. |
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Term
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Definition
-O2 status determines which device is most appropriate. comfort is a factor, best O2 device for each patient is the one capable of providing hi or her O2 needs,
-If a patient needs only a small amount of additional O2 to maintain adequate oxygenation, use a cannula or low concentration venturi-type mask.
-patient requires moderate amount of O2, a simple mask is suitable
-patient needs high concentration O2, a reservoir-type of mask or more sophisticated system is required |
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Term
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Definition
O2 Safety:
-requires prescription.
-inform patient ofimportance of wearing the O2 device.
-check O2 flow often to ensure that the prescribed amount is being delivered.
-if patient has a nebulizer or humidifier (to minimize drying effect), ensure that the reservoir is filled with water and is attached properly. a leak in teh delivery system can prevent the patient from receiving full amount of O2. all connections must be tight.
-in the home a "no smoking" sign must be posted by the oxygen. educate about the importance of not smoking.
-O2 is not flammable but it greatly accelerates combustion and could cause a fire from a small spark |
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Term
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Definition
| Hazards of O2: -O2 could harm with misuse. -relatively low O2 concentrations can damage newborn;s retina and result in blindness. Meticulously monitor newborns on O2. -high O2 concentrations are toxic to lung tissue. severely ill patients requiring intense O2 therapy for extended periods may suffer resultant lung damage. -O2 toxicity poses a danger for the patient who needs intensive respiratory care. O2 can cause hypoventilation in some patients with advanced COPD. -Hypoventilation is relatively uncommon but is also difficult to predict. patients with COPD must be considered at risk. a patient with COPD who requires more O2 to achieve minimally acceptable blood gases should be observed carefully. -Some patients with COPD breathe in response to hypoxemia. if the receive too much O2, thei PaO2 rises excessively and their drive to breathe decreases. this causes hypoventilation, which can lead to respiratory arrest. so patients with COPD must be maintained with only low concentrations of O2 |
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Term
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Definition
Nasal cannula:
O2 capacity: 22%-44% when operated at 1-6L/min
1. most commony used O2 device c of convenience and comfort
2. delivered O2 concentration can vary with patient breathing patter; "rule of four" used to estimate concentration: for each L/min of O2, concentration increases by 4%
3. limited max O2 flow to 6L/min t minimize drying of nasal mucosa; use humidifier PRN
4. nasal passages must be patent for patient to receive O2: mouth breathing does not appreciably diminish delivered O1
5. delivered O2 concentration can vary depending on patient's breathing pattern; relatively consistent O2 delivery with quiet steady breathing |
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Term
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Definition
Venturi mask:
O2 capacity: 24%-50% when operated at 3-8 l/min as specified by manufacturer
1. provides precise and consistent O2 concentration
2. essential toa djust mask according to specifications to ensure accurate O2 delivery
3. noisy; like all masks may cause claustrophobia |
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Term
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Definition
Simple mask:
O2 capability: 40-60% when operated at 6-10 L/min
1. most common midrange O2 delivery device
2.minimum of 5L/min O2 required to prevent patient from rebreathing exhales CO2
3. as with cannula, acutal delivered O2 concentration varies with breathing pattern
4. not suitable for patients with COPD be of potential for excessive oxygenation |
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Term
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Definition
reservoir mask:
up to 90%+ when operated at 10-15L/min
1.used for critically ill patient
2. sufficient flow to keep O2 reservoir inflated. |
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Term
| Hypervenitliiation management |
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Definition
Hyperventilation Management:
-rapid breathing symptoms such as dizziness and tingling sensation; ABG indicate a PaCO2 below 35 mmHg & subjective feeling of dyspnea
-decrease patient anxiety getting the pt to breath at a slower rate. use paper bag as a rebreathing device.
-in the process of rebreathing teh exhaled CO2 form the bag, the patient;s PaCO can gradually slow the rate of breathing until it returns to normal.
-as with dyspnea a complete assessment of hyperventilation is needed, and referral to the physician may be required. |
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Term
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Definition
| retained secretions increase the work of breathing and may contribute to atelectasis and hypoxemia. no single measure controls respiratory secretions more effectively than a strong cough that pushes secretions upward. to cough effectively, the patient must be able to take a deep breath and generate rapid airflow. difficult for a pt with post op trauma related pain, unwilling , COPD, too weak, or do not understand how to produce and effective cough. pt with endotracheal or tracheostomy tube cannot cough with optimal efficiency |
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Term
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Definition
Deep Cough:
encourage pt to cough deeply. helps to mobilize secretions and open collapsed alveoli.
-inspire deeply as possible, then hold the breath a second closing the glottis. then release the air suddenly opening the glottis.
-can cause pain around the incisional areas after abdominal or thoracic surgery.
-to help control paint, support incisional area with a pillow, using it to splint the immobilized wound.
-schedule cough session after pt has gotten pain meds |
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Term
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Definition
Stacked cough: may cause less pain and almost as effective as deep ought. release several short blasts of air instead of one deep cough.
-prevents excessive stretching of the incisional area and also minimizes the airway collapse that may accompany deep coughing |
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Term
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Definition
Low-FLow (Huff) cough:
-is the most effective cough for patients with COPD, whose airways tend to collapse with rapid exhalation. slowing the airflow actually is more helpful in expelling secretions.
-instruct the pt to inhale deeply. instead of closing the glottis and generating high pressure, the pt says "huff" three or four times while exhaling. |
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Term
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Definition
Quad Cough: Patients with neuromuscular disease and quadriplegia pts often need firect assistance to generate an effective cough.
-pt takes a deep breath, nurse provides a deep breath with a manual resuscitation bag. holds the deep breath for a moment. with your hands placed just below the pts rib cage, assist the pt by quickly pushing in and upward, much like performing the Heimlich maneuver. resultant rush of air acts as a cough by dislodging mucus from the airways. |
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Term
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Definition
| Incentive Spirometry: motivates the pt to breath deeply by offering the incentive of measuring progress. the pt and nurse set realistic goals for each breathing session and the pt works independently tower acheiving each goal. motivates the pt to take responsibility for the progress. a reasonably therapy schedule is 8-10 breaths/hr. to avoid hyperventilation, encourage the patient to perform the exersices slowly. |
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Term
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Definition
Pursed lip breathing: pts with obstructive lung disease such as COPD or asthma by causing a back pressure in the airways, which eases exhalation and prevents air trapping.
-pt takes deep breath and holds it for a moment, then exhales slowly through lips held almost closed. builds pressure backwards through the airways.
-this back pressure pushed the airways open throughout exhalation and prevents airway collapse. thus more air escapes during exhalation and helps prevent air trapping. |
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Term
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Definition
Chest Physiotherapy: prescribed to help clear excessive bronchial secretions from airways. based on the premise that mucus can be shaken from the walls of the airways and helped to drain from the lungs. useful for pts with CF, COPD, and pneumonia.
-Primary techniques of secretion mobilization are percussion, vibration and postural drainage.
-most effective when used together. the patients ability to tolerate may limit the vigor which they are applied so positioning and clapping techniques may beed to be modified.
-respiratory therapists or physical therapist provides chest physiotherapy in the acute care setting |
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Term
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Definition
| Percussion: percussion produces a mechanical wave of energy that is tramsitted through the chest wall to the mucus-coated bronchial tubes. strike the chest rhythmically with cupped hands over the area where secretions are located. avoid striking over the spine of kidneys, female breasts, or on incision or broken ribs |
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Term
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Definition
| Vibration: works same as percussion. use your hands, placed on pt chest and rapidly and vigorously vibrate them while the pt exhales. |
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Term
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Definition
Postural Drainage: uses gravity to assist in the movement of secretion. placing a mucus filled segment of the lung higher than the rest of the lung allows the mucus in that segment to flow more readily downward toward larger airways. so coughing and suctioning more easily removes mucus.
-not all postural drainage positions are tolerated well
Trendelenburg positions can increase shortness of breath in pt w. COPD bc organs limit Diaphragm movement. increase intracranial pressure, contraindicated with acute head injuries and stressful with cardiac problems |
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Term
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Definition
Tracheostomy: is an artificial airway consisting of a plastic tube surgically implanted just beow the larynx into the trachea, the tube bypasses the mouth and upper airway. the surgical procedure that establishes the artificial airway is called a tracheotomy, the resultant airway is a tracheostomy. most often done as a temporary measure.
-a pt may require this procedure to bypass a severe or recurrent upper airway obstruction. the pt who regularly aspirates food or stomach contents may need a tracheostomy to protect the airway. some pts may ned to help with secretion control by trach provides ready access for suctioning. finally the patient who requires long term mechanical ventilation may beed a trach to provide the sagest and most stable artificial airway available. many are former pts of the ICU or have had head and neck surgery. |
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Term
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Definition
Tracheostomy tubes: come in various types. all contain an outer cannula that fits in to trachea and flange that rests against the neck and allows the tube to be fastened in place. -an obturator is a guide hat is inserted into the trach tube to ease insertion and then is removed.
-some attach tubes contain an inner cannula that locks into place and can be removed for cleaning |
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Term
| Cuffed tracheostomy tubes |
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Definition
Cuffed tracheostomy Tubes: contain an inflatable cuff (or balloon) that is inflated to stabilize the tube in the trachea.
-advantages of a cuffed tube include decreased risk of aspiration, prevention of air leakage, and access to mechanical ventilation. |
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Term
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Definition
| Low pressure cuffs: are preferred to decrease the incidence of tracheal mucosal damage. |
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Term
| Fenestrated tracheostomy tubes |
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Definition
| Fenestrated tracheostomy tubes: are tubes with holes in the outer cannula. when t is being ventilated, the inner cannula remains in place when weaning is attempted, the inner cannula can be removed and the cuff deflated; this allows the pt to breathe around the tube and through the fenestration. -another advantage is that speaking is possible when trace is plugged bc the hole permits exhaled air to flow over the vocal chords |
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Term
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Definition
Tracheostomy Risks:
*tube must never be plugged if cuff is inflated bc this could cause suffocation and possibly death*
-immediately after surgery, bleeding of the incision is common
-careful care of the stoma is necessary to keep it free from infection. bc the tracheostomy bypasses the defenses of the upper airway, the pt is at risk for pneumonia. Use Sterile Technique when cleaning and suctioning.
-pts who require trach often have decreased breathing ability. dried secretions can completely occlude the tube, creating a respiratory emergency. trach pts must stay well hydrated and air must be humidified.
-trachs cause communication problem. bc the vocal chords are above the level of the trach tube, pt cannot speak. specialized trach tubes can be attached to a standard tracy tube, making speech possibly. tracy buttons are temporarily to plug the trach so that pts ability to breathe through the natural airway can be assessed. when these button are in place, the pt can speak again.
-body image is a potential problem for these patients. pt may perceive stoma as disfiguring and may be embarrassed by its bubbling secretions. feelings of failure and depression may result from inability to perform such basic function as breathing without assistance. pt is also likely to feel fear and anxiety about the inability to speak. |
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Term
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Definition
trach care:
-necessary to decrease infection risk and ensure that crusted secretions do not plug tube.
-remove dried mucus from the inner cannula of the tube and from aronud the incision site. change stoma dress ins regularly. commercially made tracy dressings are available or gause amy be folded to size.
-do not cut dressing with scissors bc threads from gauze can cause inflammatory reaction at stoma.
-if the pt has large amounts of secretions, change trach dressing as often as necessary.
- if the trach produces few secretions, dressing might only need to be changed once or twice a day. and well establishes dry traches may require no dressing |
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Term
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Definition
Suctioning: Atelactessis and Pneumonia may develop in patients who cannot cough effectively to expectorate mucus. Excessive mucus can even cause airway to occlude.
To prevent this suction. suctioning is only appropriate when secretions are present in the upper airways as indicated by coarse crackles, diminished breath sounds, increased inspiratory pressure, increased respiratory rate or decreased O2 sat.
-Bc suctioning can remove oxygen as well as mucus, suctioning can cause temporary hypoxia. to minimize this use hyper oxygenation before each suctioning to minimize hypoxemia and atelectasis
-to suction the airways, insert a catheter through the nose, mouth or tracheal tube. attach the catheter to a portable or wall unit suction device, which provides the suction pressure for secretion removal. effective suctioning can clear the oral cavity and nasopharyngeal areas of secretions. secretions deep in the trachea are more difficult to remove, but the suctioning procedure is similar.
-Applying suctioning intermittently to help minimize catheter damage to the trachea's delicate mucosal lining. limit suctioning passes to three for each suctioning procesure with 10 seconds as recommeneded time limit for each suction attempt. suction regulator is set between 80-120 mmHg for larger children and adults and 60-80 mmHg for infants. in addition to causing hypoxia, suctioning can cause cardiac dysrhythmias, hypotension and atelectasis. bc suctioning can stimulate gag reflex, vomiting (with potential for aspiration) is possible.
-Some patients produce excessive amounts of oral secretions. use a "tonsil tip" (Yanhauer) suction tube to evacuate excess saliva and thick mucus from the back of the throat. this suction catheter is also attached to wall or portable suction.
-deep bronchial secretions may require deep suctioning. properly performed suctioning can greatly improve airflow to the lungs, promoting oxygenation.
- the process is also frightening and unpleasant. |
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