Advanced RespiratoryProcedures

Chapter 15 page 448

Objectives Spell and define key termsState the purpose of endotracheal intubation

and describe how to assist with this procedure

Describe the care of a patient who has an endotracheal tube

State the purpose of a tracheotomy Describe the parts of the tracheotomy

apparatusDemonstrate the care of a patient who has a

tracheostomy

ContCompare and contrast a a

laryngectomy and tracheotomyState the purpose of chest tubes

and the PCT responsibility in the care of a patient with a chest tube

Differentiate a pneumothorax,hemothorax,tension pneumothorax and pleural effusion

Describe PCT care for a patient who uses a ventilator

Endotracheal Intubation

Endotracheal IntubationETT Intubation is a measure that provides

complete control over the airwayAn ETT is passed through the mouth or less

commonly the nose into the patients lungsETT are available in many sizes most adults

use 6-9The patient is ventilated and suctioned

through the tube

Properly placed endotracheal tube

PCT ROLE WITH INTUBATED PATIENTTHE ETT IS INSERTED BY A QUALIFIED

HEALTH PROFESSIONAL WHO IS CERTIFIED IN ACLS

AS THE PCT YOU MAY ASSIST WITH THE INSERTION OF THE PROCEDURE OR MAY CARE FOR THE PATIENT WHO HAVE BEEN INTUBATED

TOOLS OF THE TRADELARYNGOSCOPE the instrument

used to perform the intubation procedure

Two parts the handle and the blade

Bag valve-mask device is used to assist ventilation when the endotracheal tube is not connected to a mechanical ventilator

The bag valve mask is connected to oxygen and the patient is over oxygenated prior to intubation

LARYNGOSCOPE the instrument used to perform the intubation procedure

Two parts the handle and the blade

Intubated patientsThese patients require a great deal of care

comfort measures and reassuranceThe PCT must work side by side with the RN

to provide the care needed for the patientThese patients will be unable to speakKeep the patient HOB elevated Provide oral and nasal care PRN

Breathing through the neckTracheotomy is a surgical procedure to

create an opening into the neck through which to breathe

Caring for a new trach is a sterile procedure The goal of tracheostomy care is a. keep the stoma & cannulae

clean and free from obstruction b. prevent skin irritation c. prevent infection

Procedures

Procedures 126 suctioning a tracheostomyProcedure 127 stoma care using a

nondisposable inner cannulaTracheostomy dressing and ties the dressing

is used to absorb perspiration and secretionsWhen the dressing is inserted the split faces

upward towards the patients face

Continue

The old ties are not removed until the new ties are in place

You should be able to place one or two fingers between the tape and the neck

Procedure 129 applying a tracheostomy dressing and ties

Chest Tubes

Are sterile plastic tubes that are inserted through the skin of the chest between the ribs and into the spaces between the pleural membranes that cover the lung and the pleural membrane that lines the chest wall

The tubes also allow air to escape if there is a leak of air at the suture line after lung surgery

Treatment Pneumothorax this is free air in the chest

cavity outside the lungs the free air presses against the lungs so that the lung cannot expand properly

Hemothorax is a similar condition in which there is blood in the chest cavity Spontaneous lung collapses are rare

This condition usually occurs as a result of trauma

Three reasons for a Chest TubeTo reinflate a lung affected by PneumothoraxTo correct an air leak that is slow to heal

after lung surgeryTo drain fluid that collects around the lungs

in patients who have cancer• This fluid is called pleural effusion

Caring for a patient with a chest tubeMake sure the bottle is always lower than the

patients heartMake sure that nothing pulls on the tubeRepositioning the patient every two hours or

as orderedMake sure the tube is never kinked twisted

or obstructedInforming the RN if the patient develops any

sign and symptoms listed in the observe & repot box

Observe & Report BoxVital signs changePulse oximeter alarm soundsDressing on the chest wall looseColor or amount of draniage from the chest

tube changesPatients coughs up bloodPatient becomes short of breath or cyanoticPatient develops new swelling on the torso

Tension Pneumothorax

• Sign and Symptoms of tension pneumothorax

• Chest pain• Hypotension• Distended neck veins• Tracheal shift to one side• Rapid weak pulse• Dyspena• Rapid respirations• Diaphoresis

Mechanically Ventilated

Ventilator is a mechanical device that is used to facilitate breathing in patients whose respiratory or diaphragm function is impaired

The ventilator is connected to an ETT tube or the trach

Patients who are using ventilators usually have serious medical conditions and may be unstable