FranU NURS 4750 Exam 2 (High Risk OB & Newborn and
Oxygenation) Questions With Complete Solutions
Nurses Role in ET Intubation
Positioning:
-bed flat or slight trendelenburg
-Extend pt neck to sniffing position
Premed Pt:
-Sedatives (ativan, versed, morphine, propofol)
-Paralytics (norcuron, pavulon, anectine) (must also give a sed w
this)
Monitor Vitals:
-Nurses job
-Attempts shouldn't last >30s
-Obvi tell doc if sats drop so we can O2 the pt
Verify Placement:
-Auscultation (if right main stem breath sounds will be more
pronounced on right)
-Capno (good is gold)
-Chest X-Ray (want it 2cm above carina)
Cuff Inflation:
-Maintain cuff pressure btwn 14-22mmHg or 20-30cm H2O
,-Low pressure = inadequate ventilation
-High pressure = tissue injury
Securing the Tube:
-Tape, ties, or ETT holder
-Note/document where the tube is secured at teeth or gums and
how many Centimeters its at
-Check tube measurements every time we assess
-If tube out of place & pt symptomatic bag em & call RT
-If tube out of place and pt asymptomatic call RT
Tracheostomy General Info
-Surgical incision to the neck to access the lower airway
-Used for pts with facial trauma, head/neck surgery, prolonged
intubation (@ 2 weeks we start considering this)
-Can be temp or permanent
-More comfortable for pts and facilitates faster weaning
Tracheostomy Types
Provider is gonna choose the type
Cuffed:
-For pts who are on mechanical ventilation
-Provides a seal
Non-Cuffed:
-Used for pts who do not need mechanical ventilation, they just
need an airway
,-Stenosis, cancer, tumors etc...
-Long Term Trach
Fenestrated:
-Outer cannula has holes in it which allow for air to pass over
the vocal cords so the pt can speak
-Can't use for mech vent tho
Non-Fenestrated:
-Can use a speaking valve cap to allow the pt to talk
-Deflate cuff when pt is eating/swallowing bc obstruction
-Deflate cuff to maintain patency?
Bedside Must Haves for Tracheostomies
-Ambu bag/mask for it
-Obturator (basically a stylet for trachs)
-Trach kit of the same size (incase you gotta put a new one in)
-Trach kit thats 1 size smaller (incase you can't get the bigger
one in bc of swelling)
Advantages & Disadvantages of Tracheostomies
Come make better KN 12
Advantages:
-Faster weaning
-Comfort
-Possibility of oral feedings and speech
, -Doesn't require pts to be sedated
Disadvantages:
-Hemorrhage (small amnt of bloody drainage is okay for new
trachs but large amounts are bad, apply pressure notify MD)
-Infection (bypassing the natural filtration system, site should be
pink not red)
-Pneumothorax (complication of the surgery bc air can get into
pleural space)
-SQ emphysema (trapped air under skin after surgery notify MD
asap)
-Aspiration (esp if they eat w the cuff inflated)
-Dysphagia/Nerve Damage (numbness/tingling can happen but
isn't expected, how we treat depends on how severe the deficits
are)
Accidental Decannulation of Tracheostomy
-When the cannula or the Base Plate comes out
-If its older than 72hr RN can reinsert
-If its younger than 72hr the surgeon has to reinsert
Procedure for Replacement:
-Hyperextend the neck
-Dilate trachea if retention sutures not holding the stoma open
-Place obturator in outer cannula
-Reinsert trach tube
Oxygenation) Questions With Complete Solutions
Nurses Role in ET Intubation
Positioning:
-bed flat or slight trendelenburg
-Extend pt neck to sniffing position
Premed Pt:
-Sedatives (ativan, versed, morphine, propofol)
-Paralytics (norcuron, pavulon, anectine) (must also give a sed w
this)
Monitor Vitals:
-Nurses job
-Attempts shouldn't last >30s
-Obvi tell doc if sats drop so we can O2 the pt
Verify Placement:
-Auscultation (if right main stem breath sounds will be more
pronounced on right)
-Capno (good is gold)
-Chest X-Ray (want it 2cm above carina)
Cuff Inflation:
-Maintain cuff pressure btwn 14-22mmHg or 20-30cm H2O
,-Low pressure = inadequate ventilation
-High pressure = tissue injury
Securing the Tube:
-Tape, ties, or ETT holder
-Note/document where the tube is secured at teeth or gums and
how many Centimeters its at
-Check tube measurements every time we assess
-If tube out of place & pt symptomatic bag em & call RT
-If tube out of place and pt asymptomatic call RT
Tracheostomy General Info
-Surgical incision to the neck to access the lower airway
-Used for pts with facial trauma, head/neck surgery, prolonged
intubation (@ 2 weeks we start considering this)
-Can be temp or permanent
-More comfortable for pts and facilitates faster weaning
Tracheostomy Types
Provider is gonna choose the type
Cuffed:
-For pts who are on mechanical ventilation
-Provides a seal
Non-Cuffed:
-Used for pts who do not need mechanical ventilation, they just
need an airway
,-Stenosis, cancer, tumors etc...
-Long Term Trach
Fenestrated:
-Outer cannula has holes in it which allow for air to pass over
the vocal cords so the pt can speak
-Can't use for mech vent tho
Non-Fenestrated:
-Can use a speaking valve cap to allow the pt to talk
-Deflate cuff when pt is eating/swallowing bc obstruction
-Deflate cuff to maintain patency?
Bedside Must Haves for Tracheostomies
-Ambu bag/mask for it
-Obturator (basically a stylet for trachs)
-Trach kit of the same size (incase you gotta put a new one in)
-Trach kit thats 1 size smaller (incase you can't get the bigger
one in bc of swelling)
Advantages & Disadvantages of Tracheostomies
Come make better KN 12
Advantages:
-Faster weaning
-Comfort
-Possibility of oral feedings and speech
, -Doesn't require pts to be sedated
Disadvantages:
-Hemorrhage (small amnt of bloody drainage is okay for new
trachs but large amounts are bad, apply pressure notify MD)
-Infection (bypassing the natural filtration system, site should be
pink not red)
-Pneumothorax (complication of the surgery bc air can get into
pleural space)
-SQ emphysema (trapped air under skin after surgery notify MD
asap)
-Aspiration (esp if they eat w the cuff inflated)
-Dysphagia/Nerve Damage (numbness/tingling can happen but
isn't expected, how we treat depends on how severe the deficits
are)
Accidental Decannulation of Tracheostomy
-When the cannula or the Base Plate comes out
-If its older than 72hr RN can reinsert
-If its younger than 72hr the surgeon has to reinsert
Procedure for Replacement:
-Hyperextend the neck
-Dilate trachea if retention sutures not holding the stoma open
-Place obturator in outer cannula
-Reinsert trach tube
