Nadeeka Jayasinghe Week 06

Discuss treatment modalities for:  Tracheostomy care  Metered dose inhalers  Artificial airway management  Deep breathing, coughing and turning  Chest drainage and IC tube management  Nasotracheal suctioning  Weaning a patient from mechanical ventialtion

 A tracheostomy is an opening surgically created through the neck into the trachea to allow direct access to for ventilation  Done in operating theatre or during an emergency  Provides an airway  Can remove secretions easily  Temporary vs Permanent

 Congenital abnormalities (laryngeal hypoplasia, vascular web)  Upper airway obstruction due to foreign body  Supraglottic or glottic conditions (infection, vocal cord paralysis)  Neck trauma with severe injury to thyroid or cricoid cartiledges  Subcutaneous emphysema  Severe sleep apneoa  Aspiration, inadequate cough  Inability to wean off a ventilator (sec. to resp failure)

 Provides a small secure airway for suctioining and mechanical ventilation  Nebulized meds and oxygen delivery  Useful for long term mechanical ventilation  Able to protect the skin from facial pressure sores due to straps, tube holders etc

 Increases disability / dependency  Coughing to clear the small airway is difficult  The stoma site is prone to infection, bleeding and swelling  It requires specialized nursing skill and care required may be complicated  May lead to difficulty with speech and swallowing VIDEO – tracheostomy care

 Inhaler, mist type delivery method  Most efficient and quickest way of getting the medication into airway  Acts more quicker than oral medications  Important for delivering quick relief medications (i:e; bronchodilators)  Short term vs long term medications delievery  Not all MDIs are the same but the delivery method is similar  VIDEO – MDI delivery

WHEN WOULD YOU REQUIRE ARTIFICAL AIRWAY MANAGEMENT?

Oropharyngeal airways  Used to maintain patent airway  Often used during CPR  Pulls tongue forward to prevent occlusion of airway  Tolerated by comatose patient (conscious patient will gag)  Designed to accommodate suction catheter  Can prevent biting of endotracheal tube if patient is intubated

NASOPHARYNGEAL AIRWAYS

Nasopharyngeal Airways:  Various sizes and materials (soft, latex)  Maintain patent airway  Inserted through nare into oropharyngeal area  Requires lubrication  Frequently used for naso-tracheal suctioning

 Endotracheal Intubation

INTUBATION( Indications): 1.Keep a patent airway - (relief of obstruction) 2. Protect airway from aspiration in patients with profound disturbance in consciousness with the inability to protect the airway. 3. Provide bronchial hygiene (suctioning). 4. Provide mechanical ventilation. severe pulmonary or multi-system injury associated with respiratory failure, such as sepsis, airway obstruction, hypoxemia, and hypercarbia

 Bypasses normal defense pathways (risk of infection)  Removes effectiveness of cough  No ability of for verbal communication  Loss of dignity

 The process where intensive care staff try to get the patient to breath alone without the use of the mechanical ventilator  Patients are given a ‘trial period’ on the ventilator to breath spontaneously before they are extubated  Arterial blood gases determine if the patient’s spontaneous breathing is adequate

 Patient’s level of conciousness (awake, ability to obey commands)  Satisfactory cough and breathing volumes  Arterial blood gases  Chest xray  Minimal secretions  Hemodynamic stability

CHEST TUBES:  Used for pneumothorax, chest surgery and trauma  A chest tube is a large catheter inserted through the thorax to remove blood, fluid and/or air  Traditional drainage systems: 3 bottle system  Modern drainage system: mobile chest drain system which allows the patient to move about with less restrictriction

 Tube is inserted when air or fluid enters the pleural space, compromising oxygenation and ventilation (eg: chest trauma, open chest surgery, or a large pleural leak)  A closed chest drainage system with or without suction is attached to the chest tube to promote drainage of air and/or fluid  Lung re-expansion occurs as the fluid or air is removed from the pleural space  VIDEO

 Activity 1: Discuss how deep breathing and coughing can assist a patient’s oxygenation  Activity 2: RESPIRATORY SYSTEM QUESTION TIME