Procedures

Chapter 15 page 448

Objectives Spell and define key terms State 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 apparatus Demonstrate the care of a patient who has a tracheostomy

Cont Compare and contrast a a laryngectomy and tracheotomy State 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

ETT Intubation is a measure that provides complete control over the airway An ETT is passed through the mouth or less commonly the nose into the patients lungs ETT are available in many sizes most adults use 6-9 The patient is ventilated and suctioned through the tube

Properly placed endotracheal tube

PCT ROLE WITH INTUBATED PATIENT THE 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 TRADE LARYNGOSCOPE 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 patients These patients require a great deal of care comfort measures and reassurance The PCT must work side by side with the RN to provide the care needed for the patient These patients will be unable to speak Keep the patient HOB elevated Provide oral and nasal care PRN

Breathing through the neck Tracheotomy 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 tracheostomy Procedure 127 stoma care using a nondisposable inner cannula Tracheostomy dressing and ties the dressing is used to absorb perspiration and secretions When 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 Tube To reinflate a lung affected by Pneumothorax To correct an air leak that is slow to heal after lung surgery To 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 tube Make sure the bottle is always lower than the patients heart Make sure that nothing pulls on the tube Repositioning the patient every two hours or as ordered Make sure the tube is never kinked twisted or obstructed Informing the RN if the patient develops any sign and symptoms listed in the observe & repot box

Observe & Report Box Vital signs change Pulse oximeter alarm sounds Dressing on the chest wall loose Color or amount of draniage from the chest tube changes Patients coughs up blood Patient becomes short of breath or cyanotic Patient 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