Airway Management
The Airway = the passageway for gases traveling from the nose &/or mouth
→ the alveoli of the lungs.
The Upper Airway
1. Nose
2. Pharynx
a.
b.
c. Larygopharynx
The Lower Airway
1.
2.
3. Bronchioles
The respiratory tract is lined with mucous membranes that secrete mucus,
which must be coughed up and
What type of MEDICAL-SURGICAL DIAGNOSES could jeopardize the
airway?
1. Increased mucus from
2. Impaired swallowing from
3. Thick mucus as in Cystic Fibrosis
4. Parkinson’s Disease → impaired swallowing
5. ↓ LOC from
6. Disorders of the throat, esophagus, or respiratory tract like
To help maintain the patency of the airway, nurses must use 3 Skills:
1. Liquefy Secretions
a.)
b.) Inhalation Therapy
HHN treatments improve ventilation &
↑ coughing & expectoration of sputum
c.) Collecting Sputum Specimens (See Nursing Guidelines)
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2. Chest Physiotherapy to mobilize secretions
a.) Postural Drainage = using
Pt remains
b.) Percussion = rhythmic striking
Done to
Done 3 – 5 mins in each postural drainage position
c.) Vibrations = shaking or vibrating the chest gently
To dislodge thick secretions in the frail patients.
3. Suctioning = removing secretions with a cath
a.) Nasopharyngeal Suctioning=
b.) Nasotracheal Suctioning =
c.) Oropharygeal Suctioning= into mouth toward back of throat
d.) Oral Suctioning =
e.) Tracheal Suctioning =
What Assessment facts indicate need for suctioning?
1.
*2.
[See Typed Nasopharygeal Suctioning Skill]
If at risk for airway obstruction, an artificial airway may be used.
2 Common Types of Artificial Airways:
1. Oral Airway
2. Tracheostomy tube
1. Oral Airway = a curved device that holds the tongue forward
Used for:
Insertion of oral airway:
a) Using clean gloves, spread teeth apart with a tongue blade
b) Insert oral airway
c) Remove airway every 4 hours
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2. Tracheostomy = surgically created opening into the trachea
Tracheostomy Tube
1. Some have inner & outer cannula
2. Some have inflatable balloon cuffs
a)
b) to prevent oral fluids from
3. Some are cuffless
4. Pts may not
5. Nurses must provide
6. Coughing is done thru the trach
7. Most Clients may need
[See Typed Tracheal Suctioning Skill]
Tracheostomy Care = should be done Q 8 hours & PRN
1. Cleaning the Peristomal Skin
2.
3.
[See Typed Tracheostomy Care Skill]
Oxygenation of the Patient (Chap. 20)
Oxygen is essential to life. Without it cells will die!
Hypoxemia = insufficient oxygen in arterial blood
Hypoxia =
What are Signs and Symptoms of Hypoxia?
Increased breathing, ↑pulse
Name 2 techniques for Measuring Pt’s Oxygen Level?
1. Pulse Oximetry =
2.
These 2 items measure O2 Saturation = the % of hemoglobin saturated
with oxygen.
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Normal O2 Saturation =
If too low→ need for Oxygen Therapy
What are Ways to Improve Oxygenation for the Pt
1. Positioning the Pt
2. Breathing Techniques
a. Deep Breathing =
Incentive Spirometry = a device giving visual cues of how much air
is inhaled!
b. Pursed –Lip Breathing =
c. Diaphragmatic Breathing =
d. Nasal Strips = Adhesive strips applied to the nose to ↑nasal diameter.
(When the above is inadequate, Oxygen Therapy is used.)
3. Providing Oxygen Therapy
a. Sources of Oxygen:
Wall outlet or Portable Tank
Liquid Oxygen unit
Oxygen Concentrator
b. Flowmeter =
c. Humidifier Bottle = filled with sterile distilled water; attached to
flowmeter
d. Oxygen Delivery Device = a device used to give O2 to the
What are types of Oxygen Delivery Devices:
1. Nasal Cannula= prongs in the nose; preferred device for emphysema pt.
2. Simple Mask =
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3. Partial Rebreather Mask = 1/3 of exhaled air enters reservoir bag, pt re-
breathes it + O2.
4. NonRebreather Mask = none of exhaled air enters the reservoir bag; air
leaves the mask; pt only breathes oxygen from reservoir
bag.
5. Venturi Mask= color-coded adapters
6. Face Tent = less suffocating
7. Tracheostomy Collar or T Piece = for O2 delivery to the trach pt.
8. Oxygen Tent = Plastic covering
9. CPAP = positive pressure
10. Transtracheal Oxygen = oxygen cath inserted into a surgically created
tracheal opening.
What are Hazards to giving Oxygen?
1). Fire
Nursing Guidelines 20 -2
2). Oxygen Toxicity “Box 20-2”
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