Burns, tubes etc.

G. Interventions 1. Collection chamber a. Monitor drainage; notify the HCP if drainage is more than __ to __ mL/hour or if drainage becomes bright red or increases suddenly. b. Mark the chest tube drainage in the collection chamber at 1- to 4-hour intervals, using a piece of tape.

70 100

3. Nasotracheal tubes a. Inserted through a nostril; this smaller tube increases resistance and the client's work of breathing. b. Its use is avoided in clients with __ disorders. c. It is more comfortable for the client, and the client is unable to manipulate the tube with the tongue.

bleeding

13. Keep a __ (may be needed if the system needs to be changed) and a sterile __ __ at the bedside at all times. 14. Never clamp a chest tube without a written prescription from the HCP; also, determine agency policy for clamping a chest tube. 15. If the drainage system cracks or breaks, insert the chest tube into a bottle of sterile water, remove the cracked or broken system, and replace it with a new system. 16. When the chest tube is removed, the client is asked to take a deep breath and hold it, and the tube is removed; a __ __ dressing, __ __ dressing, or __ __ (depending on the HCP's preference) is taped in place after removal of the chest tube. 17. Depending on the HCP's preference, when the chest tube is removed, the client may be asked to take a deep breath, exhale, and bear down (Valsalva maneuver).

clamp occlusive dressing dry sterile petroleum gauze Telfa dressing

1. Description a. The endotracheal tube is used to maintain a patent airway. b. Endotracheal tubes are indicated when the client needs mechanical ventilation. c. If the client requires an artificial airway for longer than __ to __ days, a tracheostomy may be created to avoid mucosal and vocal cord damage that can be caused by the endotracheal tube. d. The cuff (located at the distal end of the tube), when inflated, produces a seal between the trachea and the cuff to prevent __ and ensure delivery of a set __ __ when mechanical ventilation is used; an inflated cuff also prevents air from passing to the vocal cords, nose, or mouth. e. The pilot balloon permits air to be inserted into the cuff, prevents air from escaping, and is used as a guideline for determining the presence or absence of air in the cuff. f. The universal adapter enables attachment of the tube to mechanical ventilation tubing or other types of oxygen delivery systems. g. Types of tubes: Orotracheal and nasotracheal

10 14 aspiration tidal volume

C. Water seal chamber (see Fig. 21-5) 1. The tip of the tube is underwater, allowing fluid and air to drain from the pleural space and preventing air from entering the pleural space. 2. Water oscillates (moves up as the client inhales and moves down as the client exhales). 3. Excessive bubbling indicates an __ __ in the chest tube system.

air leak

Never insert a plug (cap) into a tracheostomy tube until the __ is deflated and the __ __ is removed; prior insertion prevents airflow to the client.

cuff inner cannula

5. Minimal leak technique a. This is used for cuff inflation and checking cuff pressures for cuffs without pressure relief valves. b. Inflate the cuff until a seal is established; no harsh sound should be heard through a stethoscope placed over the trachea when the client breathes in, but a slight air __ on __ __ is present and can be heard. c. The client cannot make verbal sounds, and no air is felt coming out of the client's mouth. 6. Occlusive technique a. This is used for cuff inflation and checking cuff pressures for cuffs with pressure relief valves. b. Provides an adequate seal in the trachea at the lowest possible cuff pressure. c. Uses same procedure as minimal leak technique, without an air leak.

leak peak inspiration

4. Interventions a. Placement is confirmed by chest x-ray film (correct placement is 1 to 2 cm above the carina). b. Assess placement by auscultating both sides of the chest while manually ventilating with a resuscitation (Ambu) bag (if breath sounds and chest wall movement are absent in the left side, the tube may be in the right main stem bronchus). c. Perform auscultation over the stomach to rule out esophageal intubation. d. If the tube is in the stomach, louder breath sounds will be heard over the stomach than over the chest, and abdominal distention will be present. e. Secure the tube with adhesive tape immediately after intubation. f. Monitor the position of the tube at the lip or nose. g. Monitor skin and mucous membranes. h. Suction the tube only when needed. i. The oral tube needs to be moved to the opposite side of the __ daily to prevent pressure and necrosis of the lip and mouth area, prevent nerve damage, and facilitate inspection and cleaning of the mouth; moving the tube to the opposite side of the mouth should be done by two HCPs.

mouth

A. Description 1. The chest tube drainage system returns __ pressure to the intrapleural space. 2. The system is used to remove abnormal accumulations of air and fluids from the pleural space

negative

2. Water seal chamber a. Monitor for fluctuation of the fluid level in the water seal chamber. b. Fluctuation in the water seal chamber stops if the tube is __, if a dependent loop exists, if the __ is not working properly, or if the lung has __. c. If the client has a known pneumothorax, __ bubbling in the water seal chamber is expected as air is drained from the chest, but continuous bubbling indicates an air leak in the system. d. Notify the HCP if there is continuous bubbling in the water seal chamber.

obstructed suction reexpanded intermittent

Cuffed Fenestrated Tube The cuffed fenestrated tube facilitates mechanical ventilation and speech and often is used for clients with __ __ __ or neuromuscular disease who do not require ventilation at all times. When not on the ventilator, the client can have the cuff deflated and the tube capped (see Fig. 21-3 for fenestrated cuffed tube with red cap) for speech. A cuffed fenestrated tube is never used in weaning from a tracheostomy because the cuff, even fully deflated, may partially obstruct the airway.

spinal cord paralysis

D. Suction control chamber (see Fig. 21-5) 1. The suction control chamber provides the suction, which can be controlled to provide negative pressure to the chest. 2. This chamber is filled with various levels of __ to achieve the desired level of suction; without this control, lung tissue could be sucked into the chest tube. 3. __ __ in this chamber indicates that there is suction and does not indicate that air is escaping from the pleural space.

water Gentle bubbling