Chapter 33, Airway Management

Arrange the steps of orotracheal intubation in order of their occurrence.

Correct 1. Assemble and check the equipment required for intubation. Correct 2. Align the patient's mouth, pharynx, and larynx. Correct 3. Provide ventilation and oxygenation by manual resuscitator bag and mask. Correct 4. Insert the laryngoscope in the patient's mouth. Correct 5. Visualize the arytenoid cartilages and epiglottis. Correct 6. Displace the epiglottis with the laryngoscope blade. Correct 7. Insert the orotracheal tube. Correct 8. Use fiberoptic laryngoscopy to assess tube position.

Place the steps in order for suctioning on a patient who is being seen for obstruction of airway.

The first action is to assess the patient for any indication based on the clinical indicators such as rhonchi heard on auscultation. The next priority is to assemble and check equipment required for suctioning such as suction catheters, gloves, and cups. The third step involves hyperoxygenating the patient by delivering 100% oxygen for 30 to 60 seconds to pediatric and adult patients. The next step involves the insertion of the catheter through the shallow suction method to prevent tracheal mucosal trauma. The respiratory therapist then applies suction and clears the catheter with the help of saline water. The patient then is reoxygenated using the same method of hyperoxygenation. The final step of the whole procedure is to monitor the patient and assess the outcomes.

Prioritize the steps involved in an orotracheal intubation procedure.

The first step of endotracheal intubation is to assemble and check whether all the equipment required for the procedure is present. The health care provider should then position the patient before starting the procedure. The patient's position should ensure the easy passage of the tube. The patient should be oxygenated and ventilated, enabling the patient to have adequate ventilation and to tolerate the intubation procedure. The provider should then visualize the patient's glottis. The epiglottis should be displaced while inserting the tube. After inserting the tube, the provider should assess the tube position to ensure proper placement and prevent any damage to the trachea. Finally, the tube should be stabilized and placement should be confirmed.

A respiratory therapist (RT) is preparing the patient for orotracheal intubation. Arrange the steps of the procedure in order.

The first step of orotracheal intubation is to assemble and check the equipment including the suction equipment and the appropriate size of the laryngoscope blade along with the light source. The next step is to check the position of the patient. The respiratory therapist should align the mouth, pharynx, and larynx of the patient. The patient should be preoxygenated and ventilated. The patient should be exposed to 100% oxygen before intubation. The next step includes the insertion of the laryngoscope using the left hand of the RT, while the right hand opens the mouth. The RT then should visualize the glottis based on the cartilage and epiglottis. Displacement of the epiglottis is the next step in the scenario using the curved or Macintosh blade. The tube is next inserted through the right side of the mouth. The next step for the insertion of the tube is to assess the position of the tube. The final step for the RT is to stabilize the tube and confirm the placement of the tube.

A respiratory therapist is preparing the patient for airway maintenance. Arrange the steps of the procedure in order.

The first step of the process is to secure airway of the patient and confirm the placement of tube. The respiratory therapist, as the next step of the procedure, provides patient communication, which includes a variety of methods including lip reading, writing messages on paper, or using picture boards. For the next step of the process, the respiratory therapist has to make sure of sufficient humidification with the help of heated humidifier or a large-volume jet nebulizer. During the procedure, the patient is susceptible to bacterial colonization and infection of the lower respiratory tract. The respiratory therapist must adhere to sterile technique, ensuring that only aseptically clean equipments are used during the process. The therapist must also ensure performing hand hygiene between contacts. The next step of the process involves suctioning of the retained secretions, blood, or other semiliquid fluids. As the process progresses, the therapist has to provide continuous cuff care. The final step of the process involves the therapist troubleshooting problems related to airway, including checking for problems such as tube obstruction, cuff leaks, and accidental extubation.

Arrange the steps of nasotracheal extubation in order of their occurrence.

The respiratory therapist assembles the equipment, such as suctioning apparatus, sterile suction catheters and gloves, aerosol nebulizer, and other equipment as needed for extubation. The patient's endotracheal tube and the pharynx above the cuff are suctioned to prevent aspiration of secretions after extubation. The respiratory therapist administers 100% oxygen to the patient to prevent hypoxemia that can occur due to the procedure. The respiratory therapist deflates the cuff and removes the tape or the holder that secures the tube. The patient is then asked to cough, and the tube is removed during the expulsive expiratory phase. The patient is administered oxygen therapy to prevent hypoxemia, and a cool mist may be administered as humidity therapy. Finally, the respiratory therapist auscultates the patient for good air movement and to identify any airway problems.

What is the correct order of the steps involved in a nasotracheal extubation?

The respiratory therapist should assemble all equipment needed before performing any procedure. This helps reduce errors during the procedure. The RT should explain the procedure to the patient and assemble materials. The endotracheal tube and pharynx should then be suctioned above the cuff to prevent the risk of aspiration after extubation. After suctioning, the patient should be oxygenated well to prevent the risk of hypoxemia during the procedure. The respiratory therapist should deflate the cuff to remove all of the air from the cuff, helping prevent damage to the vocal cords and trachea. The tube should be removed at peak inspiration or during the expulsive expiratory phase, with proper coordination with the patient. Applying appropriate oxygen therapy and humidification helps prevent complications after extubation. The patient should be assessed for proper airflow and adequate ventilation.

A respiratory therapist is preparing to clean the double-cannula tracheostomy tube. Arrange the steps of tracheostomy care in order of their occurrence.

The respiratory therapist should assemble and check equipment needed for cleaning through the tube to determine if it is working properly. The therapist then explains the procedure to the patient to prevent anxiety in the patient. The therapist suctions the patient to clear any secretions. The inner cannula is removed and placed in hydrogen peroxide to soak, so the dried secretions can be easily cleaned. The dressing is removed to clean the stoma site, and the therapist assesses the stoma site for swelling and redness. The tie, or the holder, is changed next, and the old tie is discarded. The inner cannula, if not disposable, is replaced, and the patient is monitored to determine adequate breath sounds, need for oxygenation, and vital sign fluctuations.

Arrange the steps in the sequence that a respiratory therapist would follow when performing endotracheal suctioning in an adult patient to remove bronchopulmonary secretions.

When preparing to perform endotracheal suctioning, the respiratory therapist should first assess the patient to determine the presence of clinical indications such as rhonchi. Then, the therapist should assemble all the parts and check for the presence of leaks. The respiratory therapist should next hyperoxygenate the patient with 100% oxygen for 30 to 60 seconds to minimize the risk of hypoxemia. After hyperoxygenating the patient, the respiratory therapist should insert the catheter and apply suction, and then reoxygenate the patient with 100% oxygen for 1 minute.

A respiratory therapist (RT) is examining a patient who has an endotracheal intubation. After examining the patient, the RT anticipates that the patient has a risk of asphyxiation. Which finding leads the RT to reach this conclusion?

a

An infant weighing 1.5 kg is admitted to the medical center with severe neonatal epignathus. What is the internal diameter of endotracheal tube that should be used?

a

In which patient would the respiratory therapist use a laryngeal mask airway for administering oxygen?

a

What should be the suction pressure when performing endotracheal suctioning in a neonate?

a

Which is common to both tracheal and laryngeal lesions caused by endotracheal intubation?

a

Which is most likely to result in the endotracheal tube moving toward the carina?

a

Which is the most appropriate device that will help the patient with a tracheostomy tube to initiate communication?

a

While caring for a patient with respiratory distress, a respiratory therapist (RT) decides to provide an airway that can be inserted through the oropharynx, trachea, or esophagus. Which airway would the RT select to facilitate mechanical ventilation in the patient?

a

While providing airway care to a patient, the respiratory therapist (RT) finds that the patient is having silent aspirations. Which action of the RT may have led to this finding in the patient?

a

Which statement holds true while administering prophylactic medication to a neonate before extubation to avoid or reduce the severity of postextubation complications? Select all that apply.

ab

Which symptoms indicate laryngeal injury in the patient who underwent an endotracheal intubation? Select all that apply.

ab

What actions should the respiratory therapist take while assisting the health care provider with a tracheotomy? Select all that apply.

abc

Which airway tube can extend further beyond the pharynx? Select all that apply.

abc

Which airways extend beyond the pharynx? Select all that apply.

abc

Which procedures help in quantifying the severity of the tracheal damage caused by endotracheal intubation? Select all that apply.

abc

What precautions should the respiratory therapist take while performing a blind nasal intubation in a patient? Select all that apply.

abe

Which interventions should the respiratory therapist implement to prevent trauma caused by a tracheal airway in a patient? Select all that apply.

abe

Which tracheal lesions can commonly occur in a patient with a tracheal airway? Select all that apply.

acd

Which problems are associated with tracheal postextubation in a patient who had undergone an endotracheal intubation? Select all that apply.

ad

A patient has a high heart rate and leukocytosis along with fever on the day after intubation. Which could be the most probable reasons for this nosocomial infection in the patient? Select all that apply.

ade

What should the respiratory therapist assess in a patient before preparing the patient for extubation? Select all that apply.

ade

Which problem is most likely to result from tracheal postextubation in a patient who has undergone endotracheal intubation?

ade

A respiratory therapist (RT) is caring for a patient who has undergone cricothyrotomy. Which complications does the RT anticipate to find in the patient? Select all that apply.

ae

A respiratory therapist (RT) is caring for a patient who has undergone cricothyrotomy. Which complications does the RT anticipate to find in the patient? Select all that apply. A Bleeding

ae

While assessing a patient who is on mechanical ventilation, the respiratory therapist (RT) finds that the patient has respiratory distress and changes in breath sounds. On examining the equipment, the RT does not find decreased airflow through the tube. Which conditions are expected to have caused these complications in the patient? Select all that apply.

ae

While assessing a patient who requires mechanical ventilation, the respiratory therapist finds that it is not possible to intubate the patient. Which alternative airways should the respiratory therapist select in this situation? Select all that apply.

ae

A respiratory therapist (RT) is inserting a speaking valve in a patient who has a tracheostomy tube in place. While assessing the patient before the procedure, the RT observes the patient's tracheal pressure as 6 cm H2O. What should the RT do in this situation?

b

A respiratory therapist is attending a patient who was involved in an automobile accident. The patient is gagging on his or her own blood. The respiratory therapist performs nasal intubation as a precautionary measure. What is the reason for this intervention?

b

What action should the respiratory therapist take when decreased breath sounds are noted in a patient with a tracheostomy tube?

b

What are the recommended tube size and the distance to be maintained between the lips and the tip of the tube when performing an endotracheal intubation on an infant who weighs 2.5 kg?

b

What is decannulation?

b

What is the criterion for selecting the appropriate catheter size when performing endotracheal suction in adults?

b

What is the function of a distal cuff in the double-lumen airway?

b

What is the preferred method for the removal of foreign bodies, secretions, or tissue masses beyond the main stem bronchi?

b

What is the purpose of a bronchoscopy?

b

What purpose does bronchoscopy serve?

b

Which airway has an open metal tube with a distal light source and a port for ventilating equipment?

b

Which dietary restrictions are implemented for a patient after extubation?

b

Which is the most likely condition that contraindicates a nasotracheal suctioning procedure?

b

Which is the preferred route for establishing an emergency tracheal airway for a conscious patient?

b

Which is the preferred route to place an emergency airway in a patient who is awake?

b

Which parameter indicates that the endotracheal tube can be removed from the neonate?

b

Which prophylactic medication would a respiratory therapist recommend for a patient before extubation to prevent cough?

b

Which statement about the tracheostomy tube is true?

b

Why should the respiratory therapist deflate the tracheostomy tube cuff before placing a speaking valve in a patient who is on mechanical ventilation?

b

Which complications does the respiratory therapist expect after extubating a patient who was intubated with an endotracheal tube? Select all that apply.

bcd

A patient undergoes certain laboratory tests that confirm the presence of an infection. The respiratory therapist (RT) also suspects an infection while administering airway maintenance. Which laboratory and clinical findings enable the RT to reach this conclusion? Select all that apply

bce

A patient undergoes certain laboratory tests that confirm the presence of an infection. The respiratory therapist (RT) also suspects an infection while administering airway maintenance. Which laboratory and clinical findings enable the RT to reach this conclusion? Select all that apply.

bce

What are the benefits of orally intubating a patient compared to other tracheal airway routes? Select all that apply.

bce

Which adverse effects may occur in patients who have been instilled with normal saline during endotracheal suctioning?

bce

Which methods may help assess tube position after endotracheal intubation? Select all that apply.

bde

Which represent either the normal or abnormal healing process in the airway after extubation? Select all that apply.

bde

What are contraindications to the nasotracheal suctioning procedure? Select all that apply.

be

What are the contraindications to the nasotracheal suctioning procedure? Select all that apply.

be

9. What will the respiratory therapist assess for in a patient after tracheostomy decannulation?

c

A nonventilated patient with a tracheostomy has thick mucus secretions and is at risk for bronchospasm. Which device should the respiratory therapist use to deliver humidity to this patient?

c

A patient is going through the process of trachestomy decannulation. What is the most important thing the respiratory therapist assesses in the patient after the process?

c

A respiratory therapist finds the cuff pressure of a critically ill patient who is on mechanical ventilation to be 50 mm Hg. Which is a risk to the respiratory mucosa of the patient in this condition?

c

A vascular catheter is inserted into a conscious patient who is undergoing a tracheostomy procedure. How will a health care provider communicate with this patient during the tracheostomy procedure?

c

The respiratory therapist is unable to visualize the arytenoid cartilage and epiglottis while inserting the laryngoscope in the patient's mouth. What can the respiratory therapist conclude from this?

c

What action should the respiratory therapist take before inserting the orotracheal tube in the patient's mouth?

c

What is accidental extubation?

c

What is the appropriate size of the tracheostomy tube used for a 19-year-old patient?

c

What precautions should be taken before suctioning neonates who are at risk of hypoxemia?

c

What will the respiratory therapist assess for in a patient after tracheostomy decannulation?

c

What would be the distance maintained between the incisors and the tip of the tube while performing an endotracheal intubation on a 5-year-old patient?

c

Which complication is associated with a fenestrated tracheostomy tube?

c

Which drug would a respiratory therapist recommend for a child with postextubation laryngeal edema?

c

Which endotracheal tube size would the respiratory therapist use for an 8-year-old patient?

c

Which intervention will help determine the proper placement of a fenestrated tracheostomy tube in a patient?

c

Which is an advantage of the double-lumen airway (Combitube) placement as an alternative to endotracheal intubation for maintaining upper airway patency?

c

Which is the best way for a practitioner to communicate with a critically ill patient who has an orotracheal tube in place?

c

Which is used in a patient with unilateral lung disease?

c

Which medication reduces the risk of apnea before an extubation is performed in a patient?

c

While assessing a patient who has undergone tracheotomy, the respiratory therapist (RT) finds kinking in the tube. Which action of the RT helps to reduce complications in the patient?

c

What should the respiratory therapist assess in a patient before decannulation? Select all that apply.

cde

Which factors increase the tracheal resistance in a patient who has a tracheostomy tube? Select all that apply.

cde

Which are advantages of oral intubation? Select all that apply.

ce

A respiratory therapist (RT) is preparing to insert a laryngeal mask airway in a newborn. Which action followed by the RT during insertion is most likely to provide safe and effective care to the newborn?

d

After performing the cuff leak test in a patient who has undergone tracheostomy, a respiratory therapist finds that the patient does not have a risk of upper airway edema or obstruction. What is the percentage of cuff leak in the patient?

d

Identify the fenestrated tracheostomy tube in the images.

d

The respiratory therapist notices that a patient who has a tracheostomy tube with mechanical ventilation has developed decreased cuff pressure over time. What action should the respiratory therapist take?

d

What action should the respiratory therapist take if the first attempt at orotracheal intubation fails?

d

What action should the respiratory therapist take to assess the likelihood of aspiration in a patient with a tracheal tube?

d

What does a respiratory therapist do while preparing a patient for fiberoptic bronchoscopy?

d

What is the most important factor that the respiratory therapist assesses in a patient before extubation?

d

What procedure does the image show?

d

What should the respiratory therapist assess for while preparing the patient for fiberoptic bronchoscopy?

d

What should the respiratory therapist do before changing a tracheostomy tube?

d

What should the respiratory therapist do if orotracheal intubation fails?

d

Which action of the respiratory therapist needs to be corrected to avoid atelectasis during a procedure?

d

Which condition is most likely to cause respiratory distress and breath sound changes in a patient on mechanical ventilation, assuming there is not decreased airflow in the tube?

d

Which finding in a patient indicates that a speaking valve is properly placed?

d

Which is the best method to enable communication for a patient with a tracheal tube?

d

Which is the most appropriate placement of an endotracheal tube in an adult patient?

d

While inserting a laryngeal mask airway, the respiratory therapist maintains a ventilating pressure of 40 cm H2O. Which complication does the therapist expect to find in the patient?

d

What are the rare but serious complications of tracheal lesions caused by endotracheal or tracheostomy tubes? Select all that apply.

de

What indicates that a patient is ready to switch from endotracheal tube to tracheostomy? Select all that apply.

de

What is the rationale for the application of 0.25% phenylephinephrine and 3% lidocaine to the nasal mucosa using a cotton-tipped swab while performing a nasotracheal intubation in a patient? Select all that apply.

de

Which are indications of a need for bronchoscopy? Select all that apply.

ef

A respiratory therapist is preparing the tracheostomy tube for long-term mechanical ventilation for a patient. Arrange the steps in order that the respiratory therapist should follow to change the tube.

1. Assemble and prepare equipment. Correct 2. Explain procedure to patient. Correct 3. Prepare equipment. Correct 4. Prepare patient. Correct 5. Remove old tube. Correct 6. Insert new tube and assess patient. Correct 7. Secure tube.

While collecting the equipment for performing endotrachial suctioning, the respiratory therapist selects a tracheal tube with an inner diameter of 10 mm. What will be the size of the suction catheter selected by the therapist? Record your answer using a whole number. ____________ F

18

While performing a cuff leak test in a patient, the respiratory therapist finds that the exhaled volume is 600 mL with the cuff inflated and 300 mL with the cuff deflated. Find the percentage of cuff leak in the patient. Record your answer as a whole number. ________%

50