Chapter 28
Respiratory Care
569
Bilateral Positive Airway Pressure Machine In a few situations, a patient may be placed on a bilateral positive airway pressure (BIPAP) machine, which delivers oxygen and air into the lungs through pressure. This machine may help prevent the patient from having to be connected to a ventilator via an endotracheal tube or tracheostomy tube, at least for a short time. It is also used at night for some peo- ple who have severe sleep apnea. (See Chapter 19 for more information about BIPAP.) CLINICAL JUDGMENT IN ACTION Scenario: When you enter a patient’s room, you find her lying in a supine position, with the head of the bed flat. Her breathing is labored, her eyes are wide and scared-looking, and she tells you she needs help. There is an oxygen flow- meter on the wall, and it is set at 3 L/min. The nasal cannula is looped around the flowmeter and does not appear to be connected at the bottom. • What are the cues in this situation? • What is your hypothesis? • What action(s) will you take and in what order? • How will you evaluate the effectiveness of your actions? KNOWLEDGE CONNECTION How often should patients be turned and asked to deep breathe and cough? What is the purpose of delivering a medication via a nebulizer? Why is conservation of energy important for patients with chronic lung disease? What safety issues are of concern to home health-care patients with supplemental oxygen? Nursing Interventions for Patients Needing Airway Assistance In some situations, the patient cannot maintain their own open airway because of decreased level of consciousness, recent surgery, or other situations. An arti fi cial airway is used to assist in maintaining a patent airway. It usually is made of hard plastic or soft rubber and may be placed in the oropharynx, in the nasopharynx, or within the trachea. An endotracheal airway may be inserted through the nose or mouth. Pharyngeal Airways An oropharyngeal airway is made of hard plastic in a slightly curved shape and is designed to hold the tongue in place so that it cannot obstruct the airway of an unconscious patient (Fig. 28.5). They come in a variety of sizes, from infant through adult. This type of airway is not used for con- scious patients because it can cause gagging or vomiting.
FIGURE 28.5 A variety of airway sizes and types.
A nasopharyngeal airway is made of pliable rubber and is designed to be inserted through the nose into the pharynx. This type of airway is also referred to as a nasal trumpet because of its shape (see Fig. 28.5). SUCTIONING WITH PHARYNGEAL AIRWAYS IN PLACE. The patient may be unable to clear the airway for a variety of reasons, including a weak cough, decreased level of consciousness, or postoperative pain. It is import- ant to be aware of signs that the patient needs to be suctioned, such as rattling sounds in the throat, shortness of breath, ineffective cough, and crackles on auscultating the lungs. You will use a suction catheter, a thin pliable tube with holes in the end, to remove secretions from the patient’s nose, throat, and mouth. If an oropharyngeal airway is in place, you will pass the suction catheter along the grooves in the sides of the airway. If a nasopharyngeal airway is in place, you can pass the suction catheter through the airway to the throat. If no airway is in place, you can use the pliable suction catheter to suction through the nose and down the throat. Skill 28.6 gives the steps in performing nasopharyn- geal and oropharyngeal suctioning. Then you can switch to a hard plastic tube with a larger diameter to suction the mouth. This type of suction device is referred to as a Yankauer suc- tion catheter or tonsil tip suction tube (Fig. 28.6). If the patient reacts to the presence of the tube in their mouth by biting down, it will not damage the tonsil tip, and you will still be able to suction. If that reaction occurs with the softer type of suction catheter, it will impede suction and damage the catheter. Skill 28.6 also discusses the steps of using a tonsil-tip suction device.
• WORD • BUILDING • tracheostomy: trachea – windpipe + stomy – surgical opening
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