Nursing Management of Airway Devices

Endotracheal Tubes (ETT)

• Nursing management of ETT patients requires specialized training, potentially including ALS, clinical competencies, or postgraduate courses.
• Key responsibilities include continuous respiratory monitoring.
• Securing the tube to prevent accidental dislodgement is crucial.
• Regular assessments for complications like tube malposition or infection are necessary.
• Cuff pressure monitoring (if cuffed) is essential to prevent airway damage.
• Maintaining airway patency and ventilatory support are crucial.
• Collaboration with the healthcare team for prompt responses to patient condition changes is critical.

Nasopharyngeal Tubes

• Contraindications for insertion (e.g., sinus or head trauma) must be checked.
• Patients should be positioned supine with a slightly extended head for optimal airway alignment.
• Water-soluble lubricant should be used for insertion.
• The correct tube size is essential for proper fit and function.
• Continuous monitoring for respiratory distress, nasal bleeding, displacement, or obstruction is required.

Tracheostomies

• All tracheostomy care requires two trained nurses.

• Additional registered nurse training is often required for facility compliance.

• Cuff pressure should be monitored within a 20-25 mmHg range.

• Cuff inflation/deflation may be needed per established protocol.

• Documentation of cuff pressures are necessary.

• Dressing changes follow established protocols and facility guidelines.

• Humidified oxygen usage necessitates regular line changes.

• Fenestrated tracheostomy tubes:

  • Inner cannula changes follow local protocols (often once per shift).
  • Suctioning as needed is part of the management.
  • Dressing changes follow local protocol.
  • Ongoing cuff management is essential.

• Speaking tracheostomy tubes:

  • Port changes occur if the patient desires speaking capabilities.
  • Cuff management is required.
  • Humidified oxygen management is part of care.

Airway Obstruction

• Airway obstruction is a blockage or constriction of air passages, posing a medical emergency.
• Difficulty breathing, lack of oxygen, and potentially life-threatening situations can arise.
• Obstructions can occur anywhere in the respiratory system.
• Possible causes include aspiration, allergic reactions, oedema/inflammation, trauma.
• Obstructions can be partial or complete.
• Nursing management involves re-establishing the airway (by clearing it), performing airway manoeuvres (e.g., jaw thrust), and assisting with medical interventions (e.g., intubation).

Lower Respiratory Tract Infections (LRTI)

• LRTI includes conditions such as acute bronchitis, influenza, COVID-19, pertussis, pneumonia, and TB.
• Nursing management involves continuous respiratory assessments (rate, depth, effort).
• Oxygen saturation monitoring using pulse oximetry or blood gases.
• Early intervention for respiratory distress is crucial.
• Appropriate oxygen delivery via prescribed devices; monitor for oxygen toxicity.
• Appropriate positioning for optimal air entry.
• Maintaining adequate hydration to help loosen mucus.
• Pharmacological management (antibiotics, antivirals, bronchodilators, steroids).
• Chest physiotherapy.
• Comfort measures and reassurance are vital.

Chest Trauma

• Chest trauma involves injuries to the chest wall, ribs, lungs, and other thoracic cavity structures.
• Causes include motor vehicle accidents, falls, assaults, and industrial accidents.
• Management requires prompt assessment, stabilization, and appropriate interventions.
• Nursing management involves maintaining a patent airway, administering oxygen, covering sucking chest wounds with a non-porous dressing (three sides), stabilising protruding objects, and preparing for emergency needle decompression and intubation.
• Pain relief is crucial.
• Pneumothorax may necessitate preparation for chest tube insertion.

This quiz covers the essential nursing management practices for patients using endotracheal tubes (ETT) and nasopharyngeal tubes. Focus on key responsibilities such as monitoring, securing the tubes, and assessing for complications. Test your knowledge on proper insertion techniques, contraindications, and collaborative care with the healthcare team.