Nursing Management of Endotracheal Tube
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Nursing Management of Endotracheal Tube

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Questions and Answers

Which symptom is NOT typically associated with acute coronary syndrome?

  • Chest pain not relieved by nitro
  • Elevated blood pressure
  • Nausea and vomiting
  • Decreased heart rate (correct)

    • What diagnostic feature indicates a significant concern during an acute myocardial infarction?

  • Presence of myoglobin in blood
  • Normal troponin levels
  • Low levels of creatine kinase
  • ST-segment elevation in contiguous leads (correct)

    • Which management strategy is NOT part of the MONA protocol?

  • Morphine administration
  • Nitrate therapy
  • Oxygen therapy
  • Sodium bicarbonate infusion (correct)

    • What could be the immediate treatment for a STEMI patient showing characteristic ECG changes?

    <p>Cardiac catheterization for percutaneous coronary intervention</p> Signup and view all the answers

    Which finding on a 12-lead ECG indicates likely myocardial infarction?

    <p>Q wave abnormalities</p> Signup and view all the answers

    Which psychological symptom may be observed in patients experiencing acute coronary syndrome?

    <p>Feeling of impending doom</p> Signup and view all the answers

    What is the primary goal in managing a patient presenting with acute coronary syndrome?

    <p>Maintain myocardial blood supply</p> Signup and view all the answers

    Which cardiac biomarker is most specific for myocardial injury?

    <p>Troponin</p> Signup and view all the answers

    What is the maximum recommended duration for an endotracheal tube placement before a tracheostomy is necessary?

    <p>14-21 days</p> Signup and view all the answers

    Which assessment finding is most indicative of mitral stenosis?

    <p>Low-pitched rumbling diastolic murmur and loud S1 sound</p> Signup and view all the answers

    What technique should be maintained to ensure safety during suctioning an endotracheal tube?

    <p>Sterile technique</p> Signup and view all the answers

    Which symptom is commonly associated with mitral regurgitation?

    <p>Dyspnea on exertion</p> Signup and view all the answers

    Which intervention is NOT appropriate for managing a patient with an endotracheal tube?

    <p>Maintain inadequate cuff pressure</p> Signup and view all the answers

    Which of the following is NOT a common cause of mitral regurgitation?

    <p>Chronic hypertension</p> Signup and view all the answers

    What is the primary purpose of maintaining adequate cuff pressure in an endotracheal tube?

    <p>Preventing tube displacement</p> Signup and view all the answers

    What diagnostic tool is primarily used to verify the proper placement of an endotracheal tube?

    <p>Capnography</p> Signup and view all the answers

    What is a notable risk associated with prolonged mechanical ventilation?

    <p>Elevated risk of venous thromboembolism (VTE)</p> Signup and view all the answers

    Which type of skull fracture involves a break in the continuity of the bone without displacement?

    <p>Linear (simple) fracture</p> Signup and view all the answers

    Which abnormal posturing response is characterized by flexion of the arms and extension of the legs?

    <p>Decorticate posturing</p> Signup and view all the answers

    What is the term for the sudden depression of reflex activity following a spinal cord injury?

    <p>Spinal shock</p> Signup and view all the answers

    In which stage do chronic subdural hematomas exhibit fluctuating classical signs similar to a stroke?

    <p>Chronic</p> Signup and view all the answers

    Which clinical manifestation is associated with a rapidly expanding mass due to subdural hematoma?

    <p>Bradycardia</p> Signup and view all the answers

    What may indicate skull fracture displacement, resulting in fragments being embedded into the skull?

    <p>Depressed skull fracture</p> Signup and view all the answers

    Which term describes a change in level of consciousness and neurological deficit that can indicate worsening conditions in concussions?

    <p>Encephalopathy</p> Signup and view all the answers

    Which of the following indices indicates moderate acute respiratory distress syndrome (ARDS)?

    <p>PaO2/FiO2 &gt;100 mm Hg</p> Signup and view all the answers

    Which sedative is classified as a short-acting barbiturate?

    <p>Propofol</p> Signup and view all the answers

    What is the primary purpose of the Train-of-four test in neuromuscular blockade assessment?

    <p>To assess neuromuscular blockade</p> Signup and view all the answers

    Which of the following statements about brain natriuretic peptide (BNP) levels is correct?

    <p>Normal BNP levels can rule out cardiogenic pulmonary edema</p> Signup and view all the answers

    Which term best describes the phenomenon of drive-up breathing seen in patients with ARDS?

    <p>Retractive breathing</p> Signup and view all the answers

    What is a key consideration when managing sedation in patients with ARDS?

    <p>Use sedation to manage anxiety and facilitate ventilation</p> Signup and view all the answers

    In the context of P/F ratio calculations, what does the term FiO2 refer to?

    <p>Fraction of inspired oxygen</p> Signup and view all the answers

    Which of the following is NOT a supportive measure for ARDS management?

    <p>Increasing fluid intake</p> Signup and view all the answers

    What is the primary goal of nursing management in wound care?

    <p>Restoring skin integrity and function</p> Signup and view all the answers

    Which category of disaster triage is assigned a color coding of yellow?

    <p>Delayed</p> Signup and view all the answers

    In wound cleansing, which of the following agents is typically used?

    <p>Normal saline solution</p> Signup and view all the answers

    What is characteristic of wounds categorized as expectant in disaster triage?

    <p>Chances of survival are unlikely even with care</p> Signup and view all the answers

    Which of the following conditions is classified as immediate in disaster triage?

    <p>Sucking chest wound</p> Signup and view all the answers

    What is the priority level of injuries classified as minimal in disaster triage?

    <p>3</p> Signup and view all the answers

    Which of the following best represents delayed primary closure in wound management?

    <p>Gauze and occlusive dressing</p> Signup and view all the answers

    What type of injuries fall under the 'green' category of disaster triage?

    <p>Minor injuries with no need for immediate treatment</p> Signup and view all the answers

    Study Notes

    Endotracheal Tube

    • Provides a patent airway, access for mechanical ventilation and easier removal of secretions
    • Maintain cuff pressure between 20-25 mmHg
    • Keep in place for no longer than 14-21 days, longer placement may require trachestomy

    Endotracheal Tube: Injury Prevention

    • Adminster warmed humidification
    • Maintain adequate cuff pressure
    • Suction as needed
    • Maintain skin integrity
    • Auscultate lung sounds
    • Monitor for signs and symptoms of infection
    • Administer prescribed oxygen and monitor SpO2
    • Monitor for cyanosis
    • Maintain adequate hydration
    • Use sterile technique when suctioning

    Endotracheal Tube: Placement Confirmation

    • Chest X-ray to verify proper placement
    • Capnography
    • Check cuff pressure every 6-8 hours

    Chest Tube: Nursing Management

    • Promote drainage
    • Maintain water seal

    Mitral Stenosis: Assessment

    • Valve does not completely open, blood flow reduced through the narrowed valve orifice
    • Decreased ventricular filling and decreased cardiac output
    • Causes right ventricular hypertrophy
    • Low-pitched rumbling diastolic murmur and loud S1 sound
    • Echocardiogram

    ### Mitral Stenosis: Clinical Manifestations

    • Dyspnea on exertion
    • Decreased exercise tolerance
    • Dry cough or wheezing
    • Significant pulmonary congestion

    Mitral Regurgitation: Causes

    • Blood backflows into the left atrium from the left ventricle during systole
    • May result from problems with one or more leaflets, chordae tendineae, the annulus or the papillary muscles
    • Conditions that can cause secondary mitral regurgitation: ineffective endocarditis, collagen vascular diseases, and cardiomyopathy
    • Excess blood in the atrium causes stretching followed by hypertrophy and dilation

    Mitral Regurgitation: Assessment

    • Systolic murmur of mitral regurgitation is a blowing sound best heard at the apex of the heart and may radiate to the left axilla

    Acute Coronary Syndrome: Assessment

    • "Coronary occlusion"
    • "Heart attack"
    • Myocardial infarction
    • Emergent situation
    • Acute onset of myocardial ischemia that results in myocardial death
    • Chest pain unrelieved by rest or nitro, increased JVD, elevated BP, irregular pulse
    • ST segment and T wave changes
    • Respiratory assessment: shortness of breath, dyspnea, tachypnea and crackles
    • GI: nausea, indigestion and vomiting
    • GI, skin, neurological: anxiety, restlessness and psychological fear or feeling of impending doom

    Acute Coronary Syndrome: Diagnostics

    • 12-lead ECG
    • Q wave abnormalities
    • Serial cardiac biomarkers: troponin, creatine kinase, and myoglobin

    Acute Coronary Syndrome: Medical Management

    • Minimize myocardial damage, preserve myocardial function and prevent complications
    • Immediate intervention of MONA
    • Emergent percutaneous coronary intervention
    • Thrombolytics

    STEMI: Identification

    • ECG evidence of acute MI with characteristic changes in two contiguous leads on a 12-lead ECG.
    • Significant damage to the myocardium.

    STEMI: Medical Management

    • Immediate cardiac catheterization lab for percutaneous coronary intervention

    STEMI: Hallmark Signs or Manifestations

    • Refractory hypoxemia
    • Retractive breathing

    ### Acute Respiratory Distress Syndrome (ARDS):

    • Horowitz Index PaO2/FiO2
      • Mild: >200 mmHg
      • Moderate: >100 mmHg
      • Severe < 100 mmHg
    • Brain natriuretic peptide (BNP) level
      • Used to differentiate between ARDS and cardiogenic pulmonary edema
      • Higher levels of BNP are associated with a decreased odds for ARDS
      • A normal BNP is < 100 pg/mL
    • P/F ratio calculation
      • PaO2/FiO2 is the equation
      • Horowitz Index PaO2/FiO2:
        • Mild >200 mmHg
        • Moderate >100 mm Hg
        • Severe < 100 mmHg

    ARDS: Medical Management

    • Identification and treatment of the underlying cause
    • Supportive measures
      • Supplemental oxygen
      • Intubation
      • Mechanical ventilation with PEEP
      • Circulatory support
      • Prone positioning
      • Sedation
      • Paralysis
      • Nutritional therapy
      • Frequent repositioning

    ARDS: COVID Considerations

    • ARDS most serious and frequent cause of death
    • Atypical clinical manifestations
    • Same classification system
    • Low-dose corticosteroids
    • Prone position for 12-16 hours/day
    • Neurological assessment
    • Increased sedative requirements
    • Airborne isolation

    ### Neuromuscular Blockades: Assessment

    • Used for the shortest time possible
    • Vented more easily and may appear unconscious/appear they lost motor function but they are awake can feel and hear
    • Examples
      • Vecuronium
      • Pancuronium
      • Rocuronium
      • Atracurium

    ### Neuromuscular Blockades: Nursing Management

    • Train of Four Test: Assess neuromuscular blockade
      • Four consecutive stimuli being conducted along the nerves and the response of muscle is measured in order to evaluate whether or not the stimuli is effectively being blocked
      • No blockage: muscle twitches
      • Blockage present: loss of twitch and number will indicate degree of blockage
    • Reassurance: This is due to medication and is only temporary
    • Vent and patient alarms are on at all times
    • Eye care: Patient cannot blink
    • Predispose patient to VTE, muscle atrophy, foot drop, stress ulcers, and skin breakdown

    ### Mechanical Ventilation: Patient/Ventilator Dyssynchrony Management

    ### Concussion: Education

    • Encephalopathy
    • Worsening signs of neurological deficits

    Traumatic Brain Injury: Pathophysiology

    ### Traumatic Brain Injury: Posturing

    • Abnormal posuturing response to stimuli
    • Decorticate reflection
    • Decerebrate posturing

    ### Traumatic Brain Injury: Medical Management

    • Depends on injury
    • Elevation of the skull: surgical intervention
    • Observation

    ### Skull Fractures: Types

    • Linear (simple): A break in the continuity of the bone
    • Comminuted: A splintered or multiple fracture line
    • Depressed skull fracture: Occurs when the bones of the skull are forcefully displaced downward and can vary from a slight to splintered an embedded in the skull fracture

    ### Skull Fractures: Clinical Manifestations

    ### Spinal Cord Injury: Spinal Shock

    • Sudden depression of reflex activity in the spinal cord called areflexia
    • Occurs after injury. If a complete spinal cord injury, it does usually occur
    • Loss of function of the autonomic nervous system
    • Muscles innervated; BP decreased and bradycardia
    • Reflexes that initiate bladder and bowel are affected
    • Takes 4-6 weeks to resolve

    ### Subdural Hematoma: Clinical Manifestations

    Subdural Hematoma: Assessment; Diagnostics

    Subdural Hematoma: Clinical Manifestations

    • (Acute vs. Chronic)
    • An SDH is frequently venous in origin and is caused by a rupture of small vessels that bridge the subdural space.
    • Acute symptoms: Change in LOC, pupillary signs, and hemiparesis
    • Coma, increasing blood pressure, decreasing heart rate, and slowing respiratory rate are all signs of rapidly expanding mass requiring immediate intervention.
    • Chronic symptoms: Can resemble other conditions such as stroke. Classical symptoms fluctuate due to clot breakdown and calcification and ossification of the clot in the brain, alternation in focal neurological signs, personality changes, mental deterioration, and focal seizures. Typically deeper than long

    ### Subdural Hematoma: Nursing Management

    • Goal is to restore skin integrity and function while minimizing scarring and preventing infection
    • Proper documentation
    • Aseptic technique

    Subdural Hematoma: Medical Management

    • Wound cleansing: Normal saline solution, povidone-iodine
    • Primary closure: Sutures and staples
    • Delayed primary closure: Gauze and occlusive dressing; antibiotic agents, tetanus booster

    Disaster Triage: Categories (Title, Color, Priority) and Typical Conditions

    • Immediate
      • Color: Red
      • Priority: 1
      • Typical conditions: Sucking chest wound, airway obstruction secondary to mechanical cause, shock, hemothorax, tension pneumothorax, asphyxia, unstable chest and abdominal wounds, incomplete amputations, open fractures of long bones, and second/third degree burns of 15-40% total body surface area
    • Delayed
      • Color: Yellow
      • Priority: 2
      • Typical conditions: Stable abdominal wounds without evidence of significant hemorrhage; soft tissue injuries; maxillofacial wounds without airway compromise; vascular injuries with adequate collateral circulation; genitourinary tract disruption; fractures requiring open reduction, débridement, and external fixation; most eye and central nervous system injuries
    • Minimal
      • Color: Green
      • Priority: 3
      • Upper extremity fractures, minor burns, sprains, small lacerations without significant bleeding, behavioral disorders or psychological disturbances
    • Expectant
      • Injuries are extensive and chances of survival are unlikely even with definitive care
      • Persons in this group should be separated from the other casualties, but not abandoned
      • Comfort measures should be provided when possible

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    Description

    This quiz covers essential aspects of managing endotracheal tubes, including placement, injury prevention, and nursing interventions. It focuses on maintaining airway patency, monitoring cuff pressure, and assessing for complications related to tube placement. Understanding these concepts is vital for effective patient care in critical settings.

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