Download - Endotracheal Intubation Ncm 106
Endotracheal Intubationand
Cardiocentesis
is the placement of a tube into the trachea (windpipe) in order to maintain an open airway in patients who are unconscious or unable to breathe on their own. Oxygen, anesthetics, or other gaseous medications can be delivered through the tube.
Airway protection
To treat profound hypoxaemia and respiratory failure and to initiate positive pressure ventilation
To facilitate tracheal suction and the removal of secretions
To maintain respiratory function during surgery/anaesthetics
respiratory arrest respiratory failure airway obstruction need for prolonged ventilatory support multiple trauma, head injury and abnormal
mental status inhalation injury with erythema/edema of
the vocal cords
Indication:
Laryngoscopes,
Self-refilling bag valve combination
A selection of endotracheal tubes
Oral airways
Gloves
A rigid oral suctioning catheter
EQUIPMENT
Stethoscope
Checked and working ventilator
Resuscitation equipment immediately available in case of complications
Lubrication, Magill forceps, introducer
10ml syringe
tape
The nurse should tell the patient what is about to happen, and they should then be pre-oxygenated.
PREPARING THE PATIENT
The doctor often inserts the tube with the help of a laryngoscope, . During the procedure the laryngoscope is used to hold the tongue aside while inserting the tube into the trachea. It is important that the head be positioned in the appropriate manner to allow for proper visualization. Pressure is often applied to the thyroid cartilage (Adam's apple)to help with visualization and prevent possible aspiration of stomach contents
Intubation Procedure.3gp
PROCEDURE
NURSING RESPONSIBILITIES
Gather all the materials needed
Check the light of the laryngoscope
The patient's position flat with their face at the level of the xiphoid cartilage of the standing person performing the procedure
Compresses the cricoid cartilage against the cervical vertebrae
do open gloving or wear personal protective equipment
BEFORE
nurse should calmly describe the vital-signs status of the patient regularly
Be prepared to pass the ET tube and other equipment to the person intubating or physician
If necessary, suction patient’s pharynx
observed for equal expansion and auscultation performed at the mid-axillary line
Administer sedatives, per doctors order
DURING
The tube should be secured
patient attached to an appropriate ventilator and a check X-ray ordered
arterial blood gases should be taken
auscultate both sides of the chest
suction secretions via the Endotracheal Tub
AFTER
Trauma to lips, teeth, vocal chords
Transient cardiac arrhythmia related to vagal or sympathetic nerve traffic
Hypertension, tachycardia or raised intracranial pressure
Aspiration.
Infection
POST-INTUBATION COMPLICATIONS
Tracheal ulceration
Tracheal stenosis
Hypersalivation
Laryngeal oedema
Bronchospasm
Reduced ability to communicate
Biting on tube
Discomfort
Tube kinked or damaged on insertion, resulting in perforation and leaks
CARDIOCENTESIS
is a medical procedure that involves the removal of fluid from the pericardial sac.
Pericardial effusion
INDICATION
chest X-rays, blood tests, electrocardiogram, echocardiograms
anti-inflammatory medicines and blood thinners
PREPARATION
the patient is required to take a supine position
the doctor is guided with the use of an ultrasound or electrocardiographic device.
After the needle is positioned correctly, the doctor replaces it with a catheter.
a cardiocentesis procedure lasts for two minutes to one hour, if the method runs without complications.
PROCEDURE
Close care
Monitor for pericardial output
POST OP CARE
Bleeding
lung collapse
heart attack or irregular heartbeat
severe perforation
Pneumopericardium
Pericardiocentesis.3gp
COMPLICATION