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Upper Respiratory ProblemsMedical Surgical Nursing

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Question Answer
What are the complications of OSA surgeries that a nurse should monitor for post-operatively?
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Hemorrhage and airway obstruction
T/F Patients who undergo a uvulopalatopharyngoplasty or a Genioglossal advancement and hyoid myotomy can go home within one day of the procedure.
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True
What are the signs and symptoms of an airway obstruction?
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Stridor, use of accessory muscles, suprasternal and intercostal retraction, wheezing, restlessness, tachycardia, and cyanosis
How is a tracheotomy different from a tracheostomy?
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Tracheotomy is the surgical incision Tracheostomy is the opening created (Stoma)
What 4 conditions are indications of the need for a tracheostomy?
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1-upper airway obstruction 2-facilitate secretion removal 3-permit long-term mechanical ventilation 4-permit oral intake and speech for someone requiring long-term ventilation
T/F Percutaneous tracheostomies can be performed bedside and cause less bleeding and fewer postoperative infections than a surgical tracheostomy.
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True
Patients who require mechanical ventilation are initially managed with ________ prior to the insertion of a tracheostomy.
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Endotracheal tube
Why are tracheostomies a better solution for patients in LTC than an endotracheal tube?
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-less risk of long-term damage to the airway -increased patient comfort -patient can eat and talk with a trach -Mobility is better because the trach is more secure
T/F The obturator for a trachostomy should be taped to the wall for easy access should accidental decannulation occur.
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True
Which type of tracheostomy tube does not allow speech?
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The type that has a tube with a cuff and pilot balloon
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For a tracheostomy tube with cuff and pilot balloon, the procedure for cuff inflation for a patient on mechanical ventilation involves inflating the cuff to __________ by slowly injecting air into the cuff until no leak is heard at peak inspiratory pressure (end of ventilator inspiration) when placing a stethoscope over the trachea.
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Minimal Occlusion Pressure
How is the cuff inflation pressure of a tracheostomy tube with a cuff and pilot balloon ascertained?
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By using the cuff pressure monitor
The alternative approach for cuff inflation of a tracheostomy tube with a cuff and pilot ballon is called _____________ and entails inflating the cuff to minimal occlusion pressure and then withdrawing 0.1 mL of air.
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Minimal leak technique (MLT)
What is the benefit of a tracheostomy with a cuff and balloon pilot?
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The low pressure, high volume cuff distributes pressure over a large area, minimizing pressure on the tracheal wall.
When should MLT not be used for cuff inflation?
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If the patient has a risk of aspiration, or if the trach was placed to bypass an upper airway obstruction such as head/neck surgical patients
For a tracheostomy tube with cuff and pilot balloon, the procedure for cuff inflation for a spontaneously breathing patient involves inflating the cuff to minimal occlusion pressure by slowly injecting air into the cuff until no sound is heard after _____________.
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Deep breathing or during inhalation with a manual resuscitation bag.
What should be done immediately after cuff inflation of a tracheostomy?
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Verify pressure is within accepted range: < or = 20 mm Hg or < or = 25 cm H2O with a manometer and record the pressure and volume of air in the chart
What is the accepted range for pressure of an inflated cuff?
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< or = 20 mm Hg or < or = 25 cm H2O with a manometer
What should be charted after inflation of a tracheostomy cuff?
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The amount of pressure and volume of air used for inflation.
How often should tracheostomy cuff pressures be monitored and recorded?
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Every 8 hours.
What should you do if a tracheostomy cuff pressure is too high or low?
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Add or remove pressure to the pilot tubing using a syringe and stopcock, then verify pressure is within acceptable range using a manometer.
  
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