care of the critically ill and airway management

Presenter: Lisa E. McDonaldDate: September 2o12

LEM/2010 NSDD Revised08/2012/CSON/UTech

At the end of this two (2) hour session the participants will be able to:Define the term the critically ill patientDescribe the measures taken to maintain airway patencyCompare the nursing management of the critically ill patient to the non critical patientDiscuss three priority nursing diagnosis with interventions and rationale

*LEM/2010 NSDD Revised08/2012/CSON/UTech


This is a patient who requires close physiologic monitoring because of a life- threatening disruption of the normal haemodynamic mechanisms of one or more body systems; special monitoring devices/ assist devices and a complexity of catheters are used.*LEM/2010 NSDD Revised08/2012/CSON/UTech


Arterial Blood Gases (ABGs)Arterial lines ( Invasive blood pressure monitoring)Pulse oximetersCentral venous catheter (CVC)Swan Ganz catheter



Mechanical ventilatorsEndotracheal tubeOro/nasopharyngeal airwayCardioscopeTransducers



Persons requiring airway management include (i) Post anaesthesia patients (ii) Patients with seizure disorders (iii) patients with decreased level of consciousness *LEM/2010 NSDD Revised08/2012/CSON/UTech


(iv) Post head and neck surgery patients (v) Patients with respiratory disorders eg Asthma*LEM/2010 NSDD Revised08/2012/CSON/UTech


Maintenance of an adequate airway is critical in these patientsObstruction can be sudden and dramatic or may occur slowly over the course of several hoursLoss of a patent airway may usually be mechanical.



Reasons for non patent airwayKinking of tubes, inappropriate placement of an edotracheal / tracheostomy tubeObstruction by blood or secretion ( bleeding and haematoma under skinflaps may compress trachea)



(iii) Aspiration ( may be seen in head and neck procedures)(iv) Swelling (v) displacement of the tongue, epiglottis *LEM/2010 NSDD Revised08/2012/CSON/UTech


Airway obstruction is best treated by preventionPosition patient in the lateral position with head slightly down (unless contraindicated eg. head and neck surgery)If thorocotomy position head 30-45 ( in this position abdml organs do not impair motion of diaphragm)*LEM/2010 NSDD Revised08/2012/CSON/UTech


Suction prn via oropharynx and nasopharynxDeep breathing and coughingAscultate lungs Check position of endotracheal tube (ETT)Insert airway if lax epiglottis*LEM/2010 NSDD Revised08/2012/CSON/UTech


Monitor respiratory rate and patternUse jaw thrust , head tilt to open and maintain airwayAdminister bronchodilators as prescribed*LEM/2010 NSDD Revised08/2012/CSON/UTech


Central Nervous System (i) Assess level of consciousness using GCS(ii) Assess power grades(iii) If drainage tubes in assess amt, colour and consistency of drainage (iv) Monitor intracranial pressures (ICP)*LEM/2010 NSDD Revised08/2012/CSON/UTech


(v) Observe for signs of raised intracranial pressure (normal 0-20mm hg)*LEM/2010 NSDD Revised08/2012/CSON/UTech


Respiratory (i) Monitor respiratory rate and pattern (ii) Ascultate chest (iii) Monitor oxygen saturation (iv) Monitor ABGs (v) Assess colour of mucous membranes



Respiratory (vi) Position to facilitate ventilation (vii) Assess for use of accessory muscles (viii) Monitor for decrease in mentation/CL *LEM/2010 NSDD Revised08/2012/CSON/UTech


Cardiovascular (i) Monitor BP ( invasive/non-invasive) and HR (ii) Monitor temperature (iii) Assess peripheral pulses (iv) Monitor central venous pressure (CVP)



Cardiovascular (v) Assess jugular vein for distension (vi) Assess perfusion and capillary refill (vii) If chest tubes present assess amt. colour, consistency of drainage, airleaks blockage, change bottle using asepsis



Cardiovascular(viii) Monitor lab. values eg. CBCs, tests specific to disease condition eg amylase levels-Pancreatitis (ix) Monitor IV fluid intake (x) Monitor urine output*LEM/2010 NSDD Revised08/2012/CSON/UTech


GastrointestinalAssess bowel soundsAsses Ng tube for placement prior to feeds, aspirate q4hrlyIf being given Total Parenteral Nutrition, assess IV sites, maintain aseptic technique in administering and dressing site*LEM/2010 NSDD Revised08/2012/CSON/UTech


Gastrointestinal(iv) Monitor drainage from Gastrostomy, Jeunostomy, tubes amt., colour, consistency(v) Monitor lab. values - U&Es(vi) Monitor blood glucose levels, administer insulin if required (vii) Assess abdomen for distention, girth



GenitourinaryStrict intake and outputDo urinalysisAdvocate for urinary catheter change, sen tip of catheter for culture



MusculoskeletalDo pressure area carePassive exercisesAssess skin integrityAssess for oedemaReposition q2hrly



Alteration in breathing pattern related to the effects of anaesthesia, stasis in secretionsIneffective airway clearance related to inability to cough effectivelyImpaired cardiac output related to hypovolemic state, decreased Potential for decreased cerebral perfusion related to raised intracranial pressure*LEM/2010 NSDD Revised08/2012/CSON/UTech


Carpinito, L. J. (1995) Nursing diagnosis: application to clinical practice. Lippincott:PhiladelphiaGolden, D. M. Intensive care of the surgical patient. Yearbook medical publishers: Chicago



Hudock, C.M., Gallo,B.M., Morton, G.P. (1998) Critical CareNursing. Lippincott: Philadelphia*LEM/2010 NSDD Revised08/2012/CSON/UTech


*Hudock, C.M., Gallo,B.M., Morton, G.P. (1998) Critical Care Nursing. Lippincott:Philadelphia

care of the critically ill and airway management

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