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A patient in the ICU has had an endotracheal tube in place for 3 weeks. The physician has ordered that a tracheostomy tube be placed. The patients family wants to know why the endotracheal tube cannot be left in place. What would be the nurses best response?
- A. The physician may feel that mechanical ventilation will have to be used long-term
- B. Long-term use of an endotracheal tube diminishes the normal breathing reflex
- C. When an endotracheal tube is left in too long it can damage the lining of the windpipe
- D. It is much harder to breathe through an endotracheal tube than a tracheostomy
Correct Answer: C
Rationale: Endotracheal intubation may be used for no longer than 2 to 3 weeks, by which time a tracheostomy must be considered to decrease irritation of and, trauma to, the tracheal lining, to reduce the incidence of vocal cord paralysis (secondary to laryngeal nerve damage), and to decrease the work of breathing. The need for long-term ventilation would not be the primary rationale for this change in treatment. Endotracheal tubes do not diminish the breathing reflex.
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The nurse is caring for a patient who is scheduled to have a thoracotomy. When planning preoperative teaching, what information should the nurse communicate to the patient?
- A. How to milk the chest tubing
- B. How to splint the incision when coughing
- C. How to take prophylactic antibiotics correctly
- D. How to manage the need for fluid restriction
Correct Answer: B
Rationale: Prior to thoracotomy, the nurse educates the patient about how to splint the incision with the hands, a pillow, or a folded towel. The patient is not taught how to milk the chest tubing because this is performed by the nurse. Prophylactic antibiotics are not normally used and fluid restriction is not indicated following thoracotomy.
While caring for a patient with an endotracheal tube, the nurses recognizes that suctioning is required how often?
- A. Every 2 hours when the patient is awake
- B. When adventitious breath sounds are auscultated
- C. When there is a need to prevent the patient from coughing
- D. When the nurse needs to stimulate the cough reflex
Correct Answer: B
Rationale: It is usually necessary to suction the patients secretions because of the decreased effectiveness of the cough mechanism. Tracheal suctioning is performed when adventitious breath sounds are detected or whenever secretions are present. Unnecessary suctioning, such as scheduling every 2 hours, can initiate bronchospasm and cause trauma to the tracheal mucosa.
A nurse educator is reviewing the indications for chest drainage systems with a group of medical nurses. What indications should the nurses identify? Select all that apply.
- A. Post thoracotomy
- B. Spontaneous pneumothorax
- C. Need for postural drainage
- D. Chest trauma resulting in pneumothorax
- E. Pleurisy
Correct Answer: A,B,D
Rationale: Chest drainage systems are used in treatment of spontaneous pneumothorax and trauma resulting in pneumothorax. Postural drainage and pleurisy are not criteria for use of a chest drainage system.
The OR nurse is setting up a water-seal chest drainage system for a patient who has just had a thoracotomy. The nurse knows that the amount of suction in the system is determined by the water level. At what suction level should the nurse set the system?
- A. 20 cm H2O
- B. 15 cm H2O
- C. 10 cm H2O
- D. 5 cm H2O
Correct Answer: A
Rationale: The amount of suction is determined by the water level. It is usually set at 20 cm H2O; adding more fluid results in more suction.
A nurse is teaching a patient how to perform flow type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the patient?
- A. Hold the spirometer at your lips and breathe in and out like you normally would
- B. When youre ready, blow hard into the spirometer for as long as you can
- C. Take a deep breath and then blow short, forceful breaths into the spirometer
- D. Breathe in deeply through the spirometer, hold your breath briefly, and then exhale
Correct Answer: D
Rationale: The patient should be taught to place the mouthpiece of the spirometer firmly in the mouth, breathe air in through the mouth, and hold the breath at the end of inspiration for about 3 seconds. The patient should then exhale slowly through the mouthpiece.