You are caring for a patient who underwent major abdominal surgery 24 hours ago. The 72-year-old male patient is weak and lethargic because of large doses of medication for pain control. After noting audible gurgling on inspiration and expiration, you complete a respiratory assessment. Which assessment parameters indicate the need for oral suction? (Select all that apply.)
A) Unusual restlessness.
C) Gurgling and adventitious lung sounds.
D) Evidence of emesis in the mouth.
E) Persistent coughing.
F) Persistent complaints of pain.
G) Weakness and lethargy accompanied by drooling.
A, B, C, D, E, G
The following signs indicate the need for oropharyngeal suctioning: (1) restlessness, especially if it is new or unusual for your patient; (2) obvious, excessive oral secretions as evidenced by drooling and/or gagging; (3) gurgling and/or audible crackles and wheezes that occur on inspiration and/or expiration; (4) evidence of gastric contents and/or emesis in the mouth; (5) persistent coughing that fails to clear the upper airway; and (6) weakness and lethargy accompanied by drooling and gagging. Persistent complaints of pain are more likely related to the surgery.
You are busy performing routine assessments of the patients on the unit. You note audible gurgling on inspiration and expiration of the stable postoperative patient. Which of the following tasks can you delegate to competent NAP?
A) Performing oral suctioning.
B) Assessing the adequacy of respiratory functioning.
C) Evaluating the outcome of oral suctioning.
D) Performing nasotracheal suctioning.
CORRECT ANSWER IS A
Since the patient is stable, the task of performing oral suctioning may be delegated to NAP. However, the responsibility for assessing the adequacy of respiratory functioning and evaluating the patient outcome of oral suctioning remains with you. Nasotracheal suctioning requires sterile technique and cannot be delegated to NAP.
You are preparing to perform oropharyngeal suctioning. Which of the following steps in the sequence is incorrect?
A) Assist the patient into a supine position. Prepare supplies. Turn the suction unit on and set the suction control gauge to high. Connect the suction tubing to the suction machine and to the Yankauer suction catheter.
B) Place the suction catheter in the container of water and apply suction. If the patient has an oxygen device, remove it, placing it near the patient's face. Insert the catheter gently into the mouth along the gingival border (gum line).
C) Gently move the catheter around the patient's mouth until all of the secretions are cleared. Encourage the patient to cough. Replace the oxygen mask. Suction water from the basin through the catheter until the catheter is cleared of secretions. Reassess the patient's respiratory status and repeat the procedure if necessary.
D) Turn off the suction source. Wipe the patient's face. Discard the water into an appropriate receptacle. Discard the Yankauer suction catheter or place it in a nonairtight container to ensure that it remains uncontaminated. Provide oral care. Remove the gloves and perform hand hygiene. Record the procedure
CORRECT ANSWER IS A
You should place the patient in a Fowler's position, then perform hand hygiene, and finally set the suction control gauge to low. The other options are correct steps in the sequence for performing oropharyngeal suctioning.
You are teaching the spouse of a patient how to perform oral suctioning for when they return home. Which of the following statements, if made by the spouse, indicates further instruction is needed?
A) "It would be abnormal to obtain bloody secretions."
B) "Because oral secretions are thick, suction settings should be set on high."
C) "I should be careful to avoid touching the back of the throat with the tip of the suction catheter."
D) "I should encourage fluids to help keep secretions thin."
CORRECT ANSWER IS B
Suction settings should be low to ensure that the oral tissue is uninjured during suctioning. Bloody secretions may be an indication of mucosal damage. The oropharynx should be assessed for any tissue injury, and the frequency of suctioning should be evaluated. Touching the back of the throat can stimulate the gag reflex. Unless contraindicated, fluids should be encouraged to reduce the viscosity of secretions
Which of the following patients is most likely to experience some difficulty with effective coughing?
A) The elderly patient who had outpatient foot surgery.
B) The middle-age man who is postoperative for knee arthroplasty.
C) The patient who is postoperative for abdominal surgery.
D) The patient who preoperatively practiced cascade coughing.
CORRECT ANSWER IS C
Abdominal surgery causes pain and weakness of the abdominal muscles, both of which can result in ineffective airway clearance. Learning coughing techniques preoperatively will aid in postoperative performance of these skills.
Which of the following patients should be assessed for a worsening clinical situation?
A) The COPD patient whose pulse oximetry remains the same after oropharyngeal suctioning.
B) The patient with absence of adventitious lung sounds on inspiration and expiration.
C) The patient who demonstrates less drooling after being suctioned.
D) The patient with presence of blood in the secretions.
CORRECT ANSWER IS D
Bloody secretions are an unexpected outcome. The cause should be investigated. The removal of secretions helps to improve the oxygen saturation level. In patients with chronic pulmonary diseases such as COPD, the pulse oximetry value may remain the same. The absence of adventitious sounds are an expected finding. An expected outcome of oropharyngeal suctioning is lessened or absence of drooling.
Which of the following patients may likely require oropharyngeal suctioning? (Select all that apply.)
A) A patient who had maxillofacial surgery.
B) A patient who had trauma to the mouth.
C) A patient with impaired swallowing from neurologic injury.
D) A patient who has been diagnosed with lung cancer.
E) A patient with an artificial airway who requires oral hygiene.
F) A patient who has a nasogastric feeding tube.
G) A patient with pneumonia
A, B, C, E
The Yankauer suction device is useful in the removal of secretions from the mouth in patients after oral and maxillofacial surgery, trauma to the mouth, neurovascular injury and/or cerebrovascular accident causing hemiparesis and drooling, or impaired swallowing. Patients with artificial airways and impaired swallowing ability may require use of the Yankauer suction device to promote oral hygiene. Patients with lung cancer or pneumonia may be able to cough up or swallow secretions on their own