BALAJI COLLAGE OF NURSING

SUB : - OBSTESTRICS AND GYNECOLOGY

TOPIC : - PRACTICE TEACHING ON

ASSESSMENT OF ENDOTRACHEAL INTUBATION

SUBMITTED TO, SUBMITTED BY,

Ms. Koradiya Doli A.
First Year – MSc Nursing
 SUBMISSION ON:
TOPIC : MANAGEMENT OF PATIENT WITH UPER RESPIRATORY

DISORDER

SUBTOPIC : ASSESSMENT OF ENDOTRACHEAL INTUBATION

UNIT : 9TH

TIME : 2.30 TO 3.30 PM

DATE : / /2023

DURATION : 1 HRS

VENUE : 2ND YEAR BSC NURSING CLASS ROOM

CLASS TAUGHT : 2ND YEAR BSC NURSING STUDENTS

PRIVIOUS KNOWLEDGE : STUDENT ARE AWARE ABOUT THE ENDOTRACHEAL

PROCEDURE AND APPLY DURING CLINICAL POSTING

AV AISDS : BLACKBOARD, CHARTS, TRANSPERANCY

DEMONSTRATION

NAME OF THE STUDENT ; JITENDRA H LATA

NAME OF THE GUIDE : MR. GANESH LAL PATIDAR

GENERAL OBJECTIVES:-

AT THE END OF THE CLASS GROUP WILL HAVE KNOWLEDGE ABOUT THE ENDOTRACHEAL
INTUBATION PROCEDURE AND APPLY DURING THEIR CLINICAL POSTINGS.

SPECIFIC OBJECTIVES:- AT THE END OF THE CLASS GROUP WILL BE ABLE TO :-

1. DEFINE THE TERM ENDOTRACHEAL INTUBATION

2. EXPLAIN THE INDICATION ENDOTRACHEAL INTUBATION.
3. EXPLAIN THE CONTRAINDICATION OF ENDOTRACHEAL INTUBATION
4. ENLIST THE ADVANTAGES AND DISADVANTAGES ENDOTRACHEAL
INTUBATION.
5. DEMONSTRATE THE ENDOTRACHEAL INTUBATION.
6. EXPLAIN THE AFTER CARE OF PATIENT AND ARTICLES.
SR. SPECIFIC DURATION CONTENT TEACHING A.V AIDS BLACKBOARD EVALUATION
NO OBJECTIVE LEARNING
ACTIVITY

1 AT THE END 2MIN DEFINITION – THE INSERTION OF A TUBE LECTURE CHART DEFINE
OF THE CLASS INTO THE TRACHEA TO ALLOW AIR TO METHOD THE WHAT
GROUP WILL ENTER THE LUNGS. ENDOTRAC
BE ABLE TO HEAL
DEFINE THE INTUBATI
TERM ON
ENDOTRACHE
AL
INTUBATION

2 AT THE END OF 5MIN INDICATIONS FOR ENDOTRACHEAL LECTURE TRANS EXPLAIN

THE CLASS INTUBATION: METHOD PERAN THE
GROUP WILL CY INDICATIO
BE ABLE TO a. CARDIOPULMONARY ARREST N
Explain the
B. PATIENT IN DEEP COMA OR
indication UNRESPONSIVE
endotracheal
intubation C. SHALLOW OR SLOW RESPIRATIONS
(LESS THAN 8 PER MINUTE)

D. PROGRESSIVE CYANOSIS

E. GASTRIC LAVAGE / GAVAGE

F. SURGICAL PATIENTS WHERE BODY

POSITIONING OR FACIAL CONTOURS
PRECLUDE THE USE OF A MASK
3 5MIN 3. CONTRAINDICATIONS FOR LECTURE TRANS EXPALIN
AT THE END OF METHOD
ENDOTRACHEAL INTUBATION: PERAN THE
THE CLASS
CY CONTRAIN
GROUP WILL
a. OBSTRUCTION OF THE UPPER DICATION
BE ABLE TO AIRWAY DUE TO FOREIGN OBJECTS
explain the b. CERVICAL FRACTURES
contraindicat c. THE FOLLOWING CONDITIONS
ion of REQUIRE CAUTION BEFORE
endotracheal ATTEMPTING TO INTUBATE:
d. ESOPHAGEAL DISEASE
intubation e. INGESTION OF CAUSTIC
SUBSTANCES
f. MANDIBULAR FRACTURES
g. LARYNGEAL EDEMA
h. THERMAL OR CHEMICAL BURNS
LECTURE TRANS EXPLAIN
AT THE END OF
4 10MIN 4. ADVANTAGES OF METHOD PERAN THE
THE CLASS ENDOTRACHEAL INTUBATION: CY ADVANTA
GROUP WILL GES AND
BE ABLE TO a. PROVIDES AN UNOBSTRUCTED DISADVAN
Enlist the AIRWAY WHEN PROPERLY PLACED TAGES
advantages b. PREVENTS ASPIRATION OF
and SECRETIONS (BLOOD, MUCOUS,
STOMACH / BOWEL CONTENTS)
disadvantage INTO THE LUNGS
s c. CAN BE EASILY MAINTAINED FOR A
endotracheal LENGTHY PERIOD OF TIME
intubation d. DECREASES ANATOMIC DEAD SPACE
BY APPROXIMATELY 50%
e. FACILITATES POSITIVE PRESSURE
BREATHING WITHOUT GASTRIC
 INFLATION
f. FACILITATES BODY POSITIONING
AND MOVEMENT OF THE PATIENT
g. MAY BE UTILIZED TO PASS
MEDICATIONS
1. NARCAN
2. ATROPINE
3. EPINEPHRINE
4. LIDOCAINE

5. DISADVANTAGES OF
ENDOTRACHEAL INTUBATION:

a. NEED ADVANCED TRAINING TO

PROPERLY PERFORM PROCEDURE
b. BYPASSES THE NARES FUNCTION
OF WARMING AND FILTERING THE
AIR
c. INCREASED INCIDENCE OF TRAUMA
DUE TO NECK MANIPULATION
WHEN SPINAL CORD INJURY IS
SUSPECTED
d. MAY INCREASE
RESPIRATORY RESISTANCE
e. IMPROPER PLACEMENT
LECTURE DEMO
AT THE END OF METHOD
5 30MIN ENDOTRACHEAL INTUBATION NSTRA
THE CLASS PROCEDURE TION
GROUP WILL
BE ABLE TO  PREPARATION OF ENVIRONMENT
Demonstrate  PREPARATION OURSELF
the  PREPARATION OF PATIENT
endotracheal PREPARATION OF ARTICLES
intubation
1. ENDOTRACHEAL TUBE

a. SIZE OF TUBE IS DEPENDENT ON

SIZE OF PATIENT
b. 7.5 MM IS THE “UNIVERSALLY
ACCEPTED” SIZE FOR AN UNKNOWN
VICTIM
c. MEN ARE USUALLY LARGER,
THEREFORE AN 8.0 MM TUBE MAY
BE APPROPRIATE
d. FEMALES ARE USUALLY SMALLER,
THEREFORE A 7.0 MM TUBE MAY BE
APPROPRIATE

2. 10 CC SYRINGE – USED TO FILL THE CUFF

AT THE END OF THE ENDOTRACHEAL
TUBE

3. STYLET – A WIRE INSERTED INTO

THE ENDOTRACHEAL TUBE IN ORDER
TO STIFFEN IT DURING PASSAGE

4. WATER SOLUBLE LUBRICATION – KY

JELLY OR SURGILUBE

5. STETHOSCOPE – TO CHECK FOR PROPER

PLACEMENT OF THE ENDOTRACHEAL
TUBE

6. MAGILL FORCEPS – MAY BE USED TO

HELP GUIDE AN ENDOTRACHEAL TUBE
FROM THE PHARYNX INTO THE LARYNX

7. LARYNGOSCOPE HANDLE

8. LARYNGOSCOPE BLADE

9.MILLER BLADE (STRAIGHT BLADE)

10. MACINTOSH BLADE (CURVED BLADE)

11. OROPHARYNGEAL AIRWAY (BITE

BLOCK) – TO PREVENT THE PATIENT FROM
BITING DOWN ON THE ENDOTRACHEAL
TUBE

12. TAPE – TO SECURE THE

ENDOTRACHEAL TUBE IN PLACE

13. GLOVES

14. AMBU-BAG – TO FACILITATE

POSITIVE PRESSURE VENTILATIONS

15. SUCTION DEVICE – TO CLEAR THE

AIRWAY OF DEBRIS (BLOOD, MUCOUS,
SALIVA)

PROCEDURAL STEPS:

a. MAINTAIN THE PATIENT’S ABC’S

b. DETERMINE THAT THE PATIENT
REQUIRES ENDOTRACHEAL
INTUBATION
c. ASSEMBLE REQUIRED EQUIPMENT
d. POSITION THE PATIENT’S HEAD –
THREE AXES, THOSE OF THE
MOUTH, THE PHARYNX, AND THE
TRACHEA MUST BE ALIGNED TO
ACHIEVE DIRECT VISUALIZATION
OF THE VOCAL CORDS
e. SNIFFING POSITION – THE HEAD IS
EXTENDED AND THE NECK IS
FLEXED
f. A FOLDED TOWEL MAY BE PLACED
UNDER THE PATIENTS SHOULDERS
AND NECK TO ASSIST WITH
POSITIONING
g. SUCTION THE PATIENT (NO LONGER
THAN 30 SECONDS)
h. OXYGENATE PATIENT FOR 1
MINUTE WITH 100% OXYGEN
i. INSERT THE LARYNGOSCOPE BLADE
AND PLACE ENDOTRACHEAL TUBE
j. LARYNGOSCOPE HANDLE IS HELD
WITH THE LEFT HAND
k. INSERT THE LARYNGOSCOPE BLADE
IN THE PATIENTS RIGHT SIDE OF
THE MOUTH AND SWEEP TO THE
CENTER OF THE MOUTH
l. WHEN A CURVED BLADE IS USED,
THE TIP OF THE BLADE IS
ADVANCED INTO THE VALLECULA
(I.E. THE SPACE BETWEEN THE
BASE OF THE TONGUE AND THE
PHARYNGEAL SURFACE OF THE OF
 EPIGLOTTIS)

WHEN A STRAIGHT BLADE IS USED, THE

TIP OF THE BLADE IS INSERTED UNDER
THE EPIGLOTTIS

l. LIFT THE LARYNGOSCOPE BLADE IN

AN UPWARD MOTION
m. THE HANDLE MUST NOT BE USED
WITH A PRYING MOTION, AND THE
UPPER TEETH MUST NOT BE USED
AS A FULCRUM
n. VISUALIZE THE VOCAL CORDS
o. USING THE RIGHT HAND, INSERT
THE ENDOTRACHEAL TUBE UNTIL
YOU SEE THE CUFF PASS THROUGH
THE VOCAL CORDS. ADVANCE THE
TUBE AN ADDITIONAL ½ TO 1 INCH
FOR PROPER PLACEMENT.
p. REMOVE THE LARYNGOSCOPE
CAREFULLY FROM THE PATIENTS
MOUTH
q. REMOVE THE STYLET FROM THE
ENDOTRACHEAL TUBE
AT THE END OF
6 THE CLASS AFTER CARE OF PATIENT;-
GROUP WILL
BE ABLE TO SENT ARTICLES FOR WASHING
Explain the
PROVIDE COMFORTABLE POSITION TO THE
after care of PATIENT
patient and
articles DO RECORDING IN NURSES NOTES.
REFERANCES;-

 BRUNNER AND SUDDHARTH’S, TEXTBOOK OF MEDICAL SURGICAL

NURSING,TWELTH EDITION 2010, VOL.-1ST , PAGE NO 742-746
 BLACK AND JOYCEM;JANE HOKANSON HAWKS,MEDICAL SURGICAL
NURSING,8TH EDITION 2009, VOL.-2ND ,PAGE NO.1588-1590
 SEMBULINGAM K;SEMUBULINGAM PREMA, ESSENTIAL OF MEDICAL
PHYSOLOGY,5TH EDITION, JAYPEE PUBLICATION PAGE NO .645-646
 CHAURASIA’S BD, HUMAN ANATOMY,FOURTH EDITION,2006, CBS
PUBLISHERS & DISTRIBUTORS, VOLUME 3 PAGE NO.227-229
 TAYLOR CAROL;LILIIS CAROL;LEMONE PRISCILLA;LYNN
PAMELA,FUNDAMENTAL OF NURSING,2ND EDITION, 2009 PAGE NO .1399-
1401