DISASTER NURSING - RLE

Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

Lesson title: NURSING MANAGEMENT FOR AIRWAY Materials:

OBSTRUCTION Activity Sheets
Learning Targets: Improvised Materials
At the end of the module, students will be able to:
1. Perform CPR References:
2. Identify materials needed 1. Highlights of the 2020 AHA guidelines
3. Discuss steps in airway management update for CPR and ECC. American Heart
Association.
1. https://cpr.heart.org/en/resuscitation-
science/cpr-and-ecc-guidelines. Accessed
Jan. 28, 2021.
2. Pozner CN. Basic life support (BLS) in
adults.
https://www.uptodate.com/contents/search.
Accessed Jan. 28, 2021.
3. FAQ: Hands-only CPR. American
Heart Association. https://cpr.heart.org/en/cpr-
courses-and-kits/hands-only-cpr/hands-only-
cpr-resources. Accessed Jan. 19, 2021.
4. Duff JP, et al. 2019 American Heart
Association focused update on Pediatric
Advanced Life Support: An update to the
American Heart Association guidelines for
cardiopulmonary resuscitation and emergency
cardiovascular care. Circulation. 2019;
doi:10.1161/CIR.0000000000000731.
5. Atkins DL, et al. 2019 American Heart
Association focused update on pediatric basic
life support: An update to the American Heart
Association guidelines for cardiopulmonary
resuscitation and emergency cardiovascular
care. Circulation. 2019;
doi:10.1161/CIR.0000000000000736.
6. Ralson ME. Pediatric basic life
support (BLS) for health care providers.
https://www.uptodate.com/contents/search.
Accessed Jan. 28, 2021.
7. Topjian AA, et al. Part 4: Pediatric
basic and advanced life support: 2020
American Heart Association guidelines for
cardiopulmonary resuscitation and emergency
cardiovascular care. Circulation. 2020;
doi:10.1161/CIR.0000000000000901.

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

A. SUBJECT REVIEW/PREVIEW

Video Viewing: Watch the video below for your Heimlich maneuver return demonstration.
 https://www.youtube.com/watch?v=7CgtIgSyAiU

B. MAIN LESSON

AIRWAY OBSTRUCTION IS A LIFE THREATENING MEDICAL EMERGENCY

The airway may be partially or completely occluded.

 If the airway is completely obstructed, permanent brain damage or death will occur within 3 to 5 minutes
secondary to hypoxia
 Partial obstruction of the airway can lead to progressive:
 Hypoxia
 Hypercarbia/hypercapnia
 Respiratory and cardiac arrest
Causes:
 Aspiration of foreign bodies:
 Bolus of meat in adult.
 Small toys, buttons, coins, and food in children
 Anaphylaxis
 Trauma
 Inhalation or chemical burns
 Peritonsillar abscess.

Clinical Manifestations:
 Choking
 Apprehensive appearance
 Increased anxiety
 Restlessness
 Inspiratory and expiratory stridor
 Laboured breathing
 Flaring nostrils
 Confusion
 Cyanosis (late sign)

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

 Loss of consciousness.(late sign)

Assessment and Diagnostic Findings:

 Asking the person whether he or she is choking
 If the person is unconscious, inspection of the oropharynx will reveal the offending object.
 X-ray
 Laryngoscopy
 Bronchoscopy

Nursing Management:
 If the patient cannot SPEAK, BREATHE, and COUGH and CLUTCHING THE NECK, perform HEIMLICH
MANEUVER.
 If the patient can breathe and cough spontaneously, there is partial obstruction.
 Instruct the patient to cough forcefully.
 If the obstruction is removed, rescue breathing is initiated.
 If the patient has no pulse, perform cardiac compression.

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

Nursing Management:
 Opening the airway:
 HEAD-TILT-CHIN-LIFT MANEUVER.
 JAW-THRUST MANEUVER- for patient with suspected neck injury.

 Oropharyngeal airway insertion:

 To prevent the tongue use from falling back.
 To suction secretion.

Oropharyngeal Airway Insertion:

An oropharyngeal airway is a semicircular tube or tubelike plastic device that is inserted over the back of the
tongue into the lower posterior pharynx in a patient who is breathing spontaneously but who is unconscious.

Note: This type of airway prevent the tongue from falling back against the posterior pharynx
and obstructing the airway. It also allows health care providers to suction secretions.

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

Endotracheal Intubation:

Endotracheal intubation is indicated to:

1. Establish an airway for a patient who cannot be adequately ventilated with an
oropharyngeal airway.
2. Bypass an upper airway obstruction
3. Prevent aspiration
4. Permit connection of the patient to a resuscitation bag or mechanical ventilator
5. Facilitate the removal of tracheobronchial secretions.

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

Intubation with a Combitube or Laryngeal Mask Airway:

If the patient is not hospitalized and cannot be intubated in the field, emergency medical personnel may insert a
Combitube, which rapidly provides pharyngeal ventilation. When the tube is inserted into the trachea, it functions like an
endotracheal tube.

The two balloons that surround the tube are inflated after the tube is inserted:
One balloon is large (100 mL) and occludes the oropharynx. This permits ventilation by forcing air through the larynx. The
smaller balloon is inflated with 15 mL of air and is supposed to anchor the device in the esophagus at a site distal to
the glottis; however, it can occlude the trachea if it is inadvertently placed there. Breath sounds are auscultated
after balloon inflation to make sure that the oropharyngeal balloon (or cuff) does not obstruct the glottis. The
patient can be ventilated through either one of the two ports (eg, tracheal or esophageal) of the tube,

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

depending on whether the tube is placed in the trachea or esophagus.

Note If it is difficult to establish an airway, a laryngeal mask airway (LMA) may be inserted as an interim airway device.
The design of the LMA provides a “mask” in the subglottic airway with a cuff inflated within the esophagus. It allows easy
insertion for rapid airway control until a more definitive airway can be placed.

Cricothyroidotomy (Cricothyroid Membrane Puncture):

Cricothyroidotomy is the opening of the cricothyroid membrane to establish an airway.

This procedure is used in emergency situations in which endotracheal intubation is either not possible or contraindicated,
as
1. Extensivemaxillofacial trauma
2. Cervicalspine injuries
3. Laryngospasm
4. Laryngealedema
5. Hemorrhageinto neck tissue
6. Obstructionof the larynx.

Note: A cricothyroidotomy is replaced with a formal tracheostomy when the patient is able to tolerate this procedure.

Maintaining Ventilation (Role of Nurse):

1. Ensure that ventilation is adequate by checking for equal bilateral breath sounds.
2. Quickly assess for absent or diminished breath sounds
3. Monitor pulse oximetry, capnography, and arterial blood gases if the patient requires
airway or ventilatory assistance.

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

PROCEDURE FOR HEIMLICH MANEUVER

PROCEDURE/SKILL/RATIONALE SCRIPT

1. Greeting
Good morning Ma’am/Sir!
Utilizes proper opening script (identifies self and I am Nurse ______, I will be in-charge to assess
patient). This will depend on your initial assessment you.
if the patient is conscious or not.
Are you choking?
TAKE NOTE OF THE FOLLOWING NURSING
ALERTS Can you speak?
If the patient can breathe and cough You can nod your head if you hear me.
spontaneously, there is partial obstruction.
Instruct the patient to cough forcefully.
If the obstruction is removed, rescue breathing is
initiated.
If the patient has no pulse, perform cardiac
compression.

(If possible use the International Patient Safety

Goal #1)

Rationale: To ensure patient safety, consciousness,

and determine reliability of the patient’s identification
process.
2. Assessment
Are you feeling better? You can do a thumb up sign
Do rapid assessment and determine if patient requiresor nod your head if you feel better.
immediate care
Are you able to cough forcefully at the count of
Check for any signs of choking and respiratory three?
distress
(This will depend upon the patient’s level of
Encourage them to cough consciousness)

Rationale: DO NOT perform first aid if the person (Note for the universal sign of choking)
is coughing forcefully and is able to speak. A strong
cough can often dislodge the object.

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

If the person is unconscious, inspection of the

oropharynx will reveal the offending object.
Rationale: Manifested signs will help the nurse and
health care provider quickly intervene the next steps to
do. Signs such as:Choking,, Apprehensive
appearance,, Increased anxiety, Restlessness,
Inspiratory and expiratory stridor, Labored breathing,
Flaring nostrils, Confusion, Cyanosis(late sign), Loss
of consciousness (late sign)

IMPLEMENTATION Mam/Sir, I will now stand behind you and will wrap
my arms around your waist.
Perform Heimlich Maneuver:

1. Stand behind the person with your arms wrapped

around their waist.

Rationale: Taking position and balance in order to grab

hold of the patient If the person is sitting or standing,
position yourself behind the person and reach your arms
around his or her waist. For a child, you may have to
kneel.

2. Lean the person forward.

Please hold on as I lean you forward before taking
the obstruction. This will give you a little bit
Rationale: Lean them forward so the object blocking
their airway will come out of their mouth, rather than discomfort.
moving further down.

3. Ball your hand into a fist and place it on the person’s

abdomen, above their navel.

Rationale: The purpose of balling your hand into a first is

to provide a more forceful blow when you perform
abdominal thrusts

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

4. Use your free hand to grip your fist and press into the Are you feeling better now Mam/Sir? (Continue with
person’s abdomen in an upward motion. quick assessment)

 Rationale: Grasp the fist tightly with your other hand.

Make quick, upward and inward thrusts with your fist.

5. Repeat this method five times.

Rationale: You may need to repeat the procedure

several times before the object is dislodged. If
repeated attempts do not free the airway, call 911.

6. If the object is still stuck in the person’s throat, I am doing the procedure once again. This will give
repeat these steps five more times. you a little bit discomfort. Please hold on and bear
with me.

7. If the person is unconscious, clear the airway if

possible. You can do this using your finger. However,
be careful not to push the object further into the throat. I am opening your mouth to check for obstruction in
your throat, "Are you feeling better?"
Call 911 or your local emergency services, and then
begin CPR.

Rationale: Make sure the scene is safe, then tap the

person on the shoulder and ensure that the person
really needs help.

PROCEDURE FOR HEIMLICH MANEUVER

PERFORMANCE EVALUATION CHECKLIST

Name of Student__________________________________________

Level & Block_______________School Year & Term _________

OVERALL
RATING
PERFORMED PERFORMED UNABLE TO REMARKS
INDEPENDENTLY WITH PERFORM
PROCEDURE ASSISTANCE
4-5 0-1
2-3

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

NURSING ALERTS
If the patient can breathe
and cough spontaneously,
there is partial obstruction.
Instruct the patient to
cough forcefully.
If the obstruction is
removed, rescue breathing
is initiated.
If the patient has no pulse,
perform cardiac
compression.

If possible use the

International Patient Safety
Goal #1

2. Assessment
Do rapid assessment and
determine if patient requires
immediate care
Check for any signs of
choking and respiratory distress
Encourage them to cough
If the person is
unconscious, inspection of the
oropharynx will reveal the
offending object.

3. Ball your hand into a fist and

place it on the person’s
abdomen, above their navel.

4. Use your free hand to grip

your fist and press into the
person’s abdomen in an
upward motion.

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

5. Repeat this method five

times.

6. If the object is still stuck in

the person’s throat, repeat
these steps five more times.

7. If the person is unconscious,

clear the airway if possible.
You can do this using your
finger. However, be careful not
to push the object further into
the throat.

Call 911 or your local

emergency services, and then
begin CPR.

COMMENTS:___________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
_____________________________________________________________

Student Nurse’s Signature: _____________________ Preceptor: ________________ Date: ______________

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.

Multiple Choice
1. You are providing ventilations using a Bag-mask device. Suddenly, you do not see the patient's chest rise with the
ventilation. You reposition the patient to ensure an open airway. When you attempt to ventilate, you do not see his
chest rise. The most likely cause of this is:
A. The bag-mask device is faulty
B. Airway obstruction
C. The patient has suffered an MI
D. Cardiac tamponade
ANSWER: ________
RATIO:_______________________________________________________________________________________________
_______________________________________________________________________________

2. You are providing positive pressure ventilation through an ET tube to a patient in respiratory distress. Indications
that you are ventilating too fast include all of the following EXCEPT:

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

A. Increasing waveform capnography readings

B. Stomach insufflation
C. Tension pneumothorax
D. Aspiration
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

3. Signs of respiratory failure include all of the following EXCEPT:

A. Bradypnea
B. Diminished air movement
C. Decreased level of consciousness
D. Nasal flaring and retractions
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

4. The client has just had emergency intubation for respiratory distress. Immediately after endotracheal tube
insertion, which of the following actions by the nurse is most appropriate?
A. Tape the tube securely in place
B. Assess for bilateral breath sounds
C. Call for chest x-ray to determine placement
D. Assure the client that alternative communication means will be provided
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

5. A nurse is choosing a catheter to use to suction a patient's endotracheal tube via an open system. On which
variable would the nurse base the size of the catheter to use?
A. The age of the patient
B. The size of the endotracheal tube
C. The type of secretions to be suctioned
D. The height and weight of the patient
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________

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 DISASTER NURSING - RLE
Module #3 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
____________________________________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________

C. LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: 3-2-1

Three things you learned:

1. _______________________________________________________________________________________________
2 _______________________________________________________________________________________________
3. _______________________________________________________________________________________________
Two things that you’d like to learn more about:
1. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
One question you still have:
1. _______________________________________________________________________________________________

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