The nurse assists during client intubation and assesses the client for asymmetrical chest movement. Which is the best method for the nurse to use to evaluate airway placement?
1. Obtain a chest x-ray.
2. Auscultate lung sounds.
3. Measure respiratory rate.
4. Check oxygen saturation.
1
1. To verify endotracheal tube placement, the nurse reviews the client chest x-ray and visualizes the position of the tube in the lungs. Because the chest is moving unevenly, the nurse suspects that the tube is past the carina and is placed in one of the bronchi. Chest x-ray after intubation is standard procedure because ensuring the airway is the most important client need.
2. Listening to breath sounds is a secondary method of verifying endotracheal tube placement because the breath sounds are not as sensitive or specific an indicator of tube placement as the x-ray.
3. If the client is not breathing, checking the respiratory rate is useless.
4. The client should experience hypoxemia with intubation of one lung; however, this is not used as a method of verifying tube placement.
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