A comatose client needs a nasopharyngeal airway for suctioning. After the airway is inserted, he gags and coughs. Which action should the nurse take?
A. Remove the airway and insert a shorter one.
B. Reposition the airway.
C. Leave the airway in place until the client gets used to it.
D. Remove the airway and attempt suctioning without it.
Correct Answer: A. Remove the airway and insert a shorter one.
If the client gags or coughs after nasopharyngeal airway placement, the tube may be too long. The nurse should remove it and insert a shorter one. A nasopharyngeal airway device (NPA) is a hollow plastic or soft rubber tube that a healthcare provider can utilize to assist with patient oxygenation and ventilation in patients who are difficult to oxygenate or ventilate via bag mask ventilation, for example.
Option B: Simply repositioning the airway won’t solve the problem. NPAs are passed into the nose and through to the posterior pharynx. NPAs do not cause patients to gag and are, therefore, the best airway adjunct in an awake patient and a better choice in a semiconscious patient that may not tolerate an oropharyngeal airway due to the gag reflex.
Option C: The client won’t get used to the tube because it’s the wrong size. When placing an NPA, the healthcare provider should be knowledgeable regarding the sizing of the NPA. Adult sizes range from 6 to 9 cm. Sizes 6 to 7 cm should be considered in the small adult, 7 to 8 cm in the medium size adult, and 8 to 9 cm in the large adult.
Option D: Suctioning without a nasopharyngeal airway causes trauma to the natural airway. When the NPA is too long for the patient, it can create a direct route of ventilation of the stomach, causing gastric distention, increasing vomiting risk, and decreasing oxygenation and ventilation of the lungs.
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