NORCET 6 Prelims -2024
Medical & Surgical Nursing
Easy
What is the absolute contraindication for performing nasal tracheal intubation in a critically ill patient?
Appeared in: NORCET 6 Prelims -2024
Explanation
- A fracture of the base of the skull (basilar skull fracture) is an absolute contraindication for nasotracheal intubation.
- The primary danger is the potential for the endotracheal tube to pass through the fractured cribriform plate and enter the cranial cavity.
- This can lead to direct brain injury, introduction of bacteria causing meningitis, and leakage of cerebrospinal fluid (CSF).
- In trauma patients, any suspicion of a basilar skull fracture (e.g., raccoon eyes, Battle's sign) should prompt avoidance of any nasotracheal tube placement.
Why Other Options Were Wrong
- Option A: Nasotracheal intubation can be performed on conscious patients, although it requires appropriate sedation and local anesthesia. It is not an absolute contraindication.
- Option C: Limited mouth opening, or trismus, makes oral intubation difficult or impossible. Therefore, this condition is a primary indication for choosing the nasotracheal route.
- Option D: An intraoral mass that obstructs the oropharynx can make oral intubation unsafe or unfeasible. Like limited mouth opening, this is an indication for considering the nasotracheal route.
Related Visual
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Contraindications for Nasotracheal Intubation in acute care settings.
- Nurses must be vigilant in assessing trauma patients for signs of basilar skull fracture (Battle's sign, raccoon eyes, CSF leak) and immediately communicate these findings to the medical team to prevent iatrogenic injury.
- The nurse's role during intubation includes preparing equipment for both oral and nasal routes, as well as a surgical airway kit (cricothyrotomy), in case the initial plan fails.
- What if? If a patient with a basilar skull fracture requires an emergency airway and oral intubation is also impossible (e.g., due to massive facial trauma), the next step would be to prepare for an immediate surgical airway, such as a cricothyrotomy or tracheostomy.
How to Approach the Question
- First, identify the core of the question: finding an 'absolute contraindication' for 'nasal tracheal intubation'. The word 'absolute' is key, meaning a situation where the procedure must never be performed.
- Analyze each option to determine if it represents an absolute stop, a relative caution, or an indication for the procedure.
- Option A (Conscious patient): Consider if procedures are ever done on conscious patients. Yes, with sedation. So, this is relative, not absolute. Eliminate.
- Option B (Fracture of base of skull): Think about the anatomy. The nose connects to the pharynx, which is just below the base of the skull. A fracture could create a false passage. This sounds like a severe, non-negotiable risk. Keep this as a strong candidate.
- Option C (Limited mouth opening): Consider the alternative. If the mouth can't be used for intubation, another route is needed. The nasal route is the logical alternative. This is an indication, not a contraindication. Eliminate.
- Option D (Intraoral mass): Similar to limited mouth opening, if the oral route is blocked, the nasal route is a primary alternative. This is also an indication. Eliminate.
Concept Tested & Keywords
- Concept Tested: Contraindications for Nasotracheal Intubation
- Stem keywords: nasal tracheal intubation, critically ill patient, absolute contraindication
- Lead-in keywords: What is
Question ID
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Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 616-618
E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 115-117
Practise the full NORCET 6 Prelims -2024
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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