What is the oropharyngeal in nursing?

In nursing, up to 50% of unconscious patients experience airway obstruction from tongue relaxation. Understanding what is the oropharyngeal in nursing is therefore critical for effective airway management and ensuring patient safety across various healthcare settings.

Quick Summary

The oropharyngeal region is the middle part of the throat behind the oral cavity, and in nursing, its assessment and management are crucial for ensuring a patent airway, especially in unconscious, sedated, or post-operative patients, or those with compromised swallowing.

Key Points

• Anatomy: The oropharynx is the middle section of the throat behind the mouth, containing the soft palate, base of tongue, and tonsils.

• OPA Use: Oropharyngeal airways (OPAs) are rigid plastic devices used to maintain a patent airway by preventing the tongue from obstructing the throat in unconscious patients.

• Suctioning Technique: Oropharyngeal suctioning, typically performed with a Yankauer catheter, removes secretions and foreign material from the mouth and pharynx.

• Patient Safety: Nursing interventions, including proper positioning, assessment, and the correct use of airway adjuncts, are critical for preventing airway compromise and aspiration.

• Assessment: Nurses use a combination of visual inspection, observation of swallowing, and auscultation to assess the condition of a patient's oropharynx.

The Anatomy of the Oropharyngeal Region

The oropharynx is a vital anatomical area, comprising the middle section of the throat located directly behind the oral cavity. It acts as a shared passageway for both air and food, meaning any obstruction in this area can significantly impact a patient's ability to breathe and swallow safely. In a nursing context, a thorough understanding of its components is essential for effective assessment and intervention.

Key Oropharyngeal Structures

• Soft Palate: The muscular back portion of the roof of the mouth, which elevates during swallowing to prevent food from entering the nasal cavity.
• Base of the Tongue: The back one-third of the tongue, which can fall backward and obstruct the airway in an unconscious state.
• Tonsillar Fossae and Tonsils: Lymphoid tissue located on either side of the oropharynx that traps and destroys invading pathogens.
• Uvula: The small, teardrop-shaped piece of tissue that hangs from the soft palate.
• Posterior Pharyngeal Wall: The back wall of the throat, directly behind the tonsils.

Nursing Assessment of the Oropharynx

Nurses perform regular assessments of the oropharynx to identify potential or actual airway compromise. This process is a fundamental skill in maintaining patient safety, particularly in individuals at risk. The assessment includes several steps:

Inspection and Observation

1. Visual Inspection: Using a light source and a tongue depressor, the nurse visually inspects the oral cavity and oropharynx. They check for symmetry, inflammation, redness, or signs of infection in the soft palate, tonsils, and posterior pharyngeal wall.
2. Swallowing Assessment: For conscious patients, the nurse assesses the patient's ability to swallow effectively. Any drooling, coughing, or difficulty swallowing (dysphagia) is a red flag for potential oropharyngeal issues.
3. Positioning: Observe if the patient's positioning is compromising their airway. In supine, unconscious patients, the relaxed tongue can naturally fall back, requiring a positional change like the head-tilt-chin-lift or jaw-thrust maneuver.

Auscultation

• Breath Sounds: A nurse will listen to the patient's breath sounds. The presence of coarse, gurgling breath sounds or rhonchi suggests that secretions are present in the large airways and need to be cleared.
• Work of Breathing: Assessing for increased work of breathing, such as restlessness, flaring of nostrils, or use of accessory muscles, can indicate an airway obstruction.

Oropharyngeal Airways (OPA): Use and Insertion

An oropharyngeal airway is a curved plastic medical device used to maintain a clear airway in an unconscious patient by preventing the tongue from obstructing the pharynx. A critical nursing intervention, its use requires careful consideration and precise technique.

Indications for OPA Insertion

• Unconscious Patients: For patients who are unresponsive and have lost their gag reflex, the OPA mechanically holds the tongue forward to keep the airway open.
• Post-Operative Care: Used in the postanesthesia care unit (PACU) until the patient regains consciousness and airway reflexes.
• Ventilation Support: Facilitates positive-pressure ventilation with a bag-valve-mask (BVM) device.

Insertion Technique (180-Degree Rotation Method)

1. Gather Equipment: Select the correct OPA size by measuring from the corner of the patient's mouth to the angle of the jaw. Gather gloves, a mask, and a suction device.
2. Assess and Position: Ensure the patient is unconscious and has no gag reflex. Position the patient supine with the head hyperextended, if not contraindicated.
3. Insert the Airway: Open the patient's mouth. Insert the OPA with the curved tip pointing toward the roof of the mouth. As the tip passes the soft palate, rotate the airway 180 degrees so the curvature follows the tongue, settling with the flange resting against the lips.

Oropharyngeal Suctioning: Procedure and Supplies

Oropharyngeal suctioning is the process of removing secretions, blood, or vomit from the mouth and back of the throat. Nurses use a Yankauer suction catheter for this procedure, which is indicated for patients unable to clear secretions effectively.

The Suctioning Procedure

1. Preparation: Don clean gloves, a mask, and goggles. Ensure the suction equipment is set up correctly with the Yankauer catheter attached.
2. Assessment: Assess the patient for signs indicating the need for suctioning, such as audible gurgling or visible secretions.
3. Suctioning: Insert the rigid Yankauer catheter into the patient's mouth and suction along the sides of the mouth and pharynx, moving towards the back of the throat. This removes secretions and prevents aspiration.
4. Oral Hygiene: After suctioning, oral hygiene should be performed to prevent infection and discomfort, especially in patients with impaired swallowing or artificial airways.

Comparison: Oropharyngeal vs. Nasopharyngeal Airway

Both OPA and NPA are airway adjuncts, but their use depends on the patient's condition. The table below highlights the key differences.

Feature	Oropharyngeal Airway (OPA)	Nasopharyngeal Airway (NPA)
Patient Condition	Only used in unconscious patients without a gag reflex.	Can be used in semiconscious or conscious patients with a gag reflex.
Placement	Inserted through the mouth, resting over the tongue.	Inserted through the nostril, resting behind the tongue.
Key Function	Prevents the tongue from obstructing the posterior pharynx.	Bypasses the tongue entirely to keep the airway patent.
Contraindications	Trauma to the oral cavity, loose teeth, active gag reflex.	Severe facial trauma, suspected basilar skull fracture, nasal injury.
Insertion Risk	Can cause gagging, vomiting, or oral tissue trauma if improperly inserted.	Risk of stimulating nosebleed or improper placement if forceful.

Nursing Diagnoses and Patient Care

Ineffective Airway Clearance

A common nursing diagnosis for patients with oropharyngeal issues is Ineffective Airway Clearance. Nursing care plans for this diagnosis often include interventions such as:

• Positioning: Elevating the head of the bed (if tolerated) to help secretions drain and prevent aspiration.
• Encourage Coughing: For conscious patients, encouraging deep breathing and coughing exercises to clear secretions.
• Fluid Management: Encouraging adequate fluid intake to thin secretions, if not contraindicated.

Risk for Aspiration

Patients with impaired swallowing or an altered level of consciousness are at high risk for aspiration. Nursing interventions include:

• Swallowing Evaluation: A thorough swallow screen or referral to a speech-language pathologist.
• Mealtime Safety: Ensuring patients eat and drink in an upright position and are monitored during meals.
• Oral Hygiene: Regular oral care to reduce bacterial load and the risk of aspiration-related pneumonia.

Conclusion

In summary, understanding what is the oropharyngeal in nursing is foundational to providing safe and effective care. This includes comprehensive assessment, skilled use of airway adjuncts like the OPA, and implementing appropriate interventions like suctioning and patient positioning. The nurse's ability to quickly and correctly manage the oropharyngeal airway is a critical skill that can prevent serious complications and save lives. This expertise underscores the profound responsibility nurses have in maintaining patient respiratory function and overall safety.

For more in-depth information on oropharyngeal airways, consult the expert resources on platforms like StatPearls: Oropharyngeal Airway.

Frequently Asked Questions

What is the primary purpose of an oropharyngeal airway (OPA) in nursing?

The primary purpose of an OPA in nursing is to establish or maintain a patent airway in an unconscious patient by preventing the tongue from obstructing the posterior pharynx.

When should a nurse use oropharyngeal suctioning?

A nurse should use oropharyngeal suctioning when a patient is unable to clear secretions from the mouth and pharynx on their own. This is indicated by visible secretions, audible gurgling breath sounds, or increased work of breathing.

What is the difference between an OPA and an NPA?

An OPA is inserted through the mouth and is only for unconscious patients without a gag reflex. An NPA, or nasopharyngeal airway, is inserted through the nose and can be used for semiconscious patients who still have an intact gag reflex.

How does a nurse choose the correct size of an oropharyngeal airway?

To choose the correct size, a nurse measures the OPA from the corner of the patient's mouth to the angle of their mandible (jaw). An incorrectly sized OPA can cause harm or worsen the obstruction.

What are the key risks of inserting an oropharyngeal airway incorrectly?

Improper insertion can push the tongue backward, worsening the obstruction. It can also cause tissue trauma to the oral cavity, palate, or larynx, and in a conscious patient, can induce vomiting and laryngospasm.

What is the role of oral hygiene in oropharyngeal nursing care?

Oral hygiene is a crucial component of oropharyngeal care, especially in dependent or unconscious patients. It prevents the accumulation of secretions and bacteria, which can help prevent hospital-acquired infections like pneumonia.

What are some signs of an ineffective airway that a nurse would recognize?

Signs of an ineffective airway include audible or visible secretions, abnormal breath sounds (e.g., gurgling), difficulty breathing, increased respiratory rate, restlessness, and decreased oxygen saturation levels.