question

What is a tracheostomy?

answer

an opening (stoma) created in the anterior wall of the trachea

question

Tracheostomy tubes come in... (2)

answer

Various sizes and multiple angles

question

Tracheostomy tubes may be inserted (where) or (where)?

answer

bedside, OR

question

What are two indications for a tracheostomy ? (2)

answer

to bypass a severe/recurrent upper airway obstruction, patients who regularly aspirate food or stomach contents

question

for individuals on long-term mechanical ventilation, the tracheostomy provides what?

answer

a safe stable airway

question

tracheostomy's are also indicated in patients who are undergoing what?

answer

head and neck surgery

question

What are the three components of a tracheostomy tube?

answer

outer cannula, inner cannula, obturator

question

What is the obturator?

answer

the guide used during a tracheostomy tube insertion, then it must be removed

question

What is the inner cannula?

answer

it locks into place and can be removed for cleaning

question

What is the outer cannula?

answer

it fits into trachea with a flange that rests against the neck and allows tube to be fastened in place

question

How many different types of tracheostomy tubes are there? (3)

answer

cuffed, cuffless, fenestrated

question

What is a cuffed tracheostomy tube?

answer

has an infaltable cuff or balloon to stabilize the tube.

question

What is important to remember about cuffed tracheostomy tubes?

answer

the tube should never be plugged if inflated, it can cause suffocation (no air access)

question

What are the advantages of a cuffed tracheostomy tube? (4)

answer

decreases risk of aspiration (#1), prevents air leakage and permits mechanical ventilation, low pressure cuffs decrease incidence of tracheal mucosa damage (stabilized), monitor and record pressure q8h

question

What are two reasons to measure tracheostomy cuff pressures?

answer

general pulmonary hygiene, less risk of endotracheal fistula r/t tracheal ischemia

question

Cuffed tracheostomy tubes are indicated in (what?) breathing patients?

answer

spontaneously

question

What is a fenestrated endotracheal tube?

answer

a tube that has holes in the outer cannula

question

In the emergency room, a fenestrated endotracheal tube must be replaced with a (what)?

answer

solid inner cannula

question

(what?) endotracheal tubes are not indicated for use in children?

answer

fenestrated

question

Fenestrated endotracheal tubes are useful because they help with... (2)

answer

Speech, weaning off of mechanical ventilation (cuff deflated, cannula removed, client breathes through fenestrations)

question

A client who can/would like to speak would benefit the most from which type of endotracheal tube?

answer

fenestrated

question

What are some potential complications of endotracheal tubes? (9)

answer

Bleeding, pneumothoax, air embolism, aspiration, emphysema (sq or mediastinal), laryngeal nerve damage, airway obstruction, infection, trachea ischemia/necrosis/stenosis

question

Bleeding, pneumothoax, air embolism, aspiration, emphysema (sq or mediastinal), laryngeal nerve damage, airway obstruction, infection, trachea ischemia/necrosis/stenosis are all potential complications of what?

answer

endotracheal tube

question

What are some NSG interventions implemented to reduce endotracheal tube complications? (9)

answer

maintain appropriate cuff pressure, suction as needed, maintain skin integrity, asses lung sounds, monitor for infection, monitor for cyanosis, administer oxygen, sterile technique, humidified O2

question

If not properly secured when changing ties, the patient is at risk for what?

answer

accidental decannulation

question

Vigorous coughing caused my manipulation of the tube or coughing can result in what?

answer

accidental decannulation

question

If the tracheostomy is less thatn 4 days old, what could happen that can result in accidental decanulation?

answer

stoma may close due to tract not being formed yet

question

If extubation/decannulation occurs, what do we do?

answer

1. call for assistance, 2. maintain ventilation (with bag valve mask if necessary), 3. insert obturator into the new tracheostomy and insert tracheostomy into stoma, 4. remove obturator, 5. secure new tracheostomy in place, 6. auscultate lung sounds.

question

When assessing a patient with a tracheostomy, we are assesssing for.... (6)

answer

Pain, adventitious breath sounds, secretions, aspiration risk, o2 sat, psych status

question

Structurally, when assessing a patients tracheostomy we look at what? (4)

answer

the stoma, the dressing, the cuff pressure if applicable, the tracheostomy ties

question

Which NSG outcome do we hope to achieve with a tracheostomy patient?

answer

the pt will exhibit a trach tube and site free from drainage, secretions, and skin irritation/breakdown.

question

What are three other NSG outcomes we use with trach pt's?

answer

maintain normal breath sounds, uses written and nonverbal techniques effectively, demonstrates no s and s of infection

question

When managing the airway of a trach patient, it is important for the nurse to encourage what?

answer

slow, deep breathing

question

when managing the airway of a trach pt, it is important for the nurse to position a client how? why?

answer

HOB 30-45 degrees, 90 or as upright as possible to reduce aspiration risk

question

When managing the airway of a trach pt, we must monitor what? (2)

answer

cuff pressures, vital signs.

question

turning and positioning which client is an important aspect of managing their airway?

answer

trach patient

question

What do we provide to our trach patient, especially at 100% between suction passes?

answer

oxygen

question

How do we manage aspiration in a client with a trach tube(4)

answer

HOB upright (90 degrees), cuff inflated, suction available, swallow evaluation

question

HOB upright (90 degrees), cuff inflated, suction available, swallow evaluation are all important measures we implement in a trach tube client who is a (what) risk?

answer

aspiration

question

What must we monitor in a trach patient who is a aspiration risk? (2)

answer

level of concsiousness, pulmonary status

question

How can we enhave communication with a trach patient? (4)

answer

Use picture board, listen attentively, carry on one way conversations, use hand gestures

question

What can we teach the trach patient? (4)

answer

information about disease process, demonstrate skills to patient, refer patients to local agencies, provide reassurance

question

How do we evaluate the trach patient?

answer

on the basis of the outcome where the patient ehibits a trach site and tube free from drainage, irriration, skin breakdown, secretions

question

What is the purpose of tracheostomy care? (3)

answer

maintain airway patency, prevent infections/promote cleanliness, prevent skin breakdown

question

When preparing to replace inner cannula, clean trach site, suction secretions we need to remember our what?

answer

PPE

question

What position should the client be in when performing tracheostomy care if they are awake?

answer

semi fowlers

question

We replace the inner cannula with (what kind) of gloves?

answer

sterile

question

We remove the old inner cannula and dressing, and clean around the stoma with (what kind) of gloves?

answer

clean

question

When it comes to tracheostom care, (?) nurses are better than one.

answer

2

question

Prior to and after performing trach care to a client we are doing what with oxygen?

answer

hyperoxygenating

question

What are some indications that a trach client may require suctioning? (5)

answer

gurgling, restelessness, secretions, coughing, wheezing

question

After what things might a patient require suctioning? (2)

answer

Physical therapy, bronchodilators

question

Hydration is an important factor to consider when assesing when a client needs to be.. (what?)

answer

suctioned

question

positiioning and PRN meds must be considered when assessing for influences on clients what?

answer

secretions

question

What is a contraiindication to nasopharyngeal suctioning?

answer

skull and nasal fractures

question

There are 6 types of suctioning, what are they?

answer

oropharyngeal, orotracheal, nasal pharyngeal, nasal tracheal, pharyngeal, tracheal

question

What are some risk factors that might hide that a patient requires suctioning for secretions? (4)

answer

Decreased LOC, impaired gag reflex, impaired cough, heavy sedation

question

Decreased LOC, impaired gag reflex, impaired cough, heavy sedation are all factors that can mask the need for a client to be what?

answer

suctioned

question

Dehydration and lack of humidity can influence what?

answer

the functioning of a tracheostomy

question

what are some complications of suctioning?

answer

Hypoxia, dysthymias, bronchospasm, trauma, atelectasis, pain, infection

question

Hypoxia, dysthymias, bronchospasm, trauma, atelectasis, pain, infection are all complications of what?

answer

suctioning

question

What are 5 nsg diagnosis for suctioning?

answer

innefective airway clearance, risk for aspiration, impaired gas exchange, ineffective breathing pattern, nursing process-suctinoing

question

the nursing outcome for suctioning is...

answer

the patient will exhibit improved rbeath sounds and a clear and patent airway

question

we evaluate if suctioning was successful by monitoring if a trach patient has..

answer

a patent airway, improved breath sounds

question

These four things may indicate a need for suctioning..

answer

lung sounds, 02 sat, respiratory status (rate and depth, presence of pain)

question

When suctioning a patient you should be wearing what on your face?

answer

goggles

question

We can encourage the patient to do what when we are suctioning to loosen secretions?

answer

cough

question

We want to hyperoxygenate the trach client (when) and (when) when suctioning?

answer

prior and in between passes

question

We lubricate the suction catheter with what? (2)

answer

water or sterile NS

question

How much time should we allow between suctioning passes?

answer

30 seconds to one minute

question

we should never suction for more than...

answer

10-15 seconds

question

We (what?) during suction catheter insertion, and (what) when withdrawing the suction catheter?

answer

do not suction, intermittently occlude cather and rotate

question

What should we always keep at the bedside of a trach patient?

answer

a suctioning kit

question

What is the recommended pressure for wall suction in an adult?

answer

100-120mmhg

question

What is the recommended pressure for wall suction in a neonate?

answer

60-80mmhg

question

wha is the recommended pressure for wall suction in a child?

answer

60-80mmhg

question

The guideline for the insertion point of a suction cather can be determined by what? (4)

answer

determine length of ETT/trach tube, add 1 cm, find cm markings on suction catheter and find calculated length.

question

When providing oropharyngeal or nasopharyngeal suctioning to a client, we need to think about (3)...

answer

positioning, pain, suction pressures

question

In nasopharyngeal suctioning, we insert the cather through (what?) while performing what action, for what distance to the pharynx?

answer

nares, rolling, 5-6"

question

in oropharyngeal suctioning, we insert the cather through the (what?), in what area, and for what distance to the pharynx?

answer

mouth, along the side, 3-4"

question

When suctinoing through an endotracheal tube, we must only insert the suction catheter (what length) beyong the length of the tube?

answer

1 cm

question

In performing endotracheal tube suctioning, once we insert the suction catheter 1 cm beyond the end of the ETT tube, we withdraw how much before applying suction?

answer

1/2"

question

Which hand remains sterile when performing tracheostomy suctioning?

answer

dominant

question

how many breaths with a bag valve mask should a client get before suctioning if the have a tracheastomy?

answer

3-6 bag valve mask breathts

question

What should we increase the oxygen to when we are about to suction a trach patient?

answer

100 percent

question

When inserting the suction catheter, the Y-port must be....

answer

left open

question

When we are finished suctioning, we roll the suction catheter around which hand?

answer

dominant, then pull of glove out over the catheter

question

If a trach patient is spontaneously breathing, we should do what to their cuff?

answer

deflate

question

If a trach patient is receiving mechanical ventilation, we want to do what?

answer

allow constant air leak around cuff

question

In a fenestrated tube, the openings permit what? (2)

answer

air flow and speech

question

A speaking trach consists of what? (2)

answer

two pigtails, valve for speech

question

What are some psychosocial NSG diagnosis for a patient with a trach? (3)

answer

anxiety, body image disturbance, impaired verbal communication

question

What are 4 physiological nsg dx's for a trach patient?

answer

risk for aspiration, ineffective airway clearance, impaired skin integrity, risk for infection.

question

When replacing the old inner cannula with a STERILE new inner cannula, we do what with our nondominant hand?

answer

stabalize the flange to avoid dislodging trach tube

question

If a clients trach ties need to be replaced, we must remember to do what to avoid dacannulation/extubation

answer

Place new ties before removing old ties

question

if a client has a non disposable inner cannula, it must be cleansed in what manner? and it also must be (what?) before going back in the patient?

answer

sterile, dried with sterile gauze

question

Only (what type, and what type) tracheostomies can be plugged/capped? (2)

answer

fenestrated, cuffless

question

When would a patient need their fenestrated or cuffless trach plugged?

answer

when eating

question

most patients have (which type) trach's. Only patients with (what risk, what kind of ventilation) have cuffed trachs

answer

cuffless, aspiration and mechanical ventilation

question

Cuff inflation, deflation, and plugging requires that the RN be what?

answer

specially trained

question

The general guideline when performing nasopharyngeal suction is the distance from a patients (what) to their (what)?

answer

earlobe, nose

question

a spare what should always be at the bedside of a trach patient?

answer

obturator

question

We can use the (what?) to help estimate the length of the trach tube for suctioning..

answer

obturator

question

If we are suctioning bloody mucus, what has probably happened?

answer

we have gone too far with the catheter

question

There must be a (what?) for a patient with a trach to eat or drink?

answer

order

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