333 tracheostomy

Question 1

artificial airway

Answer 1

anything inserted in a pt who may or may not be breathing on their own (emergent or non emergent)

Question 2

pharyngeal airways

Answer 2

for people still breathing on their own but might have a decreased level of consciousness, loss of muscle tone, need suction (can be naso or oral)

Question 3

tracheal airways

Answer 3

unable to breath effectively on their own (long term airway patency issues)

Question 4

endotracheal tubes

Answer 4

for a pt on a ventilator

Question 5

percutaneous tube

Answer 5

bypasses oral airway and connects straight into the trachea, pt can be on vent or breathing on their own

Question 6

of a tracheostomy tube, do you remove the inner or outer cannula to clean

Answer 6

inner

Question 7

tracheostomy indications

Answer 7

-acute airway obstruction (tumor in neck)
-airway protection (after head/neck cancer surgery)
-facilitate removal of secretions

Question 8

benefits of trach for prolonged intubation

Answer 8

-less damage to airway
-more comfortable
-allowed to eat
-mobility is improved bc tube is more secure

Question 9

decannulation

Answer 9

the removal of a trach

Question 10

max amount of time pt can be on a ventilator before switching to trach

Answer 10

7-10 days

Question 11

types of trachs: shiley

Answer 11

plastic, disposable inner canula, short term, most often seen in hospital, has a cuff to keep snug fit in trachea to prevent aspiration & give stronger breaths (cuffs are needed for vents)

Question 12

types of trach: jackson

Answer 12

resuable inner canula, no cuff, obturator, need a trach care kit

Question 13

obturator

Answer 13

what is used to inset a trach that has been dislodged (guidewire)

Question 14

when are cuffs inflated

Answer 14

-pt mechanically ventilated
-inflation specifically ordered by HCP
typically NOT on med surg floors

Question 15

what do you always do before and after deflating the cuff

Answer 15

suction oropharynx before and trachea after

Question 16

what are the risks of prolonged or over inflation of cuff

Answer 16

increased mucosal pressure, causing ischemia, softening cartilage & mucosal erosion -> can cause a tracheoesophegeal fistula

Question 17

passy-muir speaking valve

Answer 17

-cuff must be deflated when in use
-do not use if pt is in any kind of res distress
-must have ok from HCP, they usually coordinate w/ SLP and RT

Question 18

what to do for tube dislodgment (accidental decannuation)

Answer 18

-keep obturator at bedside always
-insert obturator into outer cannula
-extend neck & open tissue, inset outer cannula/obturator
-remove obturator
-check bilateral breath sounds
-secure trach

Question 19

what should always be apart of your bed side safety checks for a pt with a trach

Answer 19

obturator is present at bedside along with a trach that is one size smaller

Question 20

nursing problems for a pt w/ a trach

Answer 20

-ineffective airway clearance
-impaired verbal communication
-risk for infection
-impaired swallowing
-body image disturbance
-anxiety
-pain

Question 21

components of a nurse’s trach assessment

Answer 21

what kind, what size, is the cuff inflated, is the pt complaining of discomfort, is the pt oxygenating appropriately

Question 22

how often is trach care done

Answer 22

every 12 hours

Question 23

where should you listen for breath sounds with a trach pt

Answer 23

their lungs but also around the trach