333 tracheostomy Flashcards
artificial airway
anything inserted in a pt who may or may not be breathing on their own (emergent or non emergent)
pharyngeal airways
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)
tracheal airways
unable to breath effectively on their own (long term airway patency issues)
endotracheal tubes
for a pt on a ventilator
percutaneous tube
bypasses oral airway and connects straight into the trachea, pt can be on vent or breathing on their own
of a tracheostomy tube, do you remove the inner or outer cannula to clean
inner
tracheostomy indications
-acute airway obstruction (tumor in neck)
-airway protection (after head/neck cancer surgery)
-facilitate removal of secretions
benefits of trach for prolonged intubation
-less damage to airway
-more comfortable
-allowed to eat
-mobility is improved bc tube is more secure
decannulation
the removal of a trach
max amount of time pt can be on a ventilator before switching to trach
7-10 days
types of trachs: shiley
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)
types of trach: jackson
resuable inner canula, no cuff, obturator, need a trach care kit
obturator
what is used to inset a trach that has been dislodged (guidewire)
when are cuffs inflated
-pt mechanically ventilated
-inflation specifically ordered by HCP
typically NOT on med surg floors
what do you always do before and after deflating the cuff
suction oropharynx before and trachea after
what are the risks of prolonged or over inflation of cuff
increased mucosal pressure, causing ischemia, softening cartilage & mucosal erosion -> can cause a tracheoesophegeal fistula
passy-muir speaking valve
-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
what to do for tube dislodgment (accidental decannuation)
-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
what should always be apart of your bed side safety checks for a pt with a trach
obturator is present at bedside along with a trach that is one size smaller
nursing problems for a pt w/ a trach
-ineffective airway clearance
-impaired verbal communication
-risk for infection
-impaired swallowing
-body image disturbance
-anxiety
-pain
components of a nurse’s trach assessment
what kind, what size, is the cuff inflated, is the pt complaining of discomfort, is the pt oxygenating appropriately
how often is trach care done
every 12 hours
where should you listen for breath sounds with a trach pt
their lungs but also around the trach
