5.3 Treatment and intervention Flashcards
What are the things that we need to know about changing the tube post-surgery? (4)
- When: soiled, cuff rupture
- Avoid within week 1
- First time done by surgeon
- Difficult cases (obese, short or thick neck)
Post-surgery care also includes ___________, ___________ for inspired air, and management of ____________.
- Hygiene
- Humidification
- Secretions
What kind of care do we give to the patients? (3)
- Having a tracheostomy can be very traumatic and many patients find it difficult to adjust
- Patients with a new tracheostomy will need lots of support, reassurance and eduction
- Help family find alternate modes of communication
How often should a stoma be cleaned and inspected a day?
Cleaned/inspected 2-3 X/day
We have to ________ the process of stoma care to the patients.
Teach
We need to be careful to work ________ so that the _______ does not close.
- Quickly
- Stoma
Trach may prevent _________ movement of larynx during swallowing.
Upward
Between ____-___% of patients with a tracheostomy experience at least one episode of aspiration every 48 hours.
20-70%
__________ swallow evaluations are important.
Repeated
Feeding can be either _______ or _________
Oral
Nasogastric
What are the indications for suctioning? (6)
- Secretions in the trach
- Secretions in vocal trach
- Suspected aspiration
- Sustained coughing
- Respiratory distress
- If working on swallowing
What is the first step of suctioning?
Connect the catheter to the suction machine. Do not touch the end of the catheter that will go into the trach tube
What is the second step of suctioning?
Insert the catheter the proper distance into the trach tube (usually the length of the trach tube plus 1/4 inch)
What is the third step of suctioning? (2)
Apply suction by putting your thumb over the hole in the catheter while you gently pull the catheter out.
Gently roll the catheter between your thumb and forefinger as you pull the catheter.
Who is capable of doing the suctioning? (4)
- SLP
- Respiratory care practitioner
- Nurse
- Parents may also do this at home once the child is stable
How do you complete Oral/Nasal and Tracheal suctioning? (3)
- Insert tubing without any pressure
- Saline solution used between each attempt
- When pulling up and out, apply negative pressure through button (occlude proximal portion of suction)
What are the special notes for tracheal suctioning? (2)
important to know this for the exam
- Negative pressure no longer than 10-15 seconds (to avoid deoxygenating patient)
- When pulling catheter out (suctioning) apply circular motion
___________ (tracheal) or ________ (oral/nasal) is normal (monitor if it becomes excessive)
Coughing
Gagging
Monitor _____ and may provide ________ to patient as needed.
- O2
- Oxygen
What kind of patient is even more susceptible?
Ventilator dependent patients
Provide a _______ between suctioning.
Break
What should we never use for both oral/nasal as for tracheal?
- Same tubing
When should you wean a patient from a trach? (2)
- Once they demonstrate stability for 24-48 hours after discontinuing mechanical ventilation
- Appear to be stable with breathing/swallowing without aspiration
Trach stoma narrows within ____-____ hours after tube is removed
48-72
Cuff can be _______ and tube ______ without any difficulties
- Deflated
- Capped
Passy-Muir allows _____-_____ valve (air in but not out)
Expiration =
One-way
valve closed/blocks air from existing tube
Forces ______ around tracheostomy tube and through _____ _____ above
Air
Vocal Folds
How can a patient vocalize when they have a passy-muir?
Normally
What are the advantages of the Passy-Muir? (5)
- Dec. weaning time
- Increase oxygenation
- Improved speech production
- No figure occlusion needed (hands free)
- Can be vent dependent
What are the disadvantages of the Passy-Muir?
Not all are candidates
What disqualifies a patient from receiving a Passy-Muir? (5)
- Can’t have upper airway obstruction
- Patient must have good articulation with vocal folds
- Patient with lots of secretions may not be able to use it
- Not all tolerate the valve
- MUST HAVE CUFFELESS trach
What are the types of ventilation? (3)
- Spontaneous
- Manual
- Mechanical
What is the spontaneous type of ventilation?
A person’s ability to move air in and out of lungs
What is the manual type of ventilation?
Gives breaths via AMBU bag through the trach tube if person is not attached to the vent. Used after suctioning often
What is the mechanical type of ventilation?
When the body is not able to exchange respiratory gases adequately through spontaneous ventilation
What is positive pressure ventilation?
When mechanical pushes air into the lungs by way of artificial airway
What is negative pressure ventilation?
When mechanical pulls chest up to inhale
What is the control mode ventilation (CMV)?
Breathing solely through vent with set volume and rate; no spontaneous breathing. Used with ALS + spinal cord injury patients
What is the assist control mode (A/C)?
Full vent support but patient can initiate extra breaths as needed (inspiration) + with support of machine, hence, the “assist” part
What is the intermittent mandatory ventilation (IMV)? (2)
present rate + volume
patient can initiate extra breaths independent of machine; patient breaths at own rate/volume.
What is pressure support (PS)? (2)
Patient triggers vent by initiative breath.
Uses respiratory muscles without risk of fatigue
What is continuous positive end expiratory pressure (CPAP)?
Used during spontaneous breathing to overcome the work of breathing through the vent
