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N342 > Trach > Flashcards

Trach Flashcards

1
Q

What is a Tracheostomy

A

an incision in the trachea made to relieve an obstruction to breathing.

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2
Q

When would someone need a tracheostomy

A 
To bypass an obstructed airway
Cancerous tumors
Vocal cord paralysis
Congenital abnormalities of the airway
Severe head or neck injuries/surgery
Airway burns from inhalation of corrosive material, smoke or steam
Respiratory nerve damage
Protect the airway from aspiration (Patient unable to clear own secretions)
Prolonged intubation
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3
Q

When can a tracheostomy be used

A

In an emergency
As a temporary measure
Permanently
Prophylactic (Prior to a large head and neck surgery or laryngectomy)

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4
Q

What are some differences between a Endotracheal tube (ET tube) and a trach

A

ET tube is…
Easier and quicker to insert
Prevents aspiration and secretions
Tolerated for short time
Need to be sedated and weaning is diffcult if left for a long periord
Trach
Reduces the need for sedaion
Reduces damage to glottis
Trach site can bleed or lead to infection
Causes scar formation
More invasive and complicated compared to ET tube

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5
Q

What is a Larynegectomy

A

It is the removal of the larynx and loss of voice box

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6
Q

Why would a patient have a larynegectomy

A

cancer of the larynx, damage of the larynx due to trauma

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7
Q

What is the post-op care for a laryngectomy

A

Oxygen mask over the stoma.
Nutrition through feeding tube or TPN.
A speech pathologist or doctor will assess patients ability to swallow. Depending on the results patient will progress to soft foods.

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8
Q

What is some patient teaching pre and post operative for a laryngectomy

A

Use of call bell and message board to communicate
Keep HOB elevated
Suctioning secretions
Need of NG feeds until feeding is established
Keeping stoma clean and dry

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9
Q

Who is a good resource for patient’s with trach’s

A

RT

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10
Q

Why is it important to keep a patient with a tracheotomy hydrated

A

Keep their secretions thin and prevent the formation of a mucus plug

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11
Q

What type of oxygen should be applied to these patient’s and why

A

Humidification air/O2, this will help keep the secretions thin and decrease the likelihood of a mucus plug forming

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12
Q

What are some other nursing interventions (Non-pharmacological) that can help a patient’s airway patency

A

Mobilizing or changing position to help move mucos and developing an infection
Suctioning to keep airways clear and patent

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13
Q

What is opti-flow

A

Warm and humidified O2 that can be applied to the trach mask

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14
Q

What can the nurse do with opti-flow

A

Change the sterile water bag

RT will set it up

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15
Q

What type of nutrition is commonly given to trach patient post-op

A

NG feeds

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16
Q

Can the nurse insert the NG

A

NO!

Must be done by the MD, usually during surgery or in radiology

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17
Q

Why do patient’s with trach’s have swallowing issues

A

Increased secretions

Esophageal/pharyngeal pressure from the trach

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18
Q

How long can patient’s be NPO for prior to needing alternative feeding

A

48 hours

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19
Q

What move are patient’s unable to do due to the trach

A

Valslva manoeuver- they cannot forcibly exhale while keep their mouth and nose closed (bearing down)

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20
Q

What are some things nurses can do to help patient with constipation

A

Mobilize ASAP
Keep them hydrated
Bulk forming foods, high fiber, laxatives and stool softeners

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21
Q

What is one of the biggest things patient suffer from with a trach

A

Anxiety

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22
Q

What are some ways nurses can decrease anxiety

A 
Ensure the call bell is in reach
Frequent checks
Reassure client
Communication board
Have patient close to nursing desk so they can be monitored
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23
Q

What are some complications of a tracheostomy

A

Tracheal wall necrosis
Tracheal stenosis
Cuff pressure problems

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24
Q

What is a traceoespohageal fistual

A

A tracheoesophageal fistula (TEF) is a congenital or acquired communication between the trachea and esophagus

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25
Q

How does a patient acquire a TEF

A

Increased or to high of cuff pressure for a prolonged period of time

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26
Q

What are some tracheotomy complications

A

Misalignment- when the tracheotomy tube is not inserted correctly
Herniated cuff- putting too much air in the trach cuff can cause it to bulge, which can result in an obstruction in the trachea
Decannulation-Planned or accidental removal
Infection-Due to improper care

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27
Q

What is tracheomalacia

A

Weakness of floppiness of the walls of the trachea acquired due to chronic infection or prolonged intubation

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28
Q

What is needed to start weaning the patient off the trach

A

MD order

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29
Q

When the trach tube is plugged to assess the client’s ability to breath on their own

A

Corking

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30
Q

Can you cork a cuffed trach?

A

NO!

31
Q

How long on average does the corking process take

A

2-5 days

32
Q

What does the nurse need to do with a patient who is going through the corking process?

A

Constant client support
Monitor vitals and signs of distress
Respiratory status

33
Q

In Island health who is in charge of the trialing of corking

A

The RT

34
Q

If the client is in distress and is corked, what do you do?

A

Remove the cork right away and re-oxygenate patient
Check vital
Document

35
Q

What kind of trach tubes are there

A

Metal, silicone, plastic (most common)

36
Q

What is a cuffed trach

A

Air is inserted to the port via syrringe and inflates the cuff

37
Q

What does a cuff trach do

A

Prevents air moving through the vocal cord,
Allows for mechanical ventilation
Protects airway
Pressure placed on bleeding site post-operatively after neck or throat surgery

38
Q

What is an uncuffed trach

A

The ballon is deflated

39
Q

What does an uncuffed trach do

A

Allows air to pass through the vocal cords

Patient’s cannot be ventilated with an uncuffed trach

40
Q

What is an obturator

A

The obturator is used to help make insertion of the trach tube easier. The obturator has a round tip that sticks out of the end of the outer cannula. This protects the trachea from any damage as the trach tube is inserted into the airway. This must be removed as soon as the trach tube is inserted as it occludes the airway while in place

41
Q

What is a single lumen trach

A

One hollow tube or cannula for both air flow and suctioning

42
Q

When is a single lumen trach used

A

In neonates and pediatrics and are NOT cuffed

43
Q

What is a double cannula trach

A

Has both a hollow outer cannula an inner cannula which is also hollow

44
Q

What part of the double trach is removed and replaced with plastic cannula and cleaned with silicone and metal trach

A

the inner cannula

45
Q

What does the outer cannula do

A

Keeps tracheal stoma open

46
Q

When is the obturator used

A

When inserting the outer cannula

47
Q

What is a fenestrated trach tube

A

It has hole/holes built into it to allow air to pass through the vocal cords
This allows normal breathing and the ability to speak or cough through their mouth

48
Q

Cuff up or down to speak with fenestrated trach? Cork or uncork?

A

To take advantage of the fenestrations, one must deflate the cuff, remove the inner cannula and plug the outer cannula. The air passing through the fenestrations will now allow the patient to speak and breathe normally

49
Q

When is a cuffed, fenestrated tube used

A

When patients are on the ventilator but are not able to tolerate a speaking valve to speak

50
Q

What are some complications of a fenestrated trach

A

High risk of aspiration
Difficulty with ventilation
Granuloma formation at the site of the fenestration

51
Q

What is some pre-operative teaching in regards to trach

A

Ensure the patient has spoken with the surgeon
Informed Constant is obtained
Point out the effect of the surgery or taste and breathing
Enourage patient to speak with family
Teaching regarding the feeling of breathing through a straw
Getting use to communcating with pencil/pen and whiteboard
Discuss body image

52
Q

What should you do when you reccieve a patient from PARR with a Tracheostomy

A 
Have a patient near nursing station
Contact RT
Have suction ready at beside
Trach cart ready
Ensure oxygen and suction are working
53
Q

What are some key items needed on the trach cart

A

Obturator, suction equipment, normal saline, sterile water, same size trach and one smaller, dilators, ampu bag with trach attachment

54
Q

Identify eight assessments to complete for your patient who has a new tracheostomy

A 
Patent Airway/Breathing
  Circulation 
  Secretions
  Respiratory Assessment
  Positioning
  Pain Assessment
  Incision Site/Drsg
  Vital Signs/Sp02
55
Q

What are some post-op nursing interventions

A 
Encourage deep breathing and coughing
  Elevate the head of the bed. 
Suction via tracheostomy using sterile technique as needed.
 Provide tracheostomy 
   care as needed.
56
Q

How many nurses should be present for trach tie changes

A

2 RN’s (Blow me Camosun)

57
Q

What are some complications related to trach ties

A

Too tight may occlude jugular venous drainage
Too loose trach tube shifts
Irritation, skin breakdown, dislodgement

58
Q

How often should suction be done

A

Every 4 hours and PRN

59
Q

What are some risk of suctioning a patient with trach

A 
Increased secretions
Hypoxia
Dysrhythmias
Bronchospasms
Infection
Atelectasis
Mucous membrane trauma
Decannulation
60
Q

What is the most common cause of respiratory distress for patients with a trach

A

Mucus plugs

61
Q

What can you do if you think your patient has a mucus plug

A

Encourage them to cough
Suction per policy
If patient goes into respiratory distress call RT stat

62
Q

How much more likely is patient who is on a vent to develop pnemonia

A

6-21X higher

63
Q

What do you do if the trach comes out?

A 
Stay with patient
  Call for help NOW
  Need RT stat
  Hyperextend neck 
  Use retention sutures or dilator to open airway
  Insert obturator into outer cannula
  Re-Insert cannula (ensure cuff deflated)
  Remove obturator
  Secure tube
  Assess client and provide oxygen 
  Maintain ventilation with bag and mask
    (mouth to neck technique)
64
Q

What are some ways to prevent decannulation

A

Trach tie change - two person procedure
Ensure trach tube is secure
Be careful when suctioning client

65
Q

What equipment should always be at the bedside

A

Tracheostomy Tube
Tube and obturator same size as patient has in place
Tube and obturator one size smaller
Obturator and Tracheal Spreaders/ Dilators on trach cart
Trach Cart Stocked

66
Q

How long is trach care done sterile?

A

First 48 hours

67
Q

After this time how is trach care done

A

As a clean/no touch

68
Q

What mixture is used to clean the inner cannula

A

half saline half hydrogen peroxide

69
Q

How often is the trach dressing change

A

Everyday and PRN

70
Q

What type of gauze is placed under the trach

A

Pre-cut drain sponges

71
Q

Why can you not cut your own gauze

A

Can leave behind gauze fragments and lead to infection

72
Q

Why is tracheotomy care done

A

To prevent infection
Promote healing
Ensure client comfort

73
Q

How fucking done are you with studying

A

110%

N342 (3 decks)

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