Trach Flashcards
What is a Tracheostomy
an incision in the trachea made to relieve an obstruction to breathing.
When would someone need a tracheostomy
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
When can a tracheostomy be used
In an emergency
As a temporary measure
Permanently
Prophylactic (Prior to a large head and neck surgery or laryngectomy)
What are some differences between a Endotracheal tube (ET tube) and a trach
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
What is a Larynegectomy
It is the removal of the larynx and loss of voice box
Why would a patient have a larynegectomy
cancer of the larynx, damage of the larynx due to trauma
What is the post-op care for a laryngectomy
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.
What is some patient teaching pre and post operative for a laryngectomy
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
Who is a good resource for patient’s with trach’s
RT
Why is it important to keep a patient with a tracheotomy hydrated
Keep their secretions thin and prevent the formation of a mucus plug
What type of oxygen should be applied to these patient’s and why
Humidification air/O2, this will help keep the secretions thin and decrease the likelihood of a mucus plug forming
What are some other nursing interventions (Non-pharmacological) that can help a patient’s airway patency
Mobilizing or changing position to help move mucos and developing an infection
Suctioning to keep airways clear and patent
What is opti-flow
Warm and humidified O2 that can be applied to the trach mask
What can the nurse do with opti-flow
Change the sterile water bag
RT will set it up
What type of nutrition is commonly given to trach patient post-op
NG feeds
Can the nurse insert the NG
NO!
Must be done by the MD, usually during surgery or in radiology
Why do patient’s with trach’s have swallowing issues
Increased secretions
Esophageal/pharyngeal pressure from the trach
How long can patient’s be NPO for prior to needing alternative feeding
48 hours
What move are patient’s unable to do due to the trach
Valslva manoeuver- they cannot forcibly exhale while keep their mouth and nose closed (bearing down)
What are some things nurses can do to help patient with constipation
Mobilize ASAP
Keep them hydrated
Bulk forming foods, high fiber, laxatives and stool softeners
What is one of the biggest things patient suffer from with a trach
Anxiety
What are some ways nurses can decrease anxiety
Ensure the call bell is in reach Frequent checks Reassure client Communication board Have patient close to nursing desk so they can be monitored
What are some complications of a tracheostomy
Tracheal wall necrosis
Tracheal stenosis
Cuff pressure problems
What is a traceoespohageal fistual
A tracheoesophageal fistula (TEF) is a congenital or acquired communication between the trachea and esophagus
How does a patient acquire a TEF
Increased or to high of cuff pressure for a prolonged period of time
What are some tracheotomy complications
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
What is tracheomalacia
Weakness of floppiness of the walls of the trachea acquired due to chronic infection or prolonged intubation
What is needed to start weaning the patient off the trach
MD order
When the trach tube is plugged to assess the client’s ability to breath on their own
Corking
Can you cork a cuffed trach?
NO!
How long on average does the corking process take
2-5 days
What does the nurse need to do with a patient who is going through the corking process?
Constant client support
Monitor vitals and signs of distress
Respiratory status
In Island health who is in charge of the trialing of corking
The RT
If the client is in distress and is corked, what do you do?
Remove the cork right away and re-oxygenate patient
Check vital
Document
What kind of trach tubes are there
Metal, silicone, plastic (most common)
What is a cuffed trach
Air is inserted to the port via syrringe and inflates the cuff
What does a cuff trach do
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
What is an uncuffed trach
The ballon is deflated
What does an uncuffed trach do
Allows air to pass through the vocal cords
Patient’s cannot be ventilated with an uncuffed trach
What is an obturator
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
What is a single lumen trach
One hollow tube or cannula for both air flow and suctioning
When is a single lumen trach used
In neonates and pediatrics and are NOT cuffed
What is a double cannula trach
Has both a hollow outer cannula an inner cannula which is also hollow
What part of the double trach is removed and replaced with plastic cannula and cleaned with silicone and metal trach
the inner cannula
What does the outer cannula do
Keeps tracheal stoma open
When is the obturator used
When inserting the outer cannula
What is a fenestrated trach tube
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
Cuff up or down to speak with fenestrated trach? Cork or uncork?
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
When is a cuffed, fenestrated tube used
When patients are on the ventilator but are not able to tolerate a speaking valve to speak
What are some complications of a fenestrated trach
High risk of aspiration
Difficulty with ventilation
Granuloma formation at the site of the fenestration
What is some pre-operative teaching in regards to trach
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
What should you do when you reccieve a patient from PARR with a Tracheostomy
Have a patient near nursing station Contact RT Have suction ready at beside Trach cart ready Ensure oxygen and suction are working
What are some key items needed on the trach cart
Obturator, suction equipment, normal saline, sterile water, same size trach and one smaller, dilators, ampu bag with trach attachment
Identify eight assessments to complete for your patient who has a new tracheostomy
Patent Airway/Breathing Circulation Secretions Respiratory Assessment Positioning Pain Assessment Incision Site/Drsg Vital Signs/Sp02
What are some post-op nursing interventions
Encourage deep breathing and coughing Elevate the head of the bed. Suction via tracheostomy using sterile technique as needed. Provide tracheostomy care as needed.
How many nurses should be present for trach tie changes
2 RN’s (Blow me Camosun)
What are some complications related to trach ties
Too tight may occlude jugular venous drainage
Too loose trach tube shifts
Irritation, skin breakdown, dislodgement
How often should suction be done
Every 4 hours and PRN
What are some risk of suctioning a patient with trach
Increased secretions Hypoxia Dysrhythmias Bronchospasms Infection Atelectasis Mucous membrane trauma Decannulation
What is the most common cause of respiratory distress for patients with a trach
Mucus plugs
What can you do if you think your patient has a mucus plug
Encourage them to cough
Suction per policy
If patient goes into respiratory distress call RT stat
How much more likely is patient who is on a vent to develop pnemonia
6-21X higher
What do you do if the trach comes out?
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)What are some ways to prevent decannulation
Trach tie change - two person procedure
Ensure trach tube is secure
Be careful when suctioning client
What equipment should always be at the bedside
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
How long is trach care done sterile?
First 48 hours
After this time how is trach care done
As a clean/no touch
What mixture is used to clean the inner cannula
half saline half hydrogen peroxide
How often is the trach dressing change
Everyday and PRN
What type of gauze is placed under the trach
Pre-cut drain sponges
Why can you not cut your own gauze
Can leave behind gauze fragments and lead to infection
Why is tracheotomy care done
To prevent infection
Promote healing
Ensure client comfort
How fucking done are you with studying
110%
