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Nursing 306 > Trach Care > Flashcards

Trach Care Flashcards

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1
Q

How should one measure for sizing an oropharyngeal airway?

A

Measure (quick if an emergency) – base it also on age and size of person. Put flange parallel to teeth and the curved part next to the cheek – tip should be at the angle of the jaw.

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2
Q

What size of oropharyngeal airway do babies and small children use?

A

000 to 3

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3
Q

What size of oropharyngeal airway do bigger children normally wear?

A

3 to 4

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4
Q

What size of oropharyngeal airway do adults usually wear?

A

4 and over

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5
Q

Who should not have a nasopharyngeal airway inserted?

A

Patients with facial trauma.

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6
Q

What is the purpose of oral airway suctioning?

A

Removes secretions from the mouth (will also remove O2)

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7
Q

What is oropharyngeal suctioning?

A

Inserted through the mouth to the pharynx

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8
Q

What is nasopharyngeal suctioning?

A

Inserted via nares to pharynx.

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9
Q

What are some complications of airway suctioning?

A 
Complications – (negative aspects)
disruptive to mucous membranes
Damage mucous membranes
Uncomfortable
Bradycardia
Hypoxic patients can become tachycardic
Increased potential for infection
Laryngeal spasm
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10
Q

What are some anatomical features of the trachea?

A

The trachea is the first part of the airway not shared by GI tract
Trachea stretches between the larynx and the carina
In the average adult it is 10-12cm long and 2.5cm in diameter
The trachea is protected by 16-20 hyaline cartilage rings which help to maintain patency

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11
Q

How is the placement of a tracheostomy checked?

A

X-ray

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12
Q

Are tracheostomies temporary or permanent?

A

Can be temporary or permanent.

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13
Q

What is the purpose of a tracheostomy tube?

A

The tube keeps the stoma open. It shortens the length of the upper airway, and decreases the work of breathing for the patient.

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14
Q

What is a tracheostomy?

A

An artificial opening (or stoma) in the trachea

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15
Q

Where is a tracheostomy created?

A

Surgically created between 2nd and 3rd cartilaginous ring

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16
Q

What are some indications for tracheostomy?

A 
Upper airway obstruction
Upper airway bleeding
Trauma/burns
Prolonged artificial ventilation
Respiratory insufficiency
Inability to clear secretions effectively
Inability to protect own airway
17
Q

What are some complications of tracheostomy?

A 
Airway occlusion
Tissue damage (necrosis, ulceration)
Infection
Communication difficulties
Tube displacement/dislodgement
Bleeding
Tracheo-oesophageal fistula
Inability to maintain nutrition/hydration needs
Air leaks
Loss of normal airway function
Decreased sense of smell/taste
Decreased nutritional intake (as a result of decreased smell/taste)
18
Q

What are tracheostomy tubes made of?

A

Silicone.

19
Q

What are some variations in the designs of tracheostomy tubes?

A

Vary in length, size, composition and number of parts. Can also be cuffed or uncuffed, fenestrated or non fenestrated.

20
Q

What is the purpose of a fenestrated tracheostomy tube?

A

Fenestrated = has holes in it. Fenestrated ones allow air to go up and out of the airway, as well as breathe through the trach tube. This can help them to have a little bit of a voice.

21
Q

What is the purpose of a cuffed tracheostomy tube?

A

Cuff is to occlude the airway to reduce the risk of aspiration.

22
Q

What kind of patients would require a cuffed tracheostomy tube?

A

Patients on a ventilator.

23
Q

What are the three components of a tracheostomy tube?

A

Outer cannula (cuffed/uncuffed)
Inner cannula
Obturator

24
Q

What is an attachment for tracheostomy tubes that are optional?

A

May have speaking valves attached (these are expensive, $300-$400)

25
Q

What are some nursing implications for caring for patients with a trach tube?

A 
Preparation
Patient assessment
Patient education
Communication/body image
Procedures
Emergencies
Guidelines and documentation
26
Q

What should the nurse do to prepare for trach care?

A 
Equipment at bedside
Patient assessment
Procedures discussed with patient
Patient in correct position
2nd nurse identified to help (if necessary) with procedures
27
Q

What are some important aspects of patient assessment when performing trach care?

A 
Why does the patient have a tracheostomy?
How long have they had a tracheostomy?
Type/size of tube
Level of respiratory support needed
Respirations/breath sounds
Cuffed?/inflated?
Humidification method?
Suction required?/how often?
Thickness, colour, amount of sputum
Cleaning of inner tube?
Wound assessment/dressing changes
Can the patient swallow? Assessment done?
Weaning progress
When does the outer tube need changing?
What does the patient look like?
Patient education
Mouth care
28
Q

What are some important aspects f patient education for patients with tracheostomy?

A 
Explain all procedures
Pre-op education
Communication limitations/alternatives
Involve family
Utilize other experts as appropriate
29
Q

What is the reason that humidification is required for a patient with a tracheostomy tube?

A

Humidification occurs in the upper airway. When a tracheostomy is formed, the upper airway is bypassed. Humidification warms and moistens the air.

30
Q

What are some possible complications of humidification for a trach patient?

A

Potential for fluid build-up in corrugated tubing

Insufficient/excessive humidification

31
Q

How often should the inner cannula of a tracheostomy be changed?

A

Once per shift and PRN

32
Q

What are some dressing and cannula change basic principles?

A 
Preparation 
Asceptic/clean technique
Patient education
Wound assessment
Documentation
33
Q

Is a tracheosomy inner cannula change a clean procedure or a sterile procedure?

A

Clean

34
Q

What procedures regarding trach care need to be sterile?

A

Caring for a new tracheostomy (first 5-7 days)

Suctioning a tracheostomy

35
Q

What are some indications for suctioning tracheostomy?

A 
Visible or audible secretions
Suspected aspiration
Dropping peripheral O2 sats
Increased coughing
Reduced airflow
36
Q

What are some adverse affects of suctioning?

A

Hypoxia
Trauma
Infection
As necessary

37
Q

What are some measures the nurse can take in order to prevent hypoxia when suctioning a tracheostomy?

A

Might need to pre-oxygenate them a little bit. If they aren’t on continuous oxygen, we can get them to take some big deep breaths to get a bit more oxygen into them before they are suctioned. When we suction, three passes and then done. If you can’t get the secretions out with 3 passes, you need to wait a bit before trying it again. Should only have the suction in there for 10-15 seconds at a time.

38
Q

What are some measures the nurse can take in order to prevent trauma when suctioning a tracheostomy?

A
  • Apply suction on the way out, not the way in. As you introduce the suction catheter into the tube, they will start coughing. When they cough, pull it out a bit and then start the suction. If you suction on the way in, you can accidentally suction the mucous membranes and cause trauma to the tissues.
39
Q

What emergency equipment should you have available for a patient with a tracheostomy?

A

Suction machine (on the wall)
Suction catheters
If they have inline suction, make sure they have a spare one of those
If not in-line suction, make sure they have 2 or 3 extra
We need a whole tracheostomy unit that is the same size as the one the patient is wearing, as well as one that is one size smaller.
The oxygen on the wall should be working.
Make sure you have 2 or 3 spare inner cannulas.
We should have a dilator (these are foreceps that if you squeeze it, it opens). If it is a relatively new tracheostomy and the tube falls out, these will be necessary to keep it open. If it is well-established, we shouldn’t need these. But they are necessary to have in case of emergency.
Velcro
10mL syringe (to deflate the cuff in an emergency). If we don’t have one, make sure you have scissors and you can just cut it and the cuff will deflate.
Mask
Eye proception
Gloves
Bag

Nursing 306 (6 decks)

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