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254 > Trach Class > Flashcards

Trach Class Flashcards

1
Q

Tracheotomy?

A

A surgical incision in the trachea that forms a temporary or permanent opening called a tracheostomy

Normally done under general anaesthesia

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2
Q

Tracheostomy?

A

The opening made for the tube itself, the equipment and stoma

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3
Q

3 major indications for a tracheostomy tube?

A

Obstructed airway (upper)
-trauma, mechanical, tumour
Facilitate act of breathing
Remove secretions

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4
Q

Key factors to be considered in care if a trach patient?

A

Communication ability

O2 always humidified

Sunctioning

Mouth care

Mobilization/positioning

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5
Q

Why is O2 always humidified?

A

Keeps mucous membranes moist (cilia)

Still able to assist with removal of debris

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6
Q

Why do we suction for trach patient?

A

Keeps airway clean and maintain patency

Protect health of lungs

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7
Q

What safety equipment should always be present at bedside for trach pt?

A

Suction
Spare humidifier
2 spare trach insertion set -one the same size as current trach and the other one smaller
Oburator
Call bell
CPR mask/bag
Syringe if cuffed trach to increase or decrease balloon

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8
Q

What is obstruction of a trach tube usually caused by?

A

Secretions

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9
Q

What are some complications that might occur for patient with a trach?

A 
Obstruction
Abnormal bleeding 
Tube dislodgement 
Obstructed tube 
Subcu emphysema 
Tracheoesophageal fistula
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9
Q

What is a temporary trach used for?

A

Removal of secretions

Trach tube is inserted through the opening and bypasses normal airways to allow you to breathe and clear your secretions

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10
Q

Indications for trachs?

A 
Maintain patent airway
-by pass upper airway obstructions 
Facilitate the removal of secretions 
Decrease the work of breathing and increase volume entering the lungs 
Some cases of severe COPD 
Long-term ventilation
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11
Q

What level is incision for trach made?

A

Between 2&4 trachea cartilage

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12
Q

What would determine size of trach tube?

A

Anatomy of the client
Type of trauma
Site it’s going in at
Indications

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13
Q

Common sizes of trach tubes for gender?

A

Men: 8
Women: 6

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14
Q

Advantages to trachs?

A 
Life saving 
Comfort 
Decrease risk of long term  damage to airway
Manageable at home 
Allows mobility and eating
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15
Q

Potential complications of trach?

A 
Infection
Risk of bleeding 
Aspiration
Hypoxia 
Skin integrity 
Tube dislodgement 
Obstructed tube 
Subcu emphysema
16
Q

Normal vs tracheostomy breathing?

A

Normal: breathe through nose and mouth so that air is filtered, warm and humidified before it goes down trachea to lungs

Tracheostomy: air goes directly into trachea to lungs

  • air is not filtered, warm or humidified (increases mucous production)
  • suction important
17
Q

Outer cannula?

A

External tube that is inserted through the surgical opening

Provides artificial passage for breathing and may have a removable inner cannula

18
Q

Inner cannula?

A

Goes inside pt
Keeps trach patent
Only found in 2 piece set

19
Q

What is obturator?

A

Used to make tube more rigid on insertion

Plug

20
Q

What is the flange?

A

Hard plastic piece located at the top of the tracheostomy tube that lies against your neck

Identifies the size and make of tube

21
Q

What are fenestrated tracheostomies?

A

A specialized tube used for longer term trachs

Fenestrated refers to the holes in the outer, inner cannula or both that allows air to be directed past the vocal cords and through the mouth and nose
-allows speech

22
Q

Speech and trachs?

A

Before fenestrated tube is used, swallowing ability is determined
Re-taught how to speak
Re-directs air over vocal cords
Always assess for resp distress

23
Q

Cuffed tracheostomies?

A

The purpose of the cuff is to seal the airway so that all air flow goes though and not around the tube
-eliminates air flow through mouth and nose

Used in mechanical ventilation

24
Q

Non cuffed trach?

A

Allows air flow though the mouth, nose and trach

25
Q

Positioning of someone with a trach?

A

30 degrees

Laying flat increases stasis of secretions

26
Q

Essential bedside equipment for pt with a trach?

A 
Manual resuscitation device
Oxygen source
Suction source 
Trach care kit
Replacement inner cannula 
Sterile water humidifier 
Obturator 
10cc syringe for cuff
2 replacement tubes: one same size and one smaller
27
Q

What does tracheostomy care involve?

A

Suctioning the airway to remove secretions
Cleaning around the stoma
Inner cannula care
Monitoring cuff pressure

28
Q

Why suction trachea?

A

Mechanical removal of secretions from lungs so that airway passages remain patent

29
Q

When should you suction?

A

Patient unable to cough up secretions
Secretions are visible in tube
Suspected aspiration
You can hear a wheeze, bubbling or gurgling

*deep Suctioning is RN scope

30
Q

Lpn scope for trachs?

A

Providing care for well established trachs and whose condition is expected to follow anticipated path

Additional education can be done to provide trach care

31
Q

Trach dressing and stoma care?

A

Not changed for first 24hrs
Dictated by facility policy
Frequency depends upon condition of site
-lots of secretions increase amount of care

32
Q

Trach ties?

A

Hold tube in place
Changes routinely when they become soiled or damaged
Important to assess every time to ensure trach tube is secure

33
Q

Problems with cuffed tubes?

A 
Higher risk of aspiration 
High pressure:
-compress trachea capillaries 
-limit blood flow 
-predispose to trach necrosis
34
Q

Emergency care of trach tube?

A

Call RN stat
Lay patient flat
Cover stoma with non adherent dressing
May need to call code blue

35
Q

Nursing assessment of pt with trach?

A 
Resp distress?
Skin: pink, warm, D&I
Trach and ties insitu 
Tubes in and tubes out 
Lean pt forward to check for pressure
O2 insitu
Chest:inflation, auscultation
Stoma site and dressing
36
Q

Suction bag and tubing?

A

Change bag and tuning when >1000

Suction should be in the yellow
(100-120)

Test suction by occluding suction port before using

37
Q

What is considered an established trach?

A

3 months +

38
Q

Prior to suctioning what should you do?

A

Hyperoxygenate pt for 2min prior

Because it prevents reap distress

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