Trach from Class Powerpoints 1+2 Flashcards
Is a trach always permanent? how else cna it be used?
In an emergency
As a temporary measure
Permanently
Prophylactically
Indications for a Tracheostomy
1) Obstruction/edema
2) Respiratory nerve damage
3) To protect the airway from aspiration
4) As a route for suctioning
5) For long term mechanical ventilation
6) Post laryngectomy
Causes of obstruction in the upper airways are
foreign body, infection, laryngeal tumour, facial fractures.
Edema can be caused by
burns to face/chest, anaphylactic reaction.
Respiratory nerve damage:
What might be required if this is the cause of trach tube?
What sort of conditions?
Can be temporary or permanent causing paralysis of the chest muscles (that assist in breathing).
In this situation performing assisted or positive pressure respirations (with the use of mechanical ventilation) may be required in conditions such as:
· Unconsciousness associated with head injuries
· Barbiturate poisoning
· Myasthenia gravis
Myasthenia Gravis what is it?
Myasthenia Gravis is a type of autoimmune disorder. In people with myasthenia gravis, the body produces antibodies that block the muscle cells from receiving messages. This can include the lungs (patient stops breathing on their own).
Why is suctioning through a trach safer than via the nasopharyngeal route
Nasopharyngeal could lead to ++ mucosal damage.
For long term mech vent…Patients can be hooked up to a ventilator either via a tracheostomy tube or an endotracheal tube (ET tube- more on this to follow). WHy don’t you just keep an ET tube?
It is not recommended that a patient is on long term mechanical ventilation with an ET tube as the tube can cause mucosal damage including necrosis. If a patient requires mechanical ventilation an endotracheal tube may be inserted initially (as this tube insertion is less invasive). However, after some time has passed the physician needs to determine if the patient can be removed from the ventilator thus eliminating the need for the endotracheal tube. If it is determined that the patient still needs mechanical ventilation the insertion of a tracheostomy tube to replace the endotracheal tube will need to be considered.
ET vs Trach?
An endotracheal tube:
- Is easier and quicker to insert compared with tracheostomy
- Prevents aspiration of secretions
- Need to be sedated
- Weaning more difficult after long period of placement
- Tolerated well for short periods
- Need to warm and filter gases as bypass the nose which would normally provide this function
A tracheostomy tube:
- Reduces the need for sedation
- Reduced damage to glottis
- Reduced work of breathing (by reducing dead space)
- Reduced patient discomfort
- More invasive and complicated compared with endotracheal tube placement
- Causes scar formation
- Tracheostomy site can bleed or become infected
- May be associated with long-term complications e.g. swallowing difficulties.
Laryngectomy
What is it
Indications
How is trach used in this case?
Removal of larynx
Loss of voice box
cancer of the larynx, damage of the larynx due to trauma.
May only require trach tube for a short period of time to hold the stoma open
How long is usual hospital stay after laryngectomy?
When are drains removed? Stitches?
7-14days
*Drains will be removed in about five days. The stitches will be removed in about one week.
Laryngectomy
Post-op teaching + post-op care?
Post-op care:
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.
Promoting airway patency/humidification Nutrition Hydration Constipation Anxiety
Patient Teaching:
Use a call bell and message board to communicate.
Keep the head of your bed raised.
Move your legs while in bed to increase circulation.
Keeping water/foreign objects out of the stoma
Covering the stoma with a shower hood when showering
Suction secretions
You are receiving a patient who has a new tracheostomy from the PACU/ICU:
What will you do to ensure the patients room is ready prior to their arrival? What resource will you contact?
Preparing the room:
Safety equipment at bedside (demonstration of equipment will be in class)
Communication board
Resources:
Contact RT
You are receiving a patient who has a new tracheostomy from the PACU/ICU:
Name eight essential assessments to complete for this patient
….?
Promoting Airway Patency — what strategies can you use?
Hydration Humidification Mobilization/ position changes Hyperinflation (“artificial sigh”) Suctioning
Use sedation and narcotic analgesic cautiously
WHY:
Hydration
Humidification
Mobilization
Humidification and hydration help to prevent development of mucous plugs
Mobilizing or changing positions will reduce the chances of developing pneumonia, atelectasis, mucous plugs.
What is hyperinflation?
is when the respiratory therapist attaches the patient’s tracheostomy to an ambu bag and air is inflated/inserted into the patient’s lungs. Hyperinflating the lungs are similar to us having a big sigh (which in essence is taking a deep breath). Hyperinflation is used to help prevent atelectasis. This is done by respiratory therapy only or by nurses with special training.
T/F A Trach tube increases the risk of a mucus plug forming
Tracheostomy tubes increase the likelihood of mucus plug formation.
Tracheostomy tubes often stimulate increased secretion production. A trach also bypasses the natural defense systems that filter and humidify the upper airway.
In addition, lack of airflow over the larynx can lead to reduced sensation in that area and decreased reflexes to cough or clear the throat.
What is Optiflow?
Who sets it up/adjusts it?
What is the role of the nurse?
High Flow O2 Delivery with Heated Humidity
Using Optiflow for trached patients is now more commonly used than the trach masks and high flow oxygen deliver system seen in the previous slide.
The respiratory therapists will come to the unit to set them up when a trached patient is admitted to the unit. Unless a nurse has had specialized training on how to adjust the settings, the RT will be doing this.
Nurses change the bags of sterile water (the look like IV bags but are not for IV administration) as needed to maintain humidification.
What is the diet order typically for a patient after trach insertion?
Most physicians order for their patients to be NPO immediately post trach insertion due to swallowing problems that can occur in tracheostomy patients.
