Trach PPT #3 Flashcards
TRACHEOSTOMY TUBES CAN DIFFER IN:
Size
Length
Angle
Metal
Cuffed or Uncuffed
Single or Double Cannula
Fenestrated
Plastic and silicone tubes are increasingly popular because…
lightweight and there is less crusting of secretions.
T/F a nurse can inflate the cuff on a trach
F - only the RT
Hwo does the cuff inflation relate to the ability of the client to speak?
- If the cuff is inflated (filled with air), it will prevent air from moving through the vocal cords. This will prevent noise or speech from forming.
- If the cuff is deflated, the air is able to move around the trach and through the patients vocal cords (thus patient can make sounds).
Purposes of cuffed trach?
Allows for mechanical ventilation
Protects airway (prevents aspiration)
Pressure placed on bleeding site post-operatively after neck or throat surgery
T/F A patient can breathe while the obturator is in?
F
Can a patient with a metal trach have an MRI?
No
Uncuffed, single lumen tubes are usually for…
neonates, infants, and young children.
Why is a fenestrated trach tube used?
holes allow air to pass through the vocal cords. This allows normal breathing and the ability to speak or cough through the mouth.
often used as the final step before trach tube removal.
T/F All feneestrated trachs are cuffless
Fenestrated trach tubes can have a cuff or be cuffless.
How do you use a fenestrated trach?
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.
What is there a risk for with fenestrated T tubes?
Note: there is a high risk for granuloma formation at the site of the fenestration (hole). There is a higher risk for aspirating secretions. With a fenestrated cuff trach it may be difficult to ventilate the patient adequately.
What pre-operative teaching will you do with the client who is undergoing a tracheostomy?
- find out what the patient knows about the surgery and fill in any gaps of knowledge.
- Inform the patient that she/he will not able to breathe through their nose after surgery
- Teach patient signs for communication and provide a pen & paper for patient after their surgery.
- Point out that surgery will affect the sense of taste and smell and eating in the initial postoperative period.
- If possible and desired by the client and family, arrange a visit by a post-laryngectomy client who effectively uses an alternate form of verbal communication.
What is the safety equipment you need at the bedside for a trach?
suction equipment, ambu bag, trach of same size and one size smaller, obturator, dilators
What do you need to do when recieving a pt from the ICU with a trach?
Safety equipment at bedside – trach cart set up
Have pt in a room near the nursing desk
Communication board
Contact RT
Also ensure tracheostomy cart is well stocked and oxygen source is available and oxygen is working.
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
Post-operative 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. - Instruct to support the head when moving in bed.
- Place the call light within easy reach at all times
- Encourage family members to remain present when possible.
- Spend as much time as possible with the client and have them in a room near the nursing desk.
WHy do you elevate the HOB with post-op trach pt?
The upright position promotes effective ventilation of the lungs, and reduces edema and swelling of the neck.
Purposes of trach care?
To prevent infection
To promote healing
Ensure client comfort
Trach suctioning schedule at VIHA
. VIHA’s policy is to suction q4h and PRN.
The risks of suctioning are:
Increased secretions Hypoxia Dysrhythmias Bronchospasms Infection Atelectasis Mucous membrane trauma Decannulation
What is the most common cause of resp distress for pts with trachs?
Mucus plugs
What do you do if your pt has a mucus plug?
If you think your patient has a mucous plug (due to increased respiratory distress) have the patient cough to attempt to remove the plug. If unsuccessful suction as per policy. If plug remains after suctioning has been attempted remove the inner cannula and immediately replace it with a new inner cannula. If patient is still in respiratory distress call RT stat.
Is pneumonia common in trach pts?
Patients who have tracheotomies develop pneumonia at a much higher rate than patients without a tracheostomy-whether or not they are eating or drinking.
Contamination of the respiratory system by oropharyngeal pathogens can occur when a patient aspirates food or liquid, saliva, or refluxed gastric contents, regardless of cuff inflation status.
How high is the risk of pneumonia for pts on a ventilator?
Patients who are on a ventilator are six to 21 times more likely to develop pneumonia than those who are not and their risk increases by about 1% each day that they stay on the ventilator
These statistics underscore the importance of the ultimate goal of weaning and decannulation.
What to do if pt decannulation occurs?
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)
