Trach PPT #3

Question 1

TRACHEOSTOMY TUBES CAN DIFFER IN:

Answer 1

Size
Length
Angle
Metal

Cuffed or Uncuffed
Single or Double Cannula
Fenestrated

Question 2

Plastic and silicone tubes are increasingly popular because…

Answer 2

lightweight and there is less crusting of secretions.

Question 3

T/F a nurse can inflate the cuff on a trach

Answer 3

F - only the RT

Question 4

Hwo does the cuff inflation relate to the ability of the client to speak?

Answer 4

• 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).

Question 5

Purposes of cuffed trach?

Answer 5

Allows for mechanical ventilation

Protects airway (prevents aspiration)

Pressure placed on bleeding site post-operatively after neck or throat surgery

Question 6

T/F A patient can breathe while the obturator is in?

Answer 6

F

Question 7

Can a patient with a metal trach have an MRI?

Answer 7

No

Question 8

Uncuffed, single lumen tubes are usually for…

Answer 8

neonates, infants, and young children.

Question 9

Why is a fenestrated trach tube used?

Answer 9

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.

Question 10

T/F All feneestrated trachs are cuffless

Answer 10

Fenestrated trach tubes can have a cuff or be cuffless.

Question 11

How do you use a fenestrated trach?

Answer 11

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.

Question 12

What is there a risk for with fenestrated T tubes?

Answer 12

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.

Question 13

What pre-operative teaching will you do with the client who is undergoing a tracheostomy?

Answer 13

• 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.

Question 14

What is the safety equipment you need at the bedside for a trach?

Answer 14

suction equipment, ambu bag, trach of same size and one size smaller, obturator, dilators

Question 15

What do you need to do when recieving a pt from the ICU with a trach?

Answer 15

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.

Question 16

Identify eight assessments to complete for your patient who has a new tracheostomy.

Answer 16

Patent Airway/Breathing
  Circulation 
  Secretions
  Respiratory Assessment
  Positioning
  Pain Assessment
  Incision Site/Drsg
  Vital Signs/Sp02

Question 17

Post-operative nursing interventions

Answer 17

• 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.

Question 18

WHy do you elevate the HOB with post-op trach pt?

Answer 18

The upright position promotes effective ventilation of the lungs, and reduces edema and swelling of the neck.

Question 19

Purposes of trach care?

Answer 19

To prevent infection
To promote healing
Ensure client comfort

Question 20

Trach suctioning schedule at VIHA

Answer 20

. VIHA’s policy is to suction q4h and PRN.

Question 21

The risks of suctioning are:

Answer 21

Increased secretions
Hypoxia
Dysrhythmias
Bronchospasms
Infection
Atelectasis
Mucous membrane trauma
Decannulation

Question 22

What is the most common cause of resp distress for pts with trachs?

Answer 22

Mucus plugs

Question 23

What do you do if your pt has a mucus plug?

Answer 23

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.

Question 24

Is pneumonia common in trach pts?

Answer 24

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.

Question 25

How high is the risk of pneumonia for pts on a ventilator?

Answer 25

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.

Question 26

What to do if pt decannulation occurs?

Answer 26

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)