Tracheostomy

Question 1

What is a tracheotomy?

Answer 1

Surgical opening in 2nd and 3rd tracheal rings

Question 2

Pediatric patients have a _____ lumen. Adult patients have a ______ lumen.

Answer 2

Single. Double.

Question 3

What is the purpose of a cuffed trach?

Answer 3

Allows for mechanical ventilation and protects airway because there is no movement past the cuff.

Question 4

Indications for trachs?

Answer 4

Obstruction, edema, suctioning route, long-term mechanical ventilation, respiratory nerve damage

Question 5

What is our post-op care for tracheas?

Answer 5

Promote patency and humidification. Patient will be on optiflow or humidified oxygen system.

Question 6

How tight are the trach ties around a peds neck? Adult neck?

Answer 6

1 finger. 2 fingers.

Question 7

What position should someone with a trach be in?

Answer 7

Semi-fowlers.

Question 8

Do all patients need hyperoxygenation before suctioning? For how long?

Answer 8

Yes. 30-60 seconds.

Question 9

How do we know when patients need suctioning?

Answer 9

Coughing, gurgling noises, PRN suction orders, SpO2 is low.

Question 10

For how long do we need to do sterile technique with suctioning/cleaning of trach?

Answer 10

48 hours

Question 11

How long is each pass of suctioning trachs?

Answer 11

10 seconds

Question 12

How many times can we use the same suction catheter without having to get a new one?

Answer 12

3 times

Question 13

How long are we allowing our patients to rest between suctions? What should we do during these rest periods?

Answer 13

60 seconds. Apply trach cuff.

Question 14

Why is it important to assess a patient’s hydration status?

Answer 14

Less hydrated = stickier secretions.

Question 15

Patient’s are unable to do what in regards to elimination? What do we do about this?

Answer 15

Bear down. Stool softeners, mobilize, hydrate.

Question 16

Why do we use narcotics cautiously with trach patients?

Answer 16

Resp. depression and constipation.

Question 17

How often are we monitoring the cuff pressure? What can excessive cuff pressure lead to?

Answer 17

q 8 hr. Tissue necrosis.

Question 18

Granulation tissue can form on the vocal cords, epiglottis, or trachea due to improper inflation of the trachea cuff?

Answer 18

True

Question 19

What do we do in the event of accidental removal of trachea tube? If you can’t get new trachea?

Answer 19

Dilators, new trach with obturator and then put in new cannula. Call code and get RT there STAT.

Question 20

What emergency equipment do we need on our trachea carts?

Answer 20

Dilator, 2 spare trachs (one smaller), BVM, suction ON/oxygen ON, green adaptor nipple (what you plug oxygen into), obturator

Question 21

What are risks of trachea suctioning?

Answer 21

Hypoxia, cardiac dysrhythmias, laryngealspasm, and bradycardia (due to stimulation of vagus).

Question 22

Why are people with tracheostomy tubes more susceptible to infection?

Answer 22

Warming and filtering action of nose and pharynx are bypassed.

Question 23

What are assessments that need to be done on a patient with a newly established tracheostomy?

Answer 23

Respiratory, VS (espeically SpO2), the trachea itself, peristomal skin, hydration status, safety equipment/emergency cart, anxiety, pain, communication.

Question 24

What are important post-op nursing interventions for someone with a newly established trach?

Answer 24

Deep breathing/coughing, suctioning PRN, cleaning PRN, HOB elevated, encourage family to stay with patient/you stay with patient as much as possible.