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NRSG 302 > Week 2 - Tracheostomy > Flashcards

Week 2 - Tracheostomy Flashcards

1
Q

What is in your upper airway?

A
  • nose
  • oral cavity
  • pharynx
  • larynx
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2
Q

what is the function of your upper airway?

A
  • heat/ cool inspired oxygen to body temp
  • filter
  • humidify
  • smell
  • phonation
  • passage for ventilation
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3
Q

What is included in your lower airway?

A
  • larynx
  • trachea
  • bronchi
  • bronchioles
  • alveoli
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4
Q

what is the function of your lower airway?

A

conducting airway fir ventilation gas exchange

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5
Q

what are the different types of artificial airways?

A
  • oropharyngeal
  • nasopharyngeal
  • endotracheal tube
  • naso-endotracheal tube
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6
Q

can an RN insert an endotracheal or naso-endotracheal tube?

A

no unless additional (rural) education

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7
Q

what do you need to do after an artificial airway is inserted?

A

verify placement

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8
Q

how do you verify a placement of an artificial airway is inserted?

A

assess bilateral breath sounds and auscultate over stomach

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9
Q

define tracheostomy

A
  • incision into the trachea
  • creates stoma or through with airway is managed
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10
Q

where is a surgical tracheostomy performed?

A
  • OR
  • sometimes pt beside in ICU
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11
Q

what is a percutaneous tracheostomy?

A

tube introduced with use of scope with light source via needle and guidewire technique

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12
Q

when is a cricothyroidotomy done?

A

only performed in emergency situations

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13
Q

out of the different types of tracheostomys which is not preferred due to proximity of the vocal cords?

A

cricothyroidotomy

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14
Q

what are the benefits of a tracheostomy tube vs. endotracheal tube?

A
  • lower risk of laryngeal/ oral injury
  • shorter ventilator weaning time
  • easier communication
  • more comfortable
  • easier to secure
  • easier to do mouth care
  • may start oral feeding sooner
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15
Q

What are the indications for a tracheostomy?

A
  • bypass airway obstruction at or above level of larynx
  • long term mechanical ventilation
  • facilitate removal of secretions
  • protect airway in pt at risk of aspiration
  • vocal cord paralysis
  • prevention of VAP
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16
Q

what does VAP stand for?

A

Ventilator Associated Pneumonia

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17
Q

what are the different complications of a tracheostomy?

A
  • abnormal bleeding
  • tube dislodgement
  • obstructed tube/ mucous plug
  • infection
  • subcutaneous emphysema
  • tracheostomy-esophagel fistula
  • tracheal stenosis
  • tracheal dilation
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18
Q

in regards to the different complications of a tracheostomy, what causes tube dislodgement?

A
  • to much suctioning
  • trach not tied in place properly
  • excessive manipulation
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19
Q

in regards to the different complications of a tracheostomy, what causes trachea-esophageal fistula?

A
  • to high cuff pressure
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20
Q

in regards to the different complications of a tracheostomy, what causes tracheal dilation?

A

long term use of cuffed trach

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21
Q

what is the purpose of the balloon on a cuffed trach?

A

isolate the lower airway from the upper airway

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22
Q

when a cuffed trach is placed with initial surgery what does it provide?

A
  • stable airway until trach is established
  • pt is weaned off ventilator and able to control secretions
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23
Q

why do most cuffed trachs have “barrel” shaped high volume low-pressure cuffs?

A

minimize pressure on the tracheal mucosa/ complications that occur with pressure necrosis

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24
Q

what does a cuffed trach help prevent?

A

apsiration

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25
Q

When is a cuff less trach used?

A
  • once patient can protect airway from aspiration
  • no longer requires mechanical ventilation (except for long term ventilated patients)
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26
Q

what can a cuff less trach allow the patient to do?

A

speak if enough air passes above the tracheostomy tube through the vocal cords

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27
Q

what can a cuff less trach facilitate ?

A

oral feeding when compared to cuffed tubes while still providing access for suctioning

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28
Q

what can a cuff less trach be?

A

plugged (corked) periodically if pt doesn’t require ventilation/ have upper airway obstruction

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29
Q

can a cuff less trach be used for long or short term ?

A

long term

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30
Q

if a cuffless trach is used long term what does this decrease the chance of?

A

less chance of causing trans-tracheal damage

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31
Q

what are the advantages of a cuff less trach?

A
  • more comfortable for pt
  • may facilitate speaking/ eating
  • progression towards decannnulation
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32
Q

what are the disadvantages of a cuff less trach?

A
  • doesn’t provide protection against aspiration
  • cannot provide adequate ventilation in code blue or with surgery
  • may dilute O2 received through trach mask or T piece
  • increases air leak
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33
Q

what are the different parts of a tracheostomy?

A
  • outer cannula
  • inner cannula
  • obturator
  • tracheal plug
  • flag/ face plate
  • pilot line/ cuff inflation line
  • pilot valve
  • pilot balloon
  • trach cuff
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34
Q

what is the purpose of the outer cannula for a tracheostomy?

A

maintains patency of stoma

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35
Q

what can the outer cannula be?

A

fenestrated

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36
Q

what is the purpose of the outer cannula being fenestrated?

A

allows air into larynx and facilitate speech

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37
Q

if the outer cannula is fenestrated what does the tracheostomy require in order to be suctioned?

A

requires non-fenestrated inner cannula

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38
Q

what is the definition of the inner cannula?

A

removable tube which secures inside the outer cannula

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39
Q

the inner cannula can be what?

A
  • disposable
  • reusable
  • high or low profile
  • fenestrated
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40
Q

what does the inner cannula provide for the tracheostomy?

A
  • protects patency of trach tube with proper cleaning
  • can be removed to restore patent airway
  • safety purposes
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41
Q

what is the purpose of the obturator?

A

reduce trauma during tracheostomy tube insertion

42
Q

describe an obturator

A
  • blunt tip
  • fits inside outer cannula
  • rounded tip
  • kept as part of emergency kit
43
Q

When is the obturator removed?

A

immediately after tracheostomy tube insertion

44
Q

what is the purpose of a tracheal plug?

A

occludes tracheostomy tube to redirect air around instead of through tracheostomy tube for weaning

45
Q

What are the different forms of a tracheal plug?

A
  • sealed inner cannula
  • cap
  • separate plug
46
Q

what is the purpose of a flange/ face plate?

A

stabilizes trach tube by preventing outer cannula from descending further into trach

47
Q

what does the flange/ face plate allow/ have?

A
  • place for ties/ sutures to attach
  • trach tubę specs written on it
  • may have locking indicator
48
Q

what do some flange/ face plates have?

A

adjustable flanges

49
Q

what is included in the trach tube specs?

A
  • tube code
  • type
  • size
50
Q

what is the purpose of the pilot line/ cuff inflation line?

A

connects pilot balloon to cuff

51
Q

what is the purpose of the pilot valve? What does it have?

A
  • spring loaded
  • keeps air from leaning out of balloon/ cuff
  • spring needs to be depressed in order to add/ remove air from cuff
52
Q

what is the purpose of the pilot balloon?

A
  • external balloon connect to cuff via pilot line
  • indicates whether cuff is inflated/ deflated
53
Q

where is the balloon located in a trach cuff?

A

at the distal end of the tube

54
Q

what does the trach cuff provide?

A
  • seal between tube and tracheal wall when inflated
  • protects against aspiration
55
Q

What is included in emergency airway equipement?

A
  • ambu bag
  • mask
  • oral airway
  • non-disposable inner cannula
  • if pt has cuffless, plugged tube in situ
56
Q

what is included in emergency airway supplies?

A
  • cuffed tracheostomy tube
  • trach dilator set
  • 10cc syringe
  • trach tubę exchanger
  • 1 pack water-soluble lube
  • obturator
57
Q

in the emergency trach airway supplies what size(s) are included for cuffed trach tubes?

A

same size and one size smaller

58
Q

if a pt is unstable and has to go to an appointment does the primary RN have to go with them?

A

yes, unless pt stable and doctor has ordered it’s okay not to go with them

59
Q

define atelectasis

A

complete or partial collapse of the entire lung or lobe of lung

60
Q

what is the purpose of suctioning?

A
  • maintain airway patency
  • promote optimal gas exchange
  • decrease chance of infection through retained secretions
61
Q

when should you suction a patients trach?

A

prn basis when indicated

62
Q

who can perform suctioning a trach?

A
  • RT
  • RN
63
Q

after a tracheostomy is surgically put in place, what must be at the pts bedside at all times?

A

emergency supply kit

64
Q

after a trach has been surgically inserted what must you monitor?

A

VS per hospital standards

65
Q

after a trach has been surgically inserted what must you assess?

A
  • sedative use
  • shock
  • hemorrhage
  • resp insufficiency
  • complications related to surgical/ medical condition
66
Q

what can sedative use cause?

A

respiratory depression

67
Q

what do you need to assess when looking at secretions?

A
  • amount
  • colour
  • consistency
68
Q

what should be applied to a fresh tracheostomy after surgery? why?

A
  • humidified air/ oxygen
  • loosens secretions/ prevent mucous plugging/ infection
69
Q

what must you maintain after a pt has a fresh tracheostomy surgically implanted? why?

A
  • hydration
  • help thin secretions
70
Q

why should you frequently change the pts position post trach insertion?

A
  • increase motility of secretions
  • prevent atelectasis
71
Q

will a pt be able to speak right after a trach is surgically implanted?

A

no

72
Q

what should be within easy reach of the pt post tracheostomy insertion? what should the pt be taught about this?

A
  • call bell > instruct pt how to pull bell out of wall if they can’t breath
  • writing board
  • pens/ paper
73
Q

why should you check the patency and cleanliness of the inner cannula regularly after a pt has a tracheostomy inserted

A

to avoid airway obstuctions

74
Q

how often should the inner cannula of a tracheostomy be changed/ cleaned after being surgically inserted? Who does this?

A
  • Q12H
  • may require more frequent checks with thick secretions
  • done by RT or RN
75
Q

what are some indications for suctioning a trach?

A
  • rattling/ gurgling resp sounds
  • ineffective cough
  • visible secretions
  • change in resp status
  • dyspnea/ restlessness
  • irregular breathing pattern
  • accessory muscle use
  • pale/ dusky color/ clammy
  • may be requested by pt, physio or swallowing assessments
76
Q

what are rattling, gurgling respiratory sounds indicative of?

A

secretions in or bellow the tracheostomy tube?

77
Q

what could cause an ineffective cough?

A
  • muscle weakness
  • decreased LOC
  • thick secretions
78
Q

if a pt is pale or dusky color and clammy and they have a trach what is this indicating?

A

poor perfusion/ oxygenation potentially due to decreased respiratory efficiency

79
Q

what is included in tracheostomy suction supplies?

A
  • suction source
  • container
  • suction tubing
  • non-sterile gloves
  • sterile gloves
  • sterile suction catheters
  • sterile disposable bowls for saline
  • normal saline/ sterile water
  • PPE
80
Q

what do you need to include in your documentation about sputum?

A
  • purulent
  • mucoid
  • bloody
  • frothy
  • amount
81
Q

when documenting about sputum what do you need to include about purulent?

A
  • consistent with infection
  • may be yellow, green, gown in color
82
Q

when documenting about sputum what could bloody sputum look like?

A
  • frank blood
  • serosanginous in appearance
83
Q

what does it mean if someone has frothy sputum what is this consistent with?

A

pulmonary edema and has pinkish tinge

84
Q

what are some possible complications of suctioning?

A
  • tracheal mucosal damage
  • hypoxia
  • dysrhythmia
  • lung collapse
  • infections
  • bronchospasm
  • low blood pressure
  • increased ICP pressure
  • intra abdominal pressure
  • intrathoracic pressure
85
Q

in regards to complications that occur with suctioning what causes tracheal mucosal damage?

A

vigorous deep and prolonged suctioning at excessive pressures

86
Q

in regards to complications that occur with suctioning what causes hypoxia?

A

secondary to oxygen desaturation

87
Q

in regards to complications that occur with suctioning what causes dysrhythmias?

A
  • lack of O2
  • stimulation of vagus nerve from tracheal irritation
88
Q

in regards to complications that occur with suctioning what causes lung collapse?

A

excessive suction pressure

89
Q

in regards to complications that occur with suctioning what causes infection

A

airway contamination

90
Q

in regards to complications that occur with suctioning what causes low blood pressure

A

vagal stimulation

91
Q

in regards to complications that occur with suctioning what causes increased ICP, intra abdominal and intrathoracic pressures?

A
  • generated with coughing
  • stimulation or instillation of saline
  • installation of topical anesthetic
92
Q

how do you provide care for a tracheostomy stoma?

A
  • keep tube free of secretions
  • keep stoma free of infection
  • check inner cannula patency with every dressing change prn
93
Q

how often do you need to change an inner cannula?

A

minimum Q24Hrs

94
Q

how often do you need to complete dressing changes and tracheostomy care?

A

at least twice daily (q12hr) and/ or prn

95
Q

how often do you need to change/ readjust trach ties?

A

when needed

96
Q

how can you secure tracheostomy tubes?

A

with sutures or ties

97
Q

when do you need to change or adjust tracheostomy ties? How tight should they be?

A
  • become to tight
  • become to loose
  • snug but not to tight allow 1 or 2 fingers to fit between the ties/ pt neck
98
Q

what do you need to always make sure of prior to letting go of the flange when changing ties for a trach?

A

new ties are secured prior to removing old ties

99
Q

why do you need to be aware of the location of the pilot balloon if present when securing a tracheostomy ?

A

to prevent inadvertent cutting of the line when cutting the ties

100
Q

how long can weaning a person off of a tracheostomy take?

A

anywhere from a few days to several months

101
Q

what is the ultimate goal of weaning weaning someone off of a tracheostomy?

A

decantation and their own airway maintenance

102
Q

when would a cuffed tracheostomy tube be used rather than an uncuffed?

A
  • aspiration risk
  • difficulty coughing independently
  • provides tight seal
  • use immediately after insertion of trach

NRSG 302 (8 decks)

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