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Trach Flashcards

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1
Q

What is a Tracheostomy

A

an incision in the trachea made to relieve an obstruction to breathing.

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2
Q

When would someone need a tracheostomy

A 
To bypass an obstructed airway
Cancerous tumors
Vocal cord paralysis
Congenital abnormalities of the airway
Severe head or neck injuries/surgery
Airway burns from inhalation of corrosive material, smoke or steam
Respiratory nerve damage
Protect the airway from aspiration (Patient unable to clear own secretions)
Prolonged intubation
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3
Q

When can a tracheostomy be used

A

In an emergency
As a temporary measure
Permanently
Prophylactic (Prior to a large head and neck surgery or laryngectomy)

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4
Q

What are some differences between a Endotracheal tube (ET tube) and a trach

A

ET tube is…
Easier and quicker to insert
Prevents aspiration and secretions
Tolerated for short time
Need to be sedated and weaning is diffcult if left for a long periord
Trach
Reduces the need for sedaion
Reduces damage to glottis
Trach site can bleed or lead to infection
Causes scar formation
More invasive and complicated compared to ET tube

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5
Q

What is a Larynegectomy

A

It is the removal of the larynx and loss of voice box

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6
Q

Why would a patient have a larynegectomy

A

cancer of the larynx, damage of the larynx due to trauma

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7
Q

What is the post-op care for a laryngectomy

A

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.

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8
Q

What is some patient teaching pre and post operative for a laryngectomy

A

Use of call bell and message board to communicate
Keep HOB elevated
Suctioning secretions
Need of NG feeds until feeding is established
Keeping stoma clean and dry

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9
Q

Who is a good resource for patient’s with trach’s

A

RT

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10
Q

Why is it important to keep a patient with a tracheotomy hydrated

A

Keep their secretions thin and prevent the formation of a mucus plug

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11
Q

What type of oxygen should be applied to these patient’s and why

A

Humidification air/O2, this will help keep the secretions thin and decrease the likelihood of a mucus plug forming

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12
Q

What are some other nursing interventions (Non-pharmacological) that can help a patient’s airway patency

A

Mobilizing or changing position to help move mucos and developing an infection
Suctioning to keep airways clear and patent

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13
Q

What is opti-flow

A

Warm and humidified O2 that can be applied to the trach mask

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14
Q

What can the nurse do with opti-flow

A

Change the sterile water bag

RT will set it up

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15
Q

What type of nutrition is commonly given to trach patient post-op

A

NG feeds

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16
Q

Can the nurse insert the NG

A

NO!

Must be done by the MD, usually during surgery or in radiology

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17
Q

Why do patient’s with trach’s have swallowing issues

A

Increased secretions

Esophageal/pharyngeal pressure from the trach

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18
Q

How long can patient’s be NPO for prior to needing alternative feeding

A

48 hours

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19
Q

What move are patient’s unable to do due to the trach

A

Valslva manoeuver- they cannot forcibly exhale while keep their mouth and nose closed (bearing down)

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20
Q

What are some things nurses can do to help patient with constipation

A

Mobilize ASAP
Keep them hydrated
Bulk forming foods, high fiber, laxatives and stool softeners

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21
Q

What is one of the biggest things patient suffer from with a trach

A

Anxiety

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22
Q

What are some ways nurses can decrease anxiety

A 
Ensure the call bell is in reach
Frequent checks
Reassure client
Communication board
Have patient close to nursing desk so they can be monitored
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23
Q

What are some complications of a tracheostomy

A

Tracheal wall necrosis
Tracheal stenosis
Cuff pressure problems

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24
Q

What is a traceoespohageal fistual

A

A tracheoesophageal fistula (TEF) is a congenital or acquired communication between the trachea and esophagus

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25
How does a patient acquire a TEF
Increased or to high of cuff pressure for a prolonged period of time
26
What are some tracheotomy complications
Misalignment- when the tracheotomy tube is not inserted correctly Herniated cuff- putting too much air in the trach cuff can cause it to bulge, which can result in an obstruction in the trachea Decannulation-Planned or accidental removal Infection-Due to improper care
27
What is tracheomalacia
Weakness of floppiness of the walls of the trachea acquired due to chronic infection or prolonged intubation
28
What is needed to start weaning the patient off the trach
MD order
29
When the trach tube is plugged to assess the client's ability to breath on their own
Corking
30
Can you cork a cuffed trach?
NO!
31
How long on average does the corking process take
2-5 days
32
What does the nurse need to do with a patient who is going through the corking process?
Constant client support Monitor vitals and signs of distress Respiratory status
33
In Island health who is in charge of the trialing of corking
The RT
34
If the client is in distress and is corked, what do you do?
Remove the cork right away and re-oxygenate patient Check vital Document
35
What kind of trach tubes are there
Metal, silicone, plastic (most common)
36
What is a cuffed trach
Air is inserted to the port via syrringe and inflates the cuff
37
What does a cuff trach do
Prevents air moving through the vocal cord, Allows for mechanical ventilation Protects airway Pressure placed on bleeding site post-operatively after neck or throat surgery
38
What is an uncuffed trach
The ballon is deflated
39
What does an uncuffed trach do
Allows air to pass through the vocal cords | Patient's cannot be ventilated with an uncuffed trach
40
What is an obturator
The obturator is used to help make insertion of the trach tube easier. The obturator has a round tip that sticks out of the end of the outer cannula. This protects the trachea from any damage as the trach tube is inserted into the airway. This must be removed as soon as the trach tube is inserted as it occludes the airway while in place
41
What is a single lumen trach
One hollow tube or cannula for both air flow and suctioning
42
When is a single lumen trach used
In neonates and pediatrics and are NOT cuffed
43
What is a double cannula trach
Has both a hollow outer cannula an inner cannula which is also hollow
44
What part of the double trach is removed and replaced with plastic cannula and cleaned with silicone and metal trach
the inner cannula
45
What does the outer cannula do
Keeps tracheal stoma open
46
When is the obturator used
When inserting the outer cannula
47
What is a fenestrated trach tube
It has hole/holes built into it to allow air to pass through the vocal cords This allows normal breathing and the ability to speak or cough through their mouth
48
Cuff up or down to speak with fenestrated trach? Cork or uncork?
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
49
When is a cuffed, fenestrated tube used
When patients are on the ventilator but are not able to tolerate a speaking valve to speak
50
What are some complications of a fenestrated trach
High risk of aspiration Difficulty with ventilation Granuloma formation at the site of the fenestration
51
What is some pre-operative teaching in regards to trach
Ensure the patient has spoken with the surgeon Informed Constant is obtained Point out the effect of the surgery or taste and breathing Enourage patient to speak with family Teaching regarding the feeling of breathing through a straw Getting use to communcating with pencil/pen and whiteboard Discuss body image
52
What should you do when you reccieve a patient from PARR with a Tracheostomy
``` Have a patient near nursing station Contact RT Have suction ready at beside Trach cart ready Ensure oxygen and suction are working ```
53
What are some key items needed on the trach cart
Obturator, suction equipment, normal saline, sterile water, same size trach and one smaller, dilators, ampu bag with trach attachment
54
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 ```
55
What are some post-op 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. ```
56
How many nurses should be present for trach tie changes
2 RN's (Blow me Camosun)
57
What are some complications related to trach ties
Too tight may occlude jugular venous drainage Too loose trach tube shifts Irritation, skin breakdown, dislodgement
58
How often should suction be done
Every 4 hours and PRN
59
What are some risk of suctioning a patient with trach
``` Increased secretions Hypoxia Dysrhythmias Bronchospasms Infection Atelectasis Mucous membrane trauma Decannulation ```
60
What is the most common cause of respiratory distress for patients with a trach
Mucus plugs
61
What can you do if you think your patient has a mucus plug
Encourage them to cough Suction per policy If patient goes into respiratory distress call RT stat
62
How much more likely is patient who is on a vent to develop pnemonia
6-21X higher
63
What do you do if the trach comes out?
``` 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) ```
64
What are some ways to prevent decannulation
Trach tie change - two person procedure Ensure trach tube is secure Be careful when suctioning client
65
What equipment should always be at the bedside
Tracheostomy Tube Tube and obturator same size as patient has in place Tube and obturator one size smaller Obturator and Tracheal Spreaders/ Dilators on trach cart Trach Cart Stocked
66
How long is trach care done sterile?
First 48 hours
67
After this time how is trach care done
As a clean/no touch
68
What mixture is used to clean the inner cannula
half saline half hydrogen peroxide
69
How often is the trach dressing change
Everyday and PRN
70
What type of gauze is placed under the trach
Pre-cut drain sponges
71
Why can you not cut your own gauze
Can leave behind gauze fragments and lead to infection
72
Why is tracheotomy care done
To prevent infection Promote healing Ensure client comfort
73
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N342 (3 decks)

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