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Adult 2 > trach > Flashcards

trach Flashcards

1
Q

post op care trach

A

ensure patent airway, confirm bilateral breath sounds, resp assessment hourly, assess for complications

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2
Q

tube dislodgement and accidental decannulation- first 72 hrs

A

emenrgency first 72 hrs, vent w manual resuscitation rapid response, keep tube of same type and size at bedside

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3
Q

tube dislodgement and accidental decannulation- after 72 hrs

A

open stoma and replace tube, then remove obturator, check for airflow through tube and bilateral breath sounds

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4
Q

tube obstruction- indicators-5

A

secretions or cuff displacement-
indicators- difficulty breathing, noisy resp, difficulty inserting suction catheter, thick/dry secretions, unexplained peak pressures

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5
Q

pneumothorax

A

air in chest cavity- X ray chest

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6
Q

subcutaneous emphysema

A
  • opening or tear in trach and air escapes into neck tissue
  • inspect and palpate for air under skin
  • notify HCP immediately
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7
Q

bleeding

A
  • constant oozing is abnormal

- wrap gauze around tube and pack gauze gently into wound to apply pressure

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8
Q

infection

A

sterile technique

  • assess stoma q 8 hrs for purulent drainage/ redness/ pain/ swelling
  • do not cut dressings, change often
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9
Q

tracheomalacia

A

constant pressure exerted by the cuff causes tracheal dilation and erosion of the cartilage

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10
Q

tracheomalacia prevention-2

A
  1. use uncuffed tube asap

2. monitor cuff pressure and air vol closely and detect changes

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11
Q

tracheal stenosis

A

narrowed trachael lumen is due to scar formation from irritation of trachael mucosa by the cuff

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12
Q

tracheal stenosis manifestations-3 +mgt

A
  1. usually seen after cuff deflated or trach removed
  2. increased coughing w inability to expectorate secretions
  3. difficulty breathing or talking
    mgt- trach dilation or surgical intervention
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13
Q

tracheal stenosis prevention-4

A
  1. prevent pulling/traction on tube
  2. properly secure in middle position
  3. maintain proper cuff pressure
  4. minimize oronasal intubation time
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14
Q

tracheoesophageal fistula (TEF)

A

excessive cuff pressure causes erosion of the post wall- a hole is created between trachea and anterior esophagus
- pt at highest risk also has NG tube

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15
Q

tracheoesophageal fistula manifestations-4

A
  1. food in secretions
  2. increase air needed for seal
  3. increase choking and coughing while eating
  4. does not receive set tidal vol on vent
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16
Q

tracheoesophageal fistula (TEF) mgt-3

A
  1. manually administer O2 by mask
  2. use small soft feeding tube instead of NG tube
  3. mon pt w ng tube closely-assess for TEF and aspiration
17
Q

tracheoesophageal fistula (TEF) prevention-3

A
  1. maintain cuff pressure
  2. mon amt of air needed for inflation for changes
  3. progress to deflated cuff or cuffless tube asap
18
Q

trachea-innominate artery fistula

A

a malpositioned tube casues distal tip to push against the lateral wall, cont pressure causes necrosis and erosion of the innominate artery
*emergency

19
Q

trachea-innominate artery fistula manifestations-3

A
  1. trach tube pulsates in synch w heart beat
  2. heavy bleeding from stoma
  3. life-threatening
20
Q

trachea-innominate artery fistula mgt-3

A
  1. remove trach tube immediately
  2. apply direct pressure to innominate art at stoma site
  3. prepare for emergent surgery
21
Q

trachea-innominate artery fistula prevention-3

A
  1. correct tube size, length, and midline position
  2. prevent pulling or tugging on tube
  3. immediately notify HCP
22
Q

cuffed tubes

A

vented w no protection from aspiration

23
Q

noncuffed tube

A

not vented

24
Q

reusable inner cannula

A

inspect/suction/clean as often as needed in first 24 hrs

25
Q

fenestrated tube-3

A

can open and close

  • do not cap if any problems present
  • may be cuffed or uncuffed
26
Q

preventing tissue damage-5

A
  1. always deflate cuff before capping
  2. keep pressure between 14-20 mmHg or 20-30 cm H2O-check at least 1 q shift
  3. use least amt of pressure to form seal
  4. maintain proper pressure/stabilize tube
  5. prevent malnutrition/dehydration/ and hypoxia
27
Q

ensuring air warming and humidification-4

A
  1. humidify as prescribed
  2. assess for fine mist
  3. increase flow rate at the floemeter to increase humidity
  4. keep temp between 98.6-100.4
28
Q

prevent infection-3

A

sterile technique, suction mouth/nose after trach, never use oral suctioning equipment for suctioning art airway

29
Q

weaning

A

cuff deflated after pt can manage secretions and does not need vent- changed to uncuffed tube- size gradually decreased- can be removed after 24 hrs of capping

30
Q

prevent aspiration-9

A

not when fatigued, thick liquids, avoid fruit, position as upright as possible, deflate tube, suction after deflation and before meal, dry swallow, spoon liquids

31
Q

tube obstruction-prevention-4*

A
  • prevention- cough and deep breathe, inner cannula care, humidify O2, suctioning
  • HCP repositions or replaces tube
32
Q

tracheomalacia-indications-4, mgt

A
  • indications- increase air needed for seal, larger tube needed to prevent leak, food in secretions, pt does not receive set tidal vol.
  • mgt- nothing unless bleeding

Adult 2 (13 decks)

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