trach

Question 1

post op care trach

Answer 1

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

Question 2

tube dislodgement and accidental decannulation- first 72 hrs

Answer 2

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

Question 3

tube dislodgement and accidental decannulation- after 72 hrs

Answer 3

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

Question 4

tube obstruction- indicators-5

Answer 4

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

Question 5

pneumothorax

Answer 5

air in chest cavity- X ray chest

Question 6

subcutaneous emphysema

Answer 6

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

Question 7

bleeding

Answer 7

• constant oozing is abnormal

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

Question 8

infection

Answer 8

sterile technique

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

Question 9

tracheomalacia

Answer 9

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

Question 10

tracheomalacia prevention-2

Answer 10

1. use uncuffed tube asap

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

Question 11

tracheal stenosis

Answer 11

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

Question 12

tracheal stenosis manifestations-3 +mgt

Answer 12

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

Question 13

tracheal stenosis prevention-4

Answer 13

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

Question 14

tracheoesophageal fistula (TEF)

Answer 14

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

Question 15

tracheoesophageal fistula manifestations-4

Answer 15

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

Question 16

tracheoesophageal fistula (TEF) mgt-3

Answer 16

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

Question 17

tracheoesophageal fistula (TEF) prevention-3

Answer 17

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

Question 18

trachea-innominate artery fistula

Answer 18

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

Question 19

trachea-innominate artery fistula manifestations-3

Answer 19

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

Question 20

trachea-innominate artery fistula mgt-3

Answer 20

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

Question 21

trachea-innominate artery fistula prevention-3

Answer 21

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

Question 22

cuffed tubes

Answer 22

vented w no protection from aspiration

Question 23

noncuffed tube

Answer 23

not vented

Question 24

reusable inner cannula

Answer 24

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

Question 25

fenestrated tube-3

Answer 25

can open and close - do not cap if any problems present - may be cuffed or uncuffed

Question 26

preventing tissue damage-5

Answer 26

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

Question 27

ensuring air warming and humidification-4

Answer 27

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

Question 28

prevent infection-3

Answer 28

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

Question 29

weaning

Answer 29

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

Question 30

prevent aspiration-9

Answer 30

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

Question 31

tube obstruction-prevention-4*

Answer 31

- prevention- cough and deep breathe, inner cannula care, humidify O2, suctioning * HCP repositions or replaces tube

Question 32

tracheomalacia-indications-4, mgt

Answer 32

- 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