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Med Surg1 Exam 3 > Tracheostomy Care > Flashcards

Tracheostomy Care Flashcards

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1
Q

What is the primary purpose of tracheostomy care?

A

To maintain a patent airway, keep the tracheostomy tube free of secretions, and provide wound care for the tracheal stoma

Tracheostomy care is also aimed at helping maintain gas exchange.

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2
Q

How often is tracheostomy care typically performed?

A

Usually every 8 hours and as needed; newly inserted tracheostomy may need attention every 1 to 2 hours

Inner cannula care should occur at least once per 8 hours and more frequently if needed.

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3
Q

What assessments must a nurse perform before tracheostomy care?

A

Assess:
* Quality, pattern, and rate of breathing
* Presence of cyanosis
* Oxygen saturation
* Lung auscultation for breath sounds
* Tracheostomy site for secretions
* Skin integrity around the tracheostomy
* Space between outer cannula and tissue
* Cuff pressure if applicable
* Need for suctioning
* Patient’s pain level

These assessments help determine the patient’s immediate needs.

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4
Q

What technique is followed for tracheostomy care in a hospital setting?

A

Sterile technique

Clean technique is used in home settings.

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5
Q

List the first three steps in the tracheostomy care procedure.

A
  1. Assess the need for care and patient status
  2. Gather necessary equipment
  3. Ensure emergency equipment is readily available

Emergency equipment includes spare tubes, obturator, manual bag, and oxygen.

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6
Q

True or False: Suctioning is performed before cleaning the inner cannula.

A

True

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7
Q

What should be used to clean the stoma site and tracheostomy plate?

A

Cleaning solutions like half-strength hydrogen peroxide followed by sterile saline

Care must be taken to avoid getting solutions into the tracheostomy.

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8
Q

What types of dressings should be used for tracheostomy care?

A

Commercially prepared or prefolded gauze without cotton filling, hydrocolloid, or polyurethane foam dressings

These help prevent aspiration of fibers and reduce pressure injury risk.

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9
Q

Fill in the blank: Cuff pressure should be maintained between _______ to prevent tracheal injury.

A

20 and 30 cm H2O

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10
Q

What is a crucial step to prevent accidental decannulation during tracheostomy care?

A

Having a second person to hold the tracheostomy tube securely while changing ties or holders

This is particularly critical in the first 72 hours post-insertion.

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11
Q

What should be monitored for signs of subcutaneous emphysema?

A

Puffiness and crackling around the stoma

This indicates air collecting under the skin and should be reported immediately.

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12
Q

True or False: Routine tracheostomy care can be delegated to assistive personnel.

A

False

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13
Q

What is an important aspect of patient and caregiver education for tracheostomy care?

A

Teaching self-care techniques, signs of infection, airway care, and communication strategies

Patients should also learn to use a mirror for self-care and maintain home humidity.

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14
Q

What is the first step in the procedure for nasopharyngeal or nasotracheal suctioning?

A

Gather equipment as needed

This includes ensuring all necessary tools and materials are ready for the procedure.

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15
Q

What must be verified before proceeding with suctioning?

A

Verify client identification

This step is crucial to ensure the right patient is being treated.

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16
Q

What should be assessed regarding the client before suctioning?

A

Determine whether the client has allergies or any contraindications to the procedure

Identifying allergies or contraindications helps to prevent adverse reactions.

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17
Q

What position should the client be placed in for suctioning?

A

Semi-Fowler’s position

This position helps facilitate better airway access and comfort.

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18
Q

At what suction setting should the suction device be turned on?

A

100 to 150 mm Hg

This range is typically effective for safely clearing the airway.

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19
Q

What should be done to prevent transmission of microorganisms during the procedure?

A

Place drape over the client’s chest

This helps to maintain a sterile environment during the procedure.

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20
Q

What is the purpose of hyperoxygenating the client?

A

To increase oxygen to 100% or ask the client to deep breathe

This is done to ensure adequate oxygenation before suctioning.

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21
Q

What solution is used to rinse the catheter and tubing?

A

Sterile 0.9% sodium chloride

This saline solution is used for rinsing to maintain sterility.

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22
Q

How long should suction be applied during the procedure?

A

10 to 15 seconds

This duration helps prevent trauma to the airway while effectively clearing secretions.

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23
Q

What should be done if there is a need to repeat suctioning?

A

Wait at least 20 seconds before suctioning again

This allows the client to recover and prevents damage to the airway.

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24
Q

What is the next step after suctioning is complete?

A

Disconnect the suction catheter from the tubing

Proper disconnection ensures safety and cleanliness post-procedure.

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25
What should be done with gloves, PPE, and the suction catheter after the procedure?
Remove and dispose of them ## Footnote This is essential for infection control and maintaining a safe environment.
26
What should be ensured about the client before leaving the room?
The client is in a safe position and has the call light within reach ## Footnote This ensures the client's safety and ability to call for help if needed.
27
Fill in the blank: During nasopharyngeal suctioning, the catheter is inserted into the client’s naris as the client takes a _______.
breath ## Footnote This technique helps facilitate easier insertion of the catheter.
28
True or False: Suctioning and catheter removal should last longer than 15 seconds.
False ## Footnote The duration should not exceed 10 to 15 seconds to avoid complications.
29
What is the first step in performing tracheostomy care?
Gather equipment ## Footnote This includes ensuring all necessary tools and materials are ready before starting the procedure.
30
What should be verified before proceeding with tracheostomy care?
Client identification ## Footnote It is crucial to confirm the identity of the client to prevent errors.
31
What is an important consideration regarding allergies before the procedure?
Determine whether the client has allergies or any contraindications to the procedure ## Footnote This helps prevent adverse reactions during care.
32
What should be done to ensure client comfort during the procedure?
Provide client education ## Footnote Educating the client about the procedure can help ease anxiety and ensure cooperation.
33
What is the importance of hand hygiene in tracheostomy care?
To prevent infection ## Footnote Proper hand hygiene is critical in maintaining a sterile environment.
34
What position should the client be assisted into for tracheostomy care?
Supine or semi-Fowler’s position ## Footnote This position can facilitate easier access to the tracheostomy site.
35
What should be placed across the client’s chest during tracheostomy care?
A liquid-absorbing towel ## Footnote This helps prevent contamination of the client's linen and bedding.
36
How long should the client be hyperoxygenated before the procedure?
At least 30 seconds or by taking five to six deep breaths ## Footnote This ensures adequate oxygenation before the procedure begins.
37
What is the purpose of using 0.9% sodium chloride during the procedure?
For cleaning and rinsing the inner cannula ## Footnote Sodium chloride helps maintain a sterile environment and aids in cleaning.
38
When cleaning the nondisposable inner cannula, what should be done after removing it?
Drop it into the 0.9% sodium chloride basin ## Footnote This prevents contamination and allows for proper cleaning.
39
What should be done with the old inner cannula when using a disposable cannula?
Dispose of it in its appropriate receptacle ## Footnote Proper disposal is essential for infection control.
40
What is the correct method for cleansing the stoma site?
Cleanse from the nearest point to the stoma outward ## Footnote This technique minimizes the risk of introducing bacteria into the stoma.
41
What should be done with the tracheostomy ties if an assistant is available?
Instruct the assistant to hold the tracheostomy tube in place while cutting the old ties ## Footnote This ensures the tube remains secure during the change.
42
How should the ends of the tracheostomy ties be secured?
In a double knot leaving enough space for one or two fingers ## Footnote This allows for proper fitting and comfort for the client.
43
What should be done if an assistant is not available during the tie change?
Do not remove the old ties until the new ties are in place ## Footnote This prevents accidental dislodgment of the tracheostomy tube.
44
What should be checked before leaving the room after the procedure?
Ensure the client is in a safe position and has the call light within reach ## Footnote This is important for the client's safety and ability to call for assistance.
45
What is the first step in performing tracheostomy or endotracheal suctioning?
Adjust bed height and position client in semi- or high Fowler’s. ## Footnote Fowler's position aids in respiratory function and comfort.
46
What should be placed across the client’s chest during the procedure?
A towel or drape. ## Footnote This helps to maintain cleanliness and absorb any secretions.
47
What technique should be used to open the closed-suction catheter package?
Aseptic technique. ## Footnote Aseptic technique is critical to prevent infection.
48
What should be connected to the ventilator circuit after opening the closed-suction catheter package?
Suction catheter. ## Footnote This allows for effective suctioning during the procedure.
49
What should be done after connecting the suction catheter to the endotracheal or tracheostomy tube?
Connect the Y on the mechanical ventilator circuit to the closed-suction catheter with flex tubing. ## Footnote Proper connection is essential for maintaining ventilation.
50
Where should one end of the connecting tubing be attached during the suctioning process?
To the suction machine. ## Footnote The other end connects to the closed system or in-line suction catheter.
51
What should the vacuum regulator be set to when turning on the suction device?
Its appropriate setting. ## Footnote This setting varies based on patient needs and institutional protocols.
52
What is the purpose of hyperoxygenating the client before suctioning?
To ensure adequate oxygenation during the procedure. ## Footnote This can be done using a bag-valve mask or adjusting the ventilator settings.
53
What should be done with the saline port before suctioning?
Unlock the suction control mechanism and open the saline port. ## Footnote This prepares the catheter for rinsing post-suctioning.
54
What action should be taken as the client inhales during suctioning?
Insert the catheter until resistance is felt or the client coughs, then withdraw about 1 cm (0.4 in). ## Footnote This technique minimizes trauma to the airway.
55
How long should suction be applied while withdrawing the catheter?
10 to 15 seconds. ## Footnote This duration helps clear secretions effectively.
56
What should be assessed after suctioning the client?
For repeated suctioning. ## Footnote Waiting 1 minute before suctioning again helps prevent airway trauma.
57
What should be done after suctioning to clear the catheter?
Push the lavage saline syringe or vial to rinse the inner lumen of the in-line catheter. ## Footnote This ensures that secretions are removed and maintains catheter function.
58
What should be done after the suctioning procedure is completed?
Turn off suction and hyperoxygenate the client again. ## Footnote This is important for patient safety and comfort.
59
What should be ensured before leaving the room after the procedure?
The client is in a safe position and has the call light within reach. ## Footnote This promotes patient safety and accessibility for assistance.
60
What is the first step in the evaluation process?
Provide privacy as needed
61
What personal protective equipment (PPE) should be put on if indicated?
Appropriate personal protective equipment
62
What should be verified before proceeding with client care?
Client identification
63
What is one of the critical assessments to perform related to allergies?
Determine whether the client has allergies
64
What type of education should be provided to the client?
Client education
65
What should be adjusted to a comfortable working height?
The bed
66
What is the initial action when preparing for tracheostomy suctioning?
Confirm the length of the tracheostomy tube
67
What type of gloves should be applied when beginning suctioning?
Nonsterile gloves
68
What device should the client be connected to during suctioning?
Pulse oximeter
69
What vital signs should be checked before suctioning?
Baseline oxygen saturation level and heart rate
70
What position should the client be placed in for suctioning?
Semi-Fowler’s position with the head slightly hyperextended
71
What is the suction setting for adults during the procedure?
80 to 120 mm Hg
72
What is the suction setting for children during the procedure?
50 to 100 mm Hg
73
Fill in the blank: The suction catheter should be inserted to the _______ length of the tracheostomy tube.
predetermined
74
What should be done if the heart rate decreases by 20/min or more from baseline during suctioning?
Discontinue suctioning
75
What should be done to oxygenate the client if necessary?
Use a bag-valve mask for 30 to 60 seconds or encourage deep breaths
76
What should be done between suctioning passes?
Rinse the catheter with sterile water
77
What action should be taken after suctioning is complete?
Disconnect the suction catheter from the tubing
78
What is the first step in endotracheal suctioning?
Open the suction kit and apply sterile gloves
79
What should be confirmed with the pulse oximeter after hyperoxygenation?
The client's oxygen saturation reading
80
What should the suction catheter be advanced to during endotracheal suctioning?
Pre-measured depth using centimeter markings
81
How long should continuous suction be applied during withdrawal of the catheter?
No longer than 10 seconds for adults
82
What should be done after suctioning is completed for endotracheal suctioning?
Disconnect the suction catheter from the tubing
83
Fill in the blank: Gloves and PPE should be _______ after suctioning.
disposed of
84
For nasopharyngeal suctioning advance
13-16 cm (5 to 6.5in)
85
If you feel resistance
Back 1-2cm (0.4-0.8in)
86
For for adult nasopharyngeal suctioning advance the catheter
13-16 cm (5 to 6.5in)

Med Surg1 Exam 3 (22 decks)

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