Tracheostomy Care & Suctioning

Question 1

Tracheostomy

Answer 1

• Long-term airway support

- Opening for tube itself

Question 2

Tracheostomy Tube

Answer 2

Tube inserted to extend through stoma into trachea

Question 3

Health teaching

Answer 3

Encourage pt to clear airway by coughing

Stress importance of adequate hydration

Question 4

What position should a pt assume?

Answer 4

Semi/high fowler’s

Promote lung expansion

Question 5

Cotton lint/fibres

Answer 5

From gauze

May be aspirated, causing a tracheal abscess

Question 6

Post care assessment

Answer 6

• Character/amount of secretions
• Drainage form tracheostomy
• Incision
• Hr and resp status, compared w baseline
• Complaints of pain/discomfort

Question 7

What size syringe is used

Answer 7

10 ml

Question 8

Why do you use minimal occlusive pressure when inflating cuff?

Answer 8

Prevent pressure on tracheal tissue

Question 9

How do you measure appropriate tracheal cuff pressure?

Answer 9

• Stethoscope, auscultate at suprasternal notch for hissing

- If voice audible, occlusion is inadequate

Question 10

When to perform Suctioning

Answer 10

PRN

resp distress/SOB/Coughing/Low O2

Cyanosis

Crackles

Question 11

Complications of suctioning

Answer 11

• Worsening respiratory status
• Bloody secretions
• Coughing
• No secretions

Question 12

Techniques to minimize complications

Answer 12

• Hyperinflation

- Hyperoxygenation

Question 13

How long to perform suctioning

Answer 13

10-15 sec

Question 14

If client has copious secretions:

Answer 14

Increase O2 delivery prior to beginning

Question 15

When is suctioning necessary

Answer 15

When pt is unable to cough and clear respiratory tract secretions

Question 16

When is oropharyngeal/nasopharyngeal suctioning used

Answer 16

When pt is able to cough but unable to clear secretions by expectorating or swallowing

After pt coughs

Question 17

When is orotracheal/nasotracheal suctioning required?

Answer 17

The pt is unable to manage secretions by coughing and does not have an artificial airway

Question 18

Why is a nasal insertion preferred?

Answer 18

Gag reflex is minimal

Question 19

Tracheal suctioning

Answer 19

Accomplished through an artificial airway

Question 20

Increase amount of secretions picked up by…

Answer 20

Rotating suction tube

Question 21

When inserting suction tube:

Answer 21

Occlude tube, DO NOT suction

Question 22

When is an artificial airway required?

Answer 22

With pts with a decreased level of consciousness or airway obstruction

Aid in removal pf secretions

Question 23

How is an oral airway measured?

Answer 23

Distance from corner of mouth to angle of jaw just below ear

Question 24

If oral airway too large

Answer 24

Force tongue toward epiglottis

obstruct

Question 25

If oral airway to small:

Answer 25

Tongue is not held in anterior mouth

Question 26

Endotracheal tube

Answer 26

Short-term artificial airway Mechanical ventilation, relieve upper airway obstruction Protect against aspiration clear secretions

Question 27

Maintenance/promotion of lung expansion: Ambulation

Answer 27

Immobility -> atelectasis and ventilator-associated pneumonia

Question 28

Maintenance/promotion of lung expansion: Positioning

Answer 28

Frequent changes prevent atelectasis 45 degreee semi-fowlers good lung down pulmonary abcess = bad lung down

Question 29

Incentive spirometry

Answer 29

Encouraging voluntary deep breathing by providing visual feedback to pts about inspiratory volume prevent atelectasis

Question 30

Chest tube

Answer 30

Remove air/fluids from pleural space, prevent it from reentering pleural space, reestablish normal pressures inserted through thorax

Question 31

Pneumothorax

Answer 31

Collection of air in pleural space Loss of intrapleural pressure Collapsed lung Sharp pain

Question 32

Hemothorax

Answer 32

Accumulation of blood and fluid in pleural cavity between visceral and parietal Prevents full expansion

Question 33

Possible affects of oxygen

Answer 33

Atelectasis or oxygen toxicity

Question 34

Low flow devices

Answer 34

Nasal cannulas, simple face masks, reservior masks Concentrations that vary w patients respiratory pattern

Question 35

High flow devices

Answer 35

Deliver O2 above normal inspiratory rates Venturi mask

Question 36

Nasal cannula

Answer 36

up to 6l/min

Question 37

4L/min

Answer 37

Not often used, drying on mucosa If used **Humidifier Skin breakdown

Question 38

Partial rebreather

Answer 38

40-70% | max 10L/min

Question 39

Non-rebreather

Answer 39

60-80% 10L/min

Question 40

Venturi mask

Answer 40

24-60% 4-12L/min

Question 41

What is an example of effective planning for emergency care for a pt with a tracheostomy

Answer 41

Keep an obturator and trach tube at bedside

Question 42

Technique for trach ties

Answer 42

Square knot ensure 2 fingers fit snugly underneath

Question 43

How to ensure catheter us working

Answer 43

Suction a small amount of sterile water

Question 44

When providing suctioning for a pt with a mask...

Answer 44

keep oxygen mask near face during procedure

Question 45

How do you evaluate effectiveness?

Answer 45

Compare pre and post suctioning data

Question 46

What do you do if a pt begins to gag/complains of nausea?

Answer 46

REMOVE