Module 11: Management and Care of an Established Tracheostomy Flashcards Preview

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Flashcards in Module 11: Management and Care of an Established Tracheostomy Deck (12)
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1
Q

discuss why patients may require a tracheostomy tube

A
  • trauma, vocal cord paralysis, foreign body, infection, neuromuscular disease, anaphylaxis, congenital, and malignancy
2
Q

Trach ties

A

fastened around the neck to hold the trash tube in place, attached to flange

3
Q

Corking/plugging

A

purposefully plugging the tube to allow patient to be weaned in preparation for decannulation

4
Q

Decannulation

A

removal of the trach tube

5
Q

Goals of Tracheostomy care

A
  • to ensure airway patency by keeping the tube free from mucus buildup
  • maintain mucous membrane and skin integrity
  • prevent infection
  • provide psychological support
6
Q

Management and Care of a Tracheostomy

A
  • oxygen and suction available at all times
  • suctioning only when assessments indicate that it is necessary
  • two spare trach tubes at the bedside - one same size and one size smaller
  • ambubag, spare inner cannula, obturator available and visible at the bedside
  • communication method must be established
  • respiratory therapist must be involved in patients care
  • if trach is corked, the cuff must be deflated
  • overinflating the cuff can cause tissue necrosis
7
Q

Special considerations for Tracheostomy

A
  • appropriate humidification must be provided
  • maintain adequate fluid status
  • recommened referrals:
    • speech language pathologist (highly recommended)
    • dietician
    • physiotherapist
8
Q

Tracheostomy care

A
  • dressing changes, stoma care and tie changes should only be done if necessary in first 24 hours
    • sterile technique used for dressing change and stoma care for first 72 hours
    • change the trash ties only when soiled or wet with 2 nurse present - one to hold teach insitu and one to change the ties
    • assess the stoma site and surrounding skin for redness, swelling and drainage
    • change the dressing frequently whenever secretions begin to collect and q8h minimum
    • assess and clean the inner cannula and stoma
9
Q

Common Complications associated with tracheostomy tubes

A
Within 72 hours 
- bleeding
- pneumothorax
- atelectasis 
- subcutaneous emphysema 
- respiratory arrest
- airway obstruction 
- tracheitis 
- cuff herniation
- cuff over inflation 
Possible complications
- infection - most common 
- tube displacement 
- tracheal damage 
- aspiration 
- accidental de-cannulation
10
Q

Weaning from a tracheostomy

A
  • physicians order required
  • patient/family may be very anxious about weaning
  • optimal nutritional status will facilitate weaning
  • readiness for decannulation
    • tolerates trash being corked x 24 hrs
    • minimal need for suctioning
11
Q

Demonstrate suctioning a tracheostomy tube

A
  • goal: to improve O2 and CO2 exchange in the lungs by removing excessive mucous secretions
  • Use sterile technique:
    • avoid introducing pathogens in the airway
12
Q

Documentation

A
  • type and size of tracheostomy in situ
  • skin integrity around tracheostomy site
  • date of tracheostomy insertion/trach tube change
  • assessment of respiratory system and status
  • oxygen/humidty needs
  • teach care procedures done:
    • suctioning
    • dressing change
  • patient response