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Flashcards in Trach Care Deck (39)
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1

How should one measure for sizing an oropharyngeal airway?

Measure (quick if an emergency) – base it also on age and size of person. Put flange parallel to teeth and the curved part next to the cheek – tip should be at the angle of the jaw.

2

What size of oropharyngeal airway do babies and small children use?

000 to 3

3

What size of oropharyngeal airway do bigger children normally wear?

3 to 4

4

What size of oropharyngeal airway do adults usually wear?

4 and over

5

Who should not have a nasopharyngeal airway inserted?

Patients with facial trauma.

6

What is the purpose of oral airway suctioning?

Removes secretions from the mouth (will also remove O2)

7

What is oropharyngeal suctioning?

Inserted through the mouth to the pharynx

8

What is nasopharyngeal suctioning?

Inserted via nares to pharynx.

9

What are some complications of airway suctioning?

Complications – (negative aspects)
disruptive to mucous membranes
Damage mucous membranes
Uncomfortable
Bradycardia
Hypoxic patients can become tachycardic
Increased potential for infection
Laryngeal spasm

10

What are some anatomical features of the trachea?

The trachea is the first part of the airway not shared by GI tract
Trachea stretches between the larynx and the carina
In the average adult it is 10-12cm long and 2.5cm in diameter
The trachea is protected by 16-20 hyaline cartilage rings which help to maintain patency

11

How is the placement of a tracheostomy checked?

X-ray

12

Are tracheostomies temporary or permanent?

Can be temporary or permanent.

13

What is the purpose of a tracheostomy tube?

The tube keeps the stoma open. It shortens the length of the upper airway, and decreases the work of breathing for the patient.

14

What is a tracheostomy?

An artificial opening (or stoma) in the trachea

15

Where is a tracheostomy created?

Surgically created between 2nd and 3rd cartilaginous ring

16

What are some indications for tracheostomy?

Upper airway obstruction
Upper airway bleeding
Trauma/burns
Prolonged artificial ventilation
Respiratory insufficiency
Inability to clear secretions effectively
Inability to protect own airway

17

What are some complications of tracheostomy?

Airway occlusion
Tissue damage (necrosis, ulceration)
Infection
Communication difficulties
Tube displacement/dislodgement
Bleeding
Tracheo-oesophageal fistula
Inability to maintain nutrition/hydration needs
Air leaks
Loss of normal airway function
Decreased sense of smell/taste
Decreased nutritional intake (as a result of decreased smell/taste)

18

What are tracheostomy tubes made of?

Silicone.

19

What are some variations in the designs of tracheostomy tubes?

Vary in length, size, composition and number of parts. Can also be cuffed or uncuffed, fenestrated or non fenestrated.

20

What is the purpose of a fenestrated tracheostomy tube?

Fenestrated = has holes in it. Fenestrated ones allow air to go up and out of the airway, as well as breathe through the trach tube. This can help them to have a little bit of a voice.

21

What is the purpose of a cuffed tracheostomy tube?

Cuff is to occlude the airway to reduce the risk of aspiration.

22

What kind of patients would require a cuffed tracheostomy tube?

Patients on a ventilator.

23

What are the three components of a tracheostomy tube?

Outer cannula (cuffed/uncuffed)
Inner cannula
Obturator

24

What is an attachment for tracheostomy tubes that are optional?

May have speaking valves attached (these are expensive, $300-$400)

25

What are some nursing implications for caring for patients with a trach tube?

Preparation
Patient assessment
Patient education
Communication/body image
Procedures
Emergencies
Guidelines and documentation

26

What should the nurse do to prepare for trach care?

Equipment at bedside
Patient assessment
Procedures discussed with patient
Patient in correct position
2nd nurse identified to help (if necessary) with procedures

27

What are some important aspects of patient assessment when performing trach care?

Why does the patient have a tracheostomy?
How long have they had a tracheostomy?
Type/size of tube
Level of respiratory support needed
Respirations/breath sounds
Cuffed?/inflated?
Humidification method?
Suction required?/how often?
Thickness, colour, amount of sputum
Cleaning of inner tube?
Wound assessment/dressing changes
Can the patient swallow? Assessment done?
Weaning progress
When does the outer tube need changing?
What does the patient look like?
Patient education
Mouth care

28

What are some important aspects f patient education for patients with tracheostomy?

Explain all procedures
Pre-op education
Communication limitations/alternatives
Involve family
Utilize other experts as appropriate

29

What is the reason that humidification is required for a patient with a tracheostomy tube?

Humidification occurs in the upper airway. When a tracheostomy is formed, the upper airway is bypassed. Humidification warms and moistens the air.

30

What are some possible complications of humidification for a trach patient?

Potential for fluid build-up in corrugated tubing
Insufficient/excessive humidification