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Nursing Skills
Test 5- Trach/Suct
| Question | Answer |
|---|---|
| What three systems does oxygenation depend on? | Pulmonary, hematologic, cardiovascular |
| What factors affect oxygenation? ( 9 ) | Age, Environment and lifestyle: , Disease processes, Obstructive pulmonary disease, Restrictive pulmonary disease, Diffusion defects, Atherosclerosis, Heart failure, Anemia |
| How is airway clearing promoted? (8) | Effective coughing:, Postural drainage:, Hydration:, Medications:, Environment and lifestyle changes:, Artificial airways:, Suctioning |
| The drawing of fluids or solids from a surface using negative pressure; clearing the airway of mucus, pus or aspirated materials to improve oxygenation and ventilation | Suctioning |
| What is the purpose of suctioning? | To maintain a patent airway |
| What is removed during suctioning? (5) | Saliva, pulmonary secretions, blood, vomitus, foreign materials |
| What does the method of suctioning depend on?(3) | Where secretions are located, Presence of an artificial airway, Clients’ condition |
| What assessment data indicates the need for suctioning? | Respiratory status, CV status, VS, Neuro status, Other indicators |
| What are signs that an individual could be a candidate for suctioning?(9) | Wheezes, crackles, rales, gurgling, low pulse ox, low respirations, ineffective rate/depth of breathing, retractions, ineffective coughing |
| What four indicators from a person’s past history could indicate they may be a candidate for suctioning? | Deviated septum, nasal polyps, nasal obstruction, nasal injury |
| What part of the airway is considered clean? Sterile? | Upper airway is clean ( nose and mouth), lower airway is sterile |
| During suctioning always keep patient well _____. | Oxygenated |
| How many mm Hg are delivered for a wall suction unit for Adult? Child? Infant? | 100-120, 90-100, 50-90 |
| How many mm Gh are delivered for a portable suction unit for Adult? Child? Infant? | 10-15, 5-10, 2-5 |
| What position is patient in for suctioning? What about an unconscious person? | semi-Fowler’s/Fowler’s position // lateral on th side |
| Only apply suction while withdrawing ______ | Cath |
| Apply suction for max of ___ seconds | 10 |
| How long of a break should be taken in between suctioning? | 1-5 minutes |
| What is the max amount of times you can suction per “visit”? | 3 |
| Is PPE to be used during suctioning? | Yes |
| What two types of equipment could be used for oropharyngeal suctioning? | Yankauer or suction catheter |
| Do we use sterile or clean technique for oropharyngeal suctioning in the mouth and pharynx? | Clean |
| Always store used equipment after it has been ___ and ____. | Cleaned and dryed |
| After suctioning mouth and pharynx encourage patient to _____. | Cough |
| Where is the cath inserted in order to reach the trachea and nasopharyngeal areas? | Through the nasal passageway |
| When suctioning the trachea and nasopharyngeal area, is clean or sterile technique to be used? | Sterile |
| After opening the suction catheter, what are the next three steps of trachea and nasopharyngeal suctioning? | Pour sterile normal saline or sterile water (100 mL) in basin, Apply sterile gloves, attach tubing , Lubricate distal catheter (6-8 cm) with water soluble lubricant |
| How is the measurement for the nasopharyngeal tube determined? | It is the length from the nose to the ear |
| When providing nasopharyngeal suctioning, remove the oxygen with the ____ hand. | Non dominant |
| When providing nasopharyngeal suctioning, insert catheter, using ___ hand, up to ) ___ inches, then apply suction as you slowly withdraw cath (___ seconds max | Sterile, 6, 10 |
| The catheter for the nasopharyngeal suctioning should be advanced _____ and _____. It should not be _____. | Slowly, gently, forced |
| What is oralpharngeal catheter tubing cleaned out with | Saline and water |
| What type of patient would be a candidate for a tracheostomy? | Someone who needed long term airway support |
| Trach tubes have an outer ______ that is inserted into the _____ just below the ____ and a _____ that rests against the neck and helps secure tube to neck. | Trach tubes have an outer cannula inserted into trachea just below the larynx and a flange that rests against the neck and helps to secure tube to neck |
| This type of trach device produces an airtight seal between the tube and the trachea (20 mmHg) | Cuff |
| What are the two reasons a cuffed trach is beneficial? | Prevents aspiration of oropharyngeal secretions and air leakage between tube and trachea |
| When are the two times that a cuffed trach is used? | Immediately after a trach and with ventilators |
| Do children require cuffed trachs? | No as airways are small |
| How do you know how much to inflate a trach cuff? | It is per MD order |
| Why is a cuff used during tube feedings? | To prevent aspiration |
| Why is a cuff used when someone is on a ventilator? | To create a tight seal |
| Why is a cuff used for someone who has increased secretions? | To prevent aspiration |
| With long term trachs, the tube is usually _____. | Deflated |
| Over inflation of trach tubing leads to ______. | Complications |
| When performing Tracheostomy Suctioning, use ____ technique. | Sterile |
| When performing Tracheostomy Suctioning, client should be _____oxygenated. When? | Hyper, Before, during and after suctioning |
| Tracheostomy Suctioning can only be done a maximum of ___ seconds per suction. | 10 |
| What size catheter is used for Tracheostomy Suctioning? | ½ of trachea opening |
| How do you clear the tubing for Tracheostomy Suctioning? When? | Use sterile water or NS before during and after |
| Tracheostomy equipment should be disposed after____. | One use |
| What are the expected outcomes for someone who has had Tracheostomy suctioning? (9) | Patient’s airways are cleared of secretions, no sounds of congestion can be detected, lung sounds are improved. Patient indicates easier breathing and decreased congestion. Patient’s vital signs show improvement; improved heart and resp. rate, O2 sat |
| What are the complications associated with suctioning? (8) | Hypoxemia, Cardiac dysrhythmia, bradycardia, Trauma, bronchospasms, Infection, Increased secretions, Aspiration |
| Should you suction on a routine or scheduled basis? | No |
| When suctioning, have all equipment at ______. What should this include? | Bedside, extra same sized trach tube, extra smaller sized trach tube, obturator |
| When suctioning, have client in a _______ position. If unconscious? | Fowler’s/semi-Fowler’s, lateral on side |
| When suctioning, hyperoxygenate when? | Before, during and after |
| When accessing the stoma site, what should be noted? | Color, amount, consistency and odor of tracheal and stoma secretions |
| What concerns should be assessed regarding respiration? | Coarse breath sounds, noisy breathing, prolonged expiratory sounds, ¯ O2 sat |
| When inserting the catheter, the suction should be ___. | Off |
| Do you suction on the way into an orifice or on the way out? | Out |
| Never suction for more than | 10 seconds |
| Tubing must be cleared with _____ or _____. When? | Clear suction tubing with (sterile) normal saline or water – before, during, after |
| How often is the inner cannula of a trach changed? | Changed daily or PRN, per agency policy |
| Changing the cannula on a trach is a _____ procedure. | Sterile |
| When completing a dressing change for a trach, what type of technique is used? | Clean |
| What do you use to wash around the stoma? | ½ normal saline and ½ hydrogen peroxide OR agency policy |
| What type of trach dressing is used? | Clean drain sponge( manufactured split sponge) |
| The outer cannula of a trach is only changed by who? | Doctor |
| What is the outer cannula held in place by? | By ties on a flange |
| Used for inserting or reinserting a trach | Obturator |
| Removing and replacing trach ties is a ____ procedure. | Clean |
| How many people should be used when removing and replacing trach ties? | Two |
| Should you remove old ties before securing new ties? | No, secure new ties before removing old ones |
| How tight should you secure trach ties? | You want to be able to get at least one finger under tie |
| What needs to be included in the documentation on trach care? | Frequency of suctioning, Amount and characteristics of secretions, Pre and post-suctioning hyperoxygenation, Vital signs, Reestablishment of oxygen therapy, Appearance of stoma, Trach care., Patient’s tolerance of procedure |
| What technique is used to clean stoma? Inner cannula? | Clean, sterile |
| What two types of devices can be used to help a person with a trach “speak” | Passy-Muir, Shiley phonate valve |
| is commonly used to help patients speak more normally. This one-way valve attaches to the outside opening of the tracheostomy tube and allows air to pass into the tracheostomy, but not out through it | Passy-Muir |
| Lightweight, medical-grade, plastic valve designed for tracheostomy patients to direct airflow past the vocal chords, giving them the ability to speak | Shiley phonate valve |
| How else can we communicate with a client who cannot speak? | Call light always within reach, Do not use intercom to answer call light, Paper and pencil, Dry erase board, Computer assisted device |
| Can suctioning sometimes increase secretions? | Yes make sure to allow for adequate rest periods |
| What are signs of hypoxia? (10) | Dyspnea, evaluated bop, increased respiratory and pulse rates, pallor, cyanosis, anxiety, restlessness, confusion, drowsiness |
| When is an inner cannula used? | When there are a lot of secretions or it is difficult to get them out. They are not always needed. |
| How deep to you go in to suction a patient’s trach? | Until they cough and then one cm less than that |
| When providing oral care what two things should you not use? What one product is recommended? | Glycerin swabs, mouthwash with alcohol, use hydrogen peroxide |
Created by:
anastasia158
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