NUR 391 Tracheostomy Care & Suctioning for Non Ventilated Pt.
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| What is a Tracheotomy? | The surgical incision into the trachea to establish an air way.
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| What is a Tracheostomy? | The Stoma the occurs from the tracheotomy.
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| Where does the tracheotomy occur on the trachea? | 2nd and 3rd tracheal rings.
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| What is a Permanent Tracheosotmy called? | Total laryngectomy.
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| What are the 3 main components of Tracheosotmies? | Outer Cannula, Inner Cannula, Obturator
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| What is the purpose of the Obturator? | To occlude the airway, it fits inside the outer cannula.
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| What type of Tracheosotmy (cuffed or uncuffed) prevents aspiration and air leakage? | Cuffed Tracheostomy
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| What type of Tracheostomy (cuffed or uncuffed) is used for long term trach care and reduces the risk of tracheal-esophageal fistulas? | Uncuffed Tracheostomy
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| Do children require cuffed tubes? Why or Why not? | No, because their trachea is elastic and it stretches to prevent leakage.
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| What type of tracheostomy (cuffed or uncuffed) has an increase risk for aspiration compounded by G-tube feedings? | Uncuffed
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| What type of tracheostomy (cuffed or uncuffed) must the HOB be elevated at all times? | Uncuffed
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| What must the inflated cuff pressure not exceed? | 20mm Hg
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| What is the risk of the Minimal Leak Technique in Cuffed Tracheostomy Tubes? | Risk of Aspiration
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| Describe the Minimal Leak Technique in Cuffed Tracheostomy Tubes? | Inflate cuff w/ minimum air for a seal, then withdraw 0.1 mL or air?
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| How are retention sutures unlike regular sutures? | Retention sutures go deep into the tissues (ie. tracheal cartilage)
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| What is the purpose of retention sutures in Tracheostomies? | To help keep the airway open.
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| What must be kept at bedside for tracheostomy patients? | Replacement tubes and obturator.
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| When should trach tapes be changed after insertion surgery? | Not before 24 hours.
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| What should a nurse do in the case a pt's trach tube becomes dislodged? | Don't leave room, Activate Rapid Response Team, try to replace tube, hold retention sutures open
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| If a pt's trach tube becomes dislodged, how should the nurse try to replace it? | Lubricate tip w/ saline, INSERT at 45 degree angle, remove obturator
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| Since air is no longer filtered or humidifed when breathing through a trach tube, what can be done to provide the pt with some comfort in regards to the dry air and secretions? | Mist collar
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| After the 1st trach tube is changed, how often should it be changed? | Monthly
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| What type of health professional evaluates a trach tube pt's risk for aspiration? | a Speech Therapist
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| What is the purpose of a Fenestrated Tracheostomy? | To allow the pt to speak by allowing air to pass over the vocal cords.
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| What is a potential complication of using a Fenestrated Tracheostomy? | Tracheal polyps
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| What should be assessed in a pt with a Fenestrated Tracheostomy? | Ability to swallow before use and Signs of Respiratory distress on the first use.
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| Does the Fenestrated Tracheostomy have an inflated or deflated cuff? | Deflated cuff
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| How do Speaking Tracheostomy tubes allow the pt to talk? | By using an inflated cuff to speech.
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| Name a Speaking Tracheostomy Valve. | Passy-Muir Valve
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| What does a Passy-Muir Valve require? | Cuffless tube or deflated cuff
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| How does a nurse evaluate a trach pt's ability to tolerate cuff deflation w/o aspiration or respiratory distress? | Listen to lungs/breathing effort, continuous pulse oximetry, check for cyanosis
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| How often should routine trach care be performed? | Every 4 hours
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| What is the purpose of suctioning a trach pt? | To maintain a patent airway and to remove accumulate respiratory secretions.
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| What situation does a pt need suctioning? | ↓ LOC, ↓ ability to cough, obstructive upper airway, facial/neck trauma or surgery
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| What causes accumulated respiratory secretions? | ↓ ability to cough and ↓ LOC
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| Can trach suctioning be done in a non-sterile method? | No, it must be STERILE
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| Should oral and oropharangeal suctioning be conducted in a sterile method? | No, it is a non sterile procedure
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| What type of catheter should be used for oral/oropharyngeal suctioning? | Yankauer catheter aka. Tonsilar Tip
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| What type of suctioning procedure requires a sterile technique? | Nasotracheal suctioning
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| How often should the Yankauer catheter (tonsilar tip) be changed? | Every 24 hours and prn.
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| What are some risks related to artificial airways and their suctioning? | Hypotension, hypertension, ↑ICP, dysrhythmia's, nosocomial infection
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| What are some signs/symptoms that may indicate a need for suctioning? | Gurgling, coughing, at pt request, ↓ respiratory rate
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| Why should a pt be well hydrated during suctioning? | For easy removal and to loosen mucus.
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| What size should the suctioning catheter be? | 14-16 Fr or 1/2 the diameter of the outer cannula.
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| When is a suctioning of ? 120mm Hg ok to use? | During ORAL suctioning.
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| What is the appropriate suctioning pressure for tracheal suctioning? | 80-120 mm Hg
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| Why should suctioning not be applied when inserting the catheter? | Trauma of the tissue lining may occur.
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| What is the maximum amount of suctioning for intermittent/continuous suctioning? | Max of 10 seconds at a time.
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| Can you suction when withdrawing the catheter? | Yes, suction should occur when withdrawing the catheter.
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| How and when should Hyperoxygenation occur? | Before and between suctioning with 100% oxygen.
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| What type of systems can be used to Hyperoxygenate a pt? | Ambu bag
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| How how much oxygen should be delivered via an Ambu bag during Hyperoxygenation? | 12-15 L/min giving 3-5 breaths
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| How should a pt be hyperoxygenated if they are on a ventilator? | 100% oxygen for 2 minutes.
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| When should you not hyperoxygenate with an Ambu bag? | If copious secretions are present because they force secretions back down the trachea.
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