E1 Tracheostomy

Question 1

Artificial Airway

Answer 1

Inserted in a patient who may or may not be breathing on their own
-Can be emergent or non-emergent

Question 2

Pharyngeal airway

Answer 2

-Still breathing on their own
-Decreased LOC, loss muscle tone, need suction frequently
-Tube goes in nose (nasalpharyngeal) or mouth (oralpharyngeal)

Question 3

Tracheal airway

Answer 3

-unable to breath on their own
-may need mechanical ventilation, long term airway patency issues

Question 4

Endotracheal

Answer 4

-Inserted through mouth and go down to trachea
-pt intubated or on ventilator

Question 5

Percutaneous

Answer 5

-Through skin, directly to trachea
-Can breath independently

Question 6

Tracheostomy Tube

Answer 6

-Plastic or metal tube that fits through a STOMA in the neck
(Stoma is surgically opened)
-Outer Cannula with an attached flange and cuff with a removable inner cannula

Question 7

Tracheostomy indications

Answer 7

-Acute airway obstruction (anything causing swelling)
-Airway protection (after head/neck cancer surgery)
-Facilitated removal of secretions
-Prolonged intubation (usually after 7-10 days)

Question 8

Benefits of tracheostomy over prolonged intubation

Answer 8

-Less damage to airway
-More confortable
-Allowed to eat
-Mobility is improved

Question 9

Cuffed Trach (Shiley)

Answer 9

-Disposable inner cannula
-Cuff obturator
-Plastic
-Short term
-Size 6-8 for adults

Question 10

What is the purpose of cuff on Shiley trach

Answer 10

Help create a snug fit in trachea to prevent aspiration and help ventilator give stronger breaths
-Seal off airway so just breathing through trach

Question 11

When are cuffs inflated?

Answer 11

-Patients mechanically ventilated or to eat to reduce risk of aspiration
-Typically not on floor (med-surg)
-Ordered by HCP
-Respiratory Therapy inflates

Question 12

What is a nurses job when it comes to inflation of cuff?

Answer 12

Just assess during head to toe to make sure deflated (or not if ordered)

Question 13

How do you deflate if needed?

Answer 13

1. Suction Mouth
2. Deflate cuff with syringe
3. Suction Trachea

Question 14

Dangers of prolonged or over-inflation of cuff?

Answer 14

-Increased mucosal pressure
-Cause Ischemia
-Softening cartilage
-Mucosal Erosion

Can get tracheoesophageal fistula

Question 15

Communication with a trach

Answer 15

-Pt can talk with tach
-Passy-Muir speaking valve
-Cuff is deflated when in use
-If pt in any kind of respiratory distress, do not use
-Must have OK by HCP

Question 16

Tube Dislodgment and Accidental Decannulation

Answer 16

Usually happens during cough or during transition times

1. Keep obturator taped at bedside
2. Insert obturator into outer cannula
3. Extend neck and open tissue; insert outer cannula/ obturator
4. Remove obturator immediately
5. Check bilateral breath sounds
6. Secure trach

Question 17

What should you keep at bedside for Trach pt

Answer 17

1. Obturator
2. Same size and Smaller Trach
3. Suction
   4 Attachment piece for Ambu Bag

Question 18

Nursing Problems for a patient with a trach

Answer 18

-Ineffective airway clearance
-Impaired verbal communication
-Risk for infection
-Impaired swallowing
-Body image disturbance
-Anxiety
-Pain

Question 19

What is a nurses job with a trach?

Answer 19

1. Trach Care
2. Suctioning
3. Trach Assessment
   -What kind?
   -What size?
   -Cuff inflated?
   -Pt complaining of discomfort
   -Oxygenating appropriately