The nurse is securing a tracheostomy tube for a client post-procedure. Which action should the nurse take to ensure proper tracheostomy care?

Choice A reason: Using a soft foam collar may reduce skin irritation but risks dislodging the tracheostomy tube if not secured properly. Leaving old ties in place until new ones are secure ensures tube stability, preventing accidental decannulation, which is critical in early tracheostomy care.

Choice B reason: Knots close to the tracheostomy tube increase pressure on the skin, risking irritation or necrosis. This is incorrect, as ties should allow slight movement. Maintaining old ties until new ones are secure prevents tube displacement, prioritizing airway safety during the procedure.

Choice C reason: Leaving old ties in place until new ones are secure prevents tracheostomy tube dislodgement, a life-threatening risk. This ensures continuous airway patency during tie changes, especially in fresh tracheostomies, making it the safest and most critical action to maintain tube stability.

Choice D reason: Placing knots laterally reduces irritation but does not address the risk of tube dislodgement during tie changes. Keeping old ties in place until new ones are secure is the priority, as it ensures the tube remains stable, preventing airway compromise.

Choice A reason: Priming an ipratropium inhaler typically requires 2 pumps, not 7, to ensure proper dosing. Excessive priming wastes medication and may reduce the inhaler’s lifespan. This action indicates misunderstanding of device preparation, necessitating further teaching to ensure effective administration and therapeutic outcomes.

Choice B reason: Attaching a spacer device enhances ipratropium delivery by improving aerosol deposition in the lungs, especially in COPD patients with poor inhalation technique. This is correct, as spacers reduce oropharyngeal deposition, minimizing side effects and maximizing bronchodilation, requiring no additional teaching.

Choice C reason: Storing ipratropium at room temperature is correct, as extreme temperatures can degrade the medication’s efficacy. This action aligns with manufacturer guidelines, ensuring the inhaler’s stability and effectiveness, indicating proper understanding and eliminating the need for further teaching on storage.

Choice D reason: Rinsing the mouth after ipratropium use is appropriate, as it reduces local side effects like dry mouth or throat irritation from residual medication. This correct action prevents complications, showing proper technique and understanding, so no additional teaching is required for this step.