Review Tracheostomy care

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Tracheostomy care

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Question 1:

A nurse is providing care for a patient with a tracheostomy tube. What type of tracheostomy tube would be most suitable for a patient who requires mechanical ventilation or has a high risk of aspiration?

A. Cuffed. B. Uncuffed. C. Fenestrated. D. Double-lumen. E. Metal.

Answer and Explanation

Choice A:

A cuffed tracheostomy tube is most suitable for a patient who requires mechanical ventilation or has a high risk of aspiration. The cuff is inflated to create a seal between the trachea and the tube, preventing aspiration of oral secretions or gastric contents into the airway. This is crucial for patients on mechanical ventilation to ensure effective ventilation and prevent complications like ventilator-associated pneumonia.

Choice B:

Uncuffed tracheostomy tubes do not have an inflatable cuff, making them unsuitable for patients who require mechanical ventilation or have a high risk of aspiration. They are more appropriate for patients who can protect their own airway and have minimal risk of aspiration.

Choice C:

Fenestrated tracheostomy tubes have an opening or fenestration on the tube that allows airflow through the upper airway, bypassing the tracheostomy tube. These tubes are used for patients who are weaning off mechanical ventilation and require speech therapy. They are not the most suitable choice for patients who need mechanical ventilation or have a high aspiration risk.

Choice D:

Double-lumen tracheostomy tubes have two separate tubes, which can be used for independent lung ventilation in certain situations. They are not specifically designed for patients requiring mechanical ventilation or with a high risk of aspiration.

Choice E:

Metal tracheostomy tubes are not commonly used for patients requiring mechanical ventilation or with a high risk of aspiration. Metal tubes may be used in certain cases, but they are not the most suitable choice for this patient population.

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Question 2:

A client with a tracheostomy tube is ready to wean from mechanical ventilation and also requires speech therapy. What type of tracheostomy tube would be the most appropriate choice for this client?

A. Cuffed. B. Uncuffed. C. Fenestrated. D. Double-lumen. E. Plastic.

Answer and Explanation

Choice A:

A cuffed tracheostomy tube with an inflated cuff is more suitable for patients requiring mechanical ventilation or those at high risk of aspiration, rather than a patient who is ready to wean from ventilation.

Choice B:

Uncuffed tracheostomy tubes may be appropriate for patients who can protect their airway and are weaning from mechanical ventilation. However, they would not be the most appropriate choice when speech therapy is also required.

Choice C:

A fenestrated tracheostomy tube would be the most appropriate choice for a client who is ready to wean from mechanical ventilation and also requires speech therapy. The fenestration in the tube allows the patient to breathe through the upper airway, facilitating the weaning process, and enabling speech by allowing air to pass over the vocal cords. This type of tube is commonly used for patients who have progressed in their recovery and are transitioning to breathing independently.

Choice D:

Double-lumen tracheostomy tubes are not typically used for weaning from mechanical ventilation or speech therapy needs. They are employed in specialized situations for independent lung ventilation.

Choice E:

Plastic tracheostomy tubes are commonly used in clinical practice and may be suitable for a patient ready to wean from mechanical ventilation and requiring speech therapy. However, the fenestrated tube is a more specific choice for this scenario.

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Question 3:

Which statement by the nurse regarding tracheostomy care is correct?

A. "I will monitor the cuff pressure to keep it between 20 to 25 cm H2O.". B. "The fenestration should remain open at all times.". C. "The inner cannula is only used when the patient requires mechanical ventilation.". D. "A fenestrated tube is used for patients with a low risk of aspiration.". E. "Metal tracheostomy tubes are commonly used for long-term ventilation.".

Answer and Explanation

Choice A:

Monitoring cuff pressure is essential, but the suggested range of 20 to 25 cm H2O is not universally applicable. The appropriate cuff pressure range may vary depending on the patient's condition, and it should be individualized based on the patient's needs.

Choice B:

Keeping the fenestration open at all times is not accurate. The fenestration can be open to allow airflow during weaning and speech therapy, but it can be temporarily occluded when assessing the patient's ability to breathe without the tube.

Choice C:

The inner cannula is not solely used during mechanical ventilation. It is also used for routine cleaning and maintenance of the tracheostomy tube, regardless of the patient's ventilation status.

Choice D:

This statement is correct. A fenestrated tracheostomy tube is designed for patients with a low risk of aspiration and are weaning from mechanical ventilation. The fenestration allows the patient to breathe through the upper airway, promoting speech and facilitating the weaning process. The fenestration can be temporarily occluded to assess the patient's readiness for decannulation.

Choice E:

Metal tracheostomy tubes are not commonly used for long-term ventilation. They are mostly used in specific situations where a plastic tube may not be suitable, such as when there is a risk of tube distortion or damage. Plastic tubes are more commonly used for long-term ventilation due to their availability, flexibility, and ease of use.

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Question 4:

A patient with a tracheostomy tube is speaking with a low risk of aspiration. What type of tracheostomy tube would be most suitable for this patient?

A. Cuffed. B. Uncuffed. C. Fenestrated. D. Double-lumen. E. Silicone.

Answer and Explanation

Choice A:

A cuffed tracheostomy tube has an inflatable cuff that can create a seal in the trachea, but it also increases the risk of aspiration. In this case, the patient is at low risk of aspiration, so a cuffed tube is not the most suitable choice.

Choice B:

An uncuffed tracheostomy tube lacks an inflatable cuff, which reduces the risk of aspiration. It allows air to flow freely around the tube and is appropriate for patients with a low risk of aspiration, making it the most suitable choice for this patient.

Choice C:

A fenestrated tracheostomy tube has an opening in the posterior wall that allows airflow through the vocal cords, facilitating speech. However, since the patient is already speaking with a low risk of aspiration, a fenestrated tube may not be necessary or the best choice.

Choice D:

A double-lumen tracheostomy tube is designed for independent lung ventilation during certain medical procedures and is not typically used for routine tracheostomy management. It would not be the most suitable choice in this scenario.

Choice E:

Silicone tracheostomy tubes are made of a soft, flexible material that can reduce the risk of tissue damage and provide greater comfort. However, the material of the tracheostomy tube is not the primary consideration for a patient with a low risk of aspiration.

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Question 5:

A nurse is preparing to perform tracheostomy care for a patient. What is the recommended interval for performing tracheostomy care?

A. Every 2 to 4 hours. B. Every 4 to 6 hours. C. Every 6 to 8 hours. D. Every 8 to 12 hours. E. Every 12 to 24 hours.

Answer and Explanation

Choice A:

Performing tracheostomy care every 2 to 4 hours would be too frequent for most patients and may cause unnecessary disruption and discomfort. This interval is not the recommended standard of care.

Choice B:

Tracheostomy care every 4 to 6 hours strikes a balance between maintaining airway hygiene and minimizing excessive handling of the tracheostomy site, reducing the risk of complications such as infection or irritation.

Choice C:

Waiting to perform tracheostomy care every 6 to 8 hours may increase the risk of mucus buildup and potential complications, especially in patients with high secretions or respiratory issues.

Choice D:

Extending the interval to every 8 to 12 hours may lead to inadequate airway clearance and increased risk of complications in patients who require more frequent care.

Choice E:

Waiting to perform tracheostomy care every 12 to 24 hours is too infrequent for most patients and may not be sufficient to maintain a patent airway and prevent complications.

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Question 6:

A client with a tracheostomy tube is experiencing dry and crusted secretions. What intervention would the nurse provide to address this issue?

A. Administering antibiotics. B. Increasing suction frequency. C. Providing humidification and hydration. D. Performing daily tracheostomy tube changes. E. Recommending a fenestrated tracheostomy tube.

Answer and Explanation

Choice A:

Administering antibiotics would be indicated if the patient develops a respiratory infection, but it would not directly address the issue of dry and crusted secretions.

Choice B:

Increasing suction frequency may help remove secretions, but it may also lead to increased irritation and trauma to the tracheal lining. It is not the first-line intervention for dry and crusted secretions.

Choice C:

Providing humidification and hydration helps to moisten the secretions, making them easier to expectorate or suction. It is the most appropriate intervention to address dry and crusted secretions in a patient with a tracheostomy tube.

Choice D:

Performing daily tracheostomy tube changes is not indicated solely to address dry and crusted secretions unless there is a specific problem with the current tube that requires changing.

Choice E:

Recommending a fenestrated tracheostomy tube would not directly address the issue of dry and crusted secretions. Fenestrated tubes are more relevant for patients who need speech assistance, which is not the primary concern in this case.

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Question 7:

A nurse is preparing to suction a client's tracheostomy tube. Which step should the nurse perform first during the suctioning procedure?

A. Position the patient in semi-Fowler's position. B. Apply a new dressing around the stoma. C. Clean the inner cannula with hydrogen peroxide. D. Gather equipment and supplies for the procedure. E. Remove the old dressing and discard it in a moisture-resistant bag.

Answer and Explanation

Choice A:

A) is an important step in tracheostomy care, but it is not the first step during the suctioning procedure. Semi-Fowler's position helps promote lung expansion and allows for better visualization during the procedure.

Choice B:

B) is essential after suctioning to maintain cleanliness and prevent infection. However, it is not the first step in the suctioning procedure. The nurse should first gather the necessary equipment.

Choice C:

C) is not the first step during suctioning. The nurse should gather equipment and supplies first before performing any cleaning or other procedures.

Choice E:

E) is an important step, but it should come after the nurse gathers the necessary equipment for the suctioning procedure.

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Question 8:

Select all the appropriate steps a nurse should take during tracheostomy care.

A. Clean the stoma with hydrogen peroxide. B. Change the ties or straps every 4 hours. C. Inspect the stoma for signs of infection. D. Reinsert the inner cannula and lock it in place. E. Apply a new dressing around the stoma and secure it with tape.

Answer and Explanation

Choice A:

A) is not recommended for tracheostomy care. Hydrogen peroxide can be irritating and damaging to the tissues. Normal saline solution should be used to clean the stoma.

Choice B:

B) is not necessary unless they are soiled or loose. Frequent changes may irritate the skin and increase the risk of infection. Straps should be changed only when needed.

Choice C:

C) is a crucial step in tracheostomy care. Signs of infection may include redness, swelling, discharge, or foul odor. Prompt identification and treatment of infection are essential to prevent complications.

Choice D:

Choice E:

E) is essential after tracheostomy care to maintain cleanliness and protect the stoma. Proper dressing helps prevent infection and skin breakdown. Suctioning a tracheostomy tube is a sterile, invasive technique that requires a nurse or a respiratory therapist. It is done to remove secretions from the tube and prevent obstruction, infection, or hypoxia. The steps of suctioning a tracheostomy tube are:

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Question 9:

A nurse is preparing to suction a tracheostomy tube for a patient. What position should the nurse place the patient in?

A. Prone position. B. Supine position. C. Semi-Fowler's position. D. Trendelenburg position.

Answer and Explanation

Choice A:

Prone position (Choice A) would not be suitable for suctioning a tracheostomy tube as it may impede breathing and proper access to the tracheostomy site.

Choice B:

Supine position (Choice B) is not the optimal position for tracheostomy suctioning. Semi-Fowler's position is preferred as it allows better lung expansion and facilitates the suctioning procedure.

Choice D:

Trendelenburg position (Choice D) is not appropriate for tracheostomy suctioning. Trendelenburg position is typically used for certain cardiovascular conditions and not for tracheostomy care.

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Question 10:

(Select all that apply). A nurse is gathering equipment for suctioning a tracheostomy tube. Which of the following items should the nurse include in the setup?

A. Sterile gloves. B. Sterile water or saline. C. Pulse oximeter. D. Sphygmomanometer.

Answer and Explanation

Choice A:

Sterile gloves are essential for aseptic technique during tracheostomy suctioning to prevent the introduction of infection. However, they are not included in the setup, as they are worn by the nurse performing the procedure.

Choice B:

Sterile water or saline is necessary for suctioning to moisten the suction catheter and facilitate the removal of secretions without causing trauma to the airway. Therefore, it should be included in the setup.

Choice C:

A pulse oximeter is used to monitor the patient's oxygen saturation and is not directly related to tracheostomy suctioning. While continuous monitoring of oxygen saturation is essential during and after the procedure, it is not a part of the setup.

Choice D:

A sphygmomanometer is used to measure blood pressure and is unrelated to tracheostomy suctioning. It is not required for this procedure.

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Question 11:

A nurse is about to insert the suction catheter into the patient's tracheostomy tube. The patient says, "I'm feeling anxious about this.”What would be the nurse's appropriate response?

A. "Don't worry, this won't take long.". B. "I understand, but we need to do this to clear your airway.". C. "You're going to be just fine, trust me.". D. "Let's skip this procedure for now, and we'll try later.".

Answer and Explanation

Choice A:

This response is dismissive of the patient's feelings and may increase their anxiety. It does not address the patient's concern appropriately.

Choice B:

This response acknowledges the patient's anxiety and provides a clear explanation for the necessity of the procedure. It is empathetic and supportive while also emphasizing the importance of the intervention.

Choice C:

This response is not entirely reassuring and may not be accurate. Simply asking the patient to trust the nurse without explaining the procedure further may not alleviate the patient's anxiety.

Choice D:

Skipping the procedure without a valid reason may compromise the patient's airway and respiratory function. Postponing essential procedures is not appropriate unless there are specific clinical reasons for doing so.

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Question 12:

A patient with a tracheostomy tube expresses concern about the procedure and asks, "Is this going to hurt?”. Which response by the nurse is most appropriate?

A. "It might hurt a little, but it will be over quickly.". B. "You won't feel any pain during the procedure.". C. "It's going to be very painful, but it's necessary.". D. "Let's administer some pain medication before we start.".

Answer and Explanation

Choice A:

This response acknowledges the patient's concern and provides a realistic expectation of potential discomfort during the procedure. It offers reassurance that any pain experienced will be brief.

Choice B:

This response is not entirely accurate. While the procedure itself may not cause pain, some patients may experience discomfort during tracheostomy suctioning due to the sensation of suction in the airway.

Choice C:

This response is not appropriate as it exaggerates the potential pain, causing unnecessary distress to the patient.

Choice D:

Administering pain medication solely for the discomfort associated with tracheostomy suctioning is not standard practice. Pain medication should only be given for clinically significant pain or as part of a larger pain management plan.

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Question 13:

A nurse is suctioning a tracheostomy tube and wants to ensure proper oxygenation between attempts. How long should the nurse wait between each suctioning attempt?

A. At least 10 seconds. B. At least 30 seconds. C. At least 1 minute. D. At least 3 minutes.

Answer and Explanation

Choice A:

Waiting for at least 10 seconds between each suctioning attempt may not provide sufficient time for the patient's oxygenation to stabilize. This short duration might not allow the patient's oxygen levels to return to an adequate baseline, leading to potential hypoxia during subsequent suctioning attempts.

Choice B:

Waiting for at least 30 seconds between suctioning attempts allows more time for the patient's oxygen levels to recover. This duration strikes a balance between preventing hypoxia and removing secretions effectively. It also helps minimize the risk of complications associated with frequent or rapid suctioning.

Choice C:

Waiting for at least 1 minute between suctioning attempts might be too long, especially if the patient is experiencing respiratory distress or has excessive secretions. Delaying suctioning for this duration could lead to an accumulation of secretions, potentially compromising the airway and causing distress for the patient.

Choice D:

Waiting for at least 3 minutes between suctioning attempts is too long and not clinically appropriate. This extended time may lead to increased secretion buildup and potential airway obstruction, especially in patients with excessive secretions or those who are critically ill.

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Question 14:

A nurse is preparing to suction a patient's tracheostomy tube and observes signs of infection around the stoma. What action should the nurse take?

A. Proceed with the suctioning as planned. B. Report the findings to the healthcare provider. C. Clean the area with hydrogen peroxide before suctioning. D. Use an antiseptic solution to cleanse the stoma.

Answer and Explanation

Choice A:

Proceeding with the suctioning as planned when signs of infection are present around the tracheostomy stoma can be detrimental to the patient's health. Suctioning in the presence of infection can exacerbate the infection, spread bacteria, and lead to more serious complications.

Choice B:

Reporting the findings of infection to the healthcare provider is the correct action. The healthcare provider needs to assess the infection and determine the appropriate course of action, such as prescribing antibiotics or adjusting the suctioning regimen to prevent further complications.

Choice C:

Cleaning the area with hydrogen peroxide before suctioning is not recommended. Hydrogen peroxide can be harsh on the skin, and using it around the stoma may cause irritation and delay healing. Moreover, cleaning the area without addressing the infection itself does not address the underlying issue.

Choice D:

Using an antiseptic solution to cleanse the stoma is not the appropriate action in the presence of infection. Antiseptic solutions are designed to prevent infections, not treat existing ones. Using an antiseptic could further irritate the area and delay proper treatment for the infection.

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Question 15:

Which of the following patients would require a higher suction pressure during tracheostomy tube suctioning?

A. A neonate with a tracheostomy tube. B. An adult with a tracheostomy tube. C. A child with a tracheostomy tube. D. An infant with a tracheostomy tube.

Answer and Explanation

Choice A:

A neonate with a tracheostomy tube would require lower suction pressure compared to an adult. Neonates have smaller and more delicate airways, making them more susceptible to damage from high suction pressures. Using lower suction pressures is essential to ensure the safety and well-being of the neonate.

Choice B:

An adult with a tracheostomy tube may require higher suction pressure compared to other age groups. Adults generally have larger airways and more significant secretion production. Adequate suction pressure is necessary to effectively remove secretions and maintain airway patency.

Choice C:

A child with a tracheostomy tube would typically require lower suction pressure than an adult. Children have smaller airways than adults, and using high suction pressures could cause harm and discomfort.

Choice D:

An infant with a tracheostomy tube would require lower suction pressure compared to an adult. Infants have smaller airways and are more sensitive to changes in pressure. Using higher suction pressure could cause trauma to the delicate tissues in their airways.

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Question 16:

(Select all that apply). A nurse is suctioning a tracheostomy tube for a patient. Which of the following actions are correct during the suctioning process?

A. Apply continuous suction while inserting the catheter. B. Rinse the catheter with sterile saline between each attempt. C. Limit suctioning attempts to three per session. D. Withdraw the catheter gently while applying suction.

Answer and Explanation

Choice A:

Applying continuous suction while inserting the catheter can cause trauma to the tracheal mucosa and increase the risk of bleeding and infection.

Choice B:

Rinsing the catheter with sterile saline between each suctioning attempt helps maintain aseptic technique, preventing the introduction of microorganisms into the airway.

Choice C:

Limiting suctioning attempts to three per session reduces the risk of hypoxia and mucosal damage, ensuring adequate oxygenation and preventing complications.

Choice D:

Withdrawing the catheter gently while applying suction prevents damage to the tracheal walls and minimizes the risk of bleeding.

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Question 17:

A nurse is caring for a patient with a tracheostomy. The patient suddenly develops bright red bleeding from the tracheostomy stoma, pulsation of the tracheostomy tube in synchrony with the heartbeat, hypotension, and tachycardia. What should the nurse do first?

A. Notify the health care provider immediately. B. Apply direct pressure to stop bleeding. C. Administer fluids and blood products as ordered. D. Ensure proper positioning and alignment of the tracheostomy tube.

Answer and Explanation

Choice A:

While notifying the healthcare provider is essential, the priority action in this situation is to stop the bleeding to prevent further complications.

Choice B:

Applying direct pressure to the tracheostomy stoma is the first action the nurse should take to control the bleeding and stabilize the patient.

Choice C:

Administering fluids and blood products may be necessary later, but it is not the first action to take when dealing with active bleeding.

Choice D:

Ensuring proper positioning and alignment of the tracheostomy tube is important, but it is not the priority in this critical situation.

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Question 18:

A client has a tracheostomy and is at risk of tracheoesophageal fistula (TEF). Which of the following interventions should the nurse implement to prevent TEF? Select all that apply:

A. Maintain proper cuff pressure. B. Progress to a deflated cuff or cuffless tube as soon as possible. C. Perform tracheal dilation or surgical intervention if needed. D. Use a small soft feeding tube instead of a nasogastric tube for tube feedings. E. Administer oxygen by mask to prevent hypoxemia.

Answer and Explanation

Choice A:

Maintaining proper cuff pressure prevents pressure-related injuries and potential tracheoesophageal fistula (TEF) formation.

Choice B:

Progressing to a deflated cuff or cuffless tube reduces the risk of TEF by minimizing pressure on the tracheal tissues.

Choice C:

Tracheal dilation or surgical intervention may be necessary if TEF has already developed but is not a preventive measure.

Choice D:

Using a small soft feeding tube instead of a nasogastric tube for tube feedings reduces the risk of trauma to the tracheal tissues and lowers the risk of TEF formation.

Choice E:

Administering oxygen by mask may be necessary for oxygenation, but it is not specifically related to preventing tracheoesophageal fistula formation.

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Question 19:

A nurse is providing care for a patient with a tracheostomy who complains of increased coughing, difficulty breathing, and stridor. The nurse assesses that the tracheal lumen has narrowed due to scar formation. Which statement by the nurse is appropriate?

A. "This might be due to an infection. Let's monitor for any fever or increased secretions.". B. "You should try to expectorate secretions frequently to help improve your breathing.". C. "Let's ensure the tracheostomy tube is securely positioned in the midline to prevent further narrowing.". D. "We might need to use a larger tracheostomy tube to maintain an air seal at the stoma.".

Answer and Explanation

Choice A:

This choice is not appropriate because increased coughing, difficulty breathing, and stridor suggest a mechanical issue rather than an infection. Monitoring for fever or increased secretions is not addressing the potential cause of the symptoms.

Choice B:

This choice is not appropriate for the presented situation. Expectorating secretions may not directly address the narrowed tracheal lumen due to scar formation, and it is not the primary intervention needed.

Choice C:

This is the correct choice. Ensuring the tracheostomy tube is securely positioned in the midline can help prevent further narrowing of the tracheal lumen. Proper alignment and securing of the tube can optimize airflow and reduce complications related to scar formation.

Choice D:

Using a larger tracheostomy tube may not be the most appropriate action in this situation. Enlarging the tube may not be necessary and could potentially cause other complications. It's better to ensure proper positioning and consider other interventions before resorting to a larger tube.

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Question 20:

A client with a tracheostomy is at risk of developing tracheomalacia. Which statement by the client indicates a need for further education?

A. "I should inform the nurse if I notice any food particles in my tracheal secretions.". B. "I may need a larger tracheostomy tube to prevent an air leak at the stoma.". C. "I should try to minimize the time the cuff is inflated to prevent tracheal dilation.". D. "I will monitor the cuff pressure and air volumes closely for any changes.".

Answer and Explanation

Choice A:

This statement is correct. The client should inform the nurse if they notice any food particles in their tracheal secretions as it could indicate aspiration and require immediate attention.

Choice B:

This statement indicates a need for further education. A larger tracheostomy tube to prevent an air leak at the stoma is not an appropriate intervention for tracheomalacia. Tracheomalacia is the weakening of the tracheal cartilage, and a larger tube would not address this underlying issue.

Choice C:

This statement is also incorrect. Minimizing the time the cuff is inflated may be beneficial to prevent tracheal stenosis but would not prevent tracheomalacia, which is a different condition altogether.

Choice D:

This statement is correct. Monitoring cuff pressure and air volumes closely is essential to prevent complications and ensure appropriate cuff inflation.

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Question 21:

A nurse is educating a patient with a tracheostomy on communication methods. Which information should the nurse include?

A. How to perform effective oral communication with the tracheostomy tube in place. B. How to use electronic devices for communication in case of emergency. C. How to perform written communication with healthcare providers and family members. D. How to use speaking valves to facilitate speech with the tracheostomy tube in place.

Answer and Explanation

Choice A:

This choice is not the most relevant information for the patient with a tracheostomy regarding communication methods. Effective oral communication with the tube in place may be challenging, and other options should be explored.

Choice B:

While electronic devices can be helpful for communication, they may not be the most practical option for a patient with a tracheostomy, especially during emergencies when devices may not be readily available.

Choice C:

This choice is somewhat relevant but not the most appropriate. While written communication is an option, it may not be the primary method used with a tracheostomy.

Choice D:

This is the correct choice. Teaching the patient how to use speaking valves to facilitate speech with the tracheostomy tube in place can significantly improve communication. Speaking valves allow airflow during inhalation and redirect exhaled air through the vocal cords, enabling speech while maintaining a closed respiratory system during exhalation. This is a valuable communication method for patients with tracheostomies.

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Tracheostomy care

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