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Nursing Interventions for Tracheostomy Care

- The nursing interventions for tracheostomy care include:

  • Assessing the patient’s respiratory status, vital signs, oxygen saturation, and level of consciousness frequently.
  • Monitoring the position, patency, and security of the tube and ensuring that it is not displaced or dislodged.
  • Changing the dressing around the stoma daily or as needed using a sterile technique and observing for signs of infection, bleeding, or skin breakdown.
  • Cleaning the stoma and the flange with normal saline or sterile water using cotton swabs or gauze pads.
  • Changing the ties or straps when they are soiled, wet, or loose using a square knot and leaving enough space for one finger between the tie and the neck.
  • Providing humidification and hydration to prevent drying and crusting of secretions.
  • Performing tracheostomy care every 8 to 12 hours or as needed using a sterile technique and following these steps:
    • Gather equipment and supplies such as gloves, goggles, mask, gown, sterile towel, sterile gloves, sterile water or saline, hydrogen peroxide, suction catheter, suction machine, tracheostomy cleaning kit, new dressing, new ties or straps, and bag-valve-mask (BVM) ventilator system connected to an oxygen source.
    • Explain the procedure to the patient and obtain consent if possible.
    • Position the patient in semi-Fowler’s position with the head slightly hyperextended.
    • Put on gloves, goggles, mask, and gown if necessary.
    • Remove the old dressing and discard it in a moisture-resistant bag.
    • Inspect the stoma for signs of infection, bleeding, or skin breakdown and report any abnormal findings to the health care provider.
    • Remove the inner cannula if present and place it in a container with sterile water or saline.
    • Clean the inner cannula with a brush or pipe cleaner soaked in hydrogen peroxide and rinse it with sterile water or saline.
    • Reinsert the inner cannula and lock it in place.
    • Clean the outer cannula and the flange with cotton swabs or gauze pads soaked in hydrogen peroxide and rinse them with sterile water or saline.
    • Apply a new dressing around the stoma and secure it with tape or clips.
    • Change the ties or straps if needed using a square knot and leaving enough space for one finger between the tie and the neck.
    • Remove gloves and perform hand hygiene.
    • Put on sterile gloves and prepare to suction the tube.

Questions on Nursing Interventions for Tracheostomy Care

Correct Answer is A

Explanation

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.

Correct Answer is C

Explanation

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.

Correct Answer is D

Explanation

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.

Correct Answer is B

Explanation

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.

Correct Answer is B

Explanation

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.

Correct Answer is C

Explanation

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.

Correct Answer is D

Explanation

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

Correct Answer is ["C","D","E"]

Explanation

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:

Correct Answer is C

Explanation

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

Correct Answer is ["B","E"]

Explanation

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

Correct Answer is B

Explanation

<p>Skipping the procedure without a valid reason may compromise the patient&#39;s airway and respiratory function. Postponing essential procedures is not appropriate unless there are specific clinical reasons for doing so.</p>

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.

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.

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.

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.

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

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

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

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.

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

<p>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 mai
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