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Alison Luckett Senior lecturer, School of Nursing, University of Central Lancashire, Preston, England Why you should read this article:
Tracheostomy insertion and management is increasingly common in critical care units and general wards. Therefore, it is important that nurses are equipped with the appropriate knowledge and skills to meet the individual needs of patients with a tracheostomy safely and competently. This article aims to enhance nurses’ understanding of the potential challenges that patients with a tracheostomy may experience, and to guide nurses in providing effective care and support to these patients. It outlines the care that should be provided for patients with a tracheostomy who are critically ill, including methods of humidification and endotracheal suctioning. This article also discusses the effects that a tracheostomy may have on a patient’s communication and psychological well-being, and explains the actions that nurses should take in an emergency and if complications occur. Nursing Standard. doi: 10.7748/ns.2019.e11297 Citation Billington J, Luckett A (2019) Care of the critically ill patient with a tracheostomy. Nursing Standard. doi: 10.7748/ns.2019.e11297 Peer review This article has been subject to external double-blind peer review and checked for plagiarism using automated software @Johnjbilly2 Correspondence
Conflict of interest None declared Published online: 07 January 2019 Want to read more?Already subscribed? Log inORUnlock full access to RCNi Plus todaySave over 50% on your first 3 monthsYour subscription package includes:
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PROVIDER ACCREDITATIONLippincott Williams & Wilkins, publisher of Nursing 2009 journal, will award 2.0 contact hours for this continuing nursing education activity. Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Lippincott Williams & Wilkins is also an approved provider of continuing nursing education by the District of Columbia and Florida #FBN2454. Lippincott Williams & Wilkins home study activities are classified for Texas nursing continuing education requirements as Type 1. This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.0 contact hours. Your certificate is valid in all states. GENERAL PURPOSE To provide nurses with an overview of the nursing care for a patient with a tracheostomy. LEARNING OBJECTIVES After reading the preceding article and taking this test, you should be able to: 1. Identify indications for a tracheostomy. 2. Differentiate between ST and PDT. 3. Describe nursing interventions for a patient with a tracheostomy. 1. A patient may need a tracheostomy due to a. nasal polyps. b. bronchodilation. c. esophageal fissures. d. long-term mechanical ventilation. 2. Current guidelines recommend a tracheostomy instead of an ET tube a. to lower the risk of complications. b. for patients needing any type of mechanical ventilation. c. for patients needing an artificial airway for more than 21 days. d. for patients needing an artificial airway for 10 days or less. 3. Advantages of a tracheostomy over an ET tube include a. less risk of infection. b. less need for direct patient care. c. improved patient comfort. d. greater cost-effectiveness. 4. Which statement is true about PDT? a. It's also called an open tracheostomy. b. It can be performed with local anesthesia. c. Any patient with an ET is a candidate for PDT. d. PDT must be performed in an OR. 5. One benefit of PDT over ST is a. lower risk of inadvertent decannulation. b. less need for humidification. c. lower costs. d. less suctioning requirements. 6. An absolute contraindication to PDT is a. tracheal obstruction. b. unfavorable neck anatomy. c. need for assistive ventilation. d. need for emergency airway management. 7. Uncuffed tracheostomy tubes a. provide aspiration protection. b. don't allow for airway clearance. c. facilitate positive-pressure ventilation. d. are used mostly for infants and children. 8. Adjustable flange tracheostomy tubes a. are used for long-term placement. b. have an opening in the tube's posterior portion. c. are appropriate for patients with large necks. d. allow for assessment of the patient's ability to breathe. 9. Which of the following is a long-term complication of ST? a. pneumothorax b. tracheal necrosis c. posterior tracheal wall injury d. air embolism 10. If inadvertent decannulation has occurred, call the emergency response team and a. force the tracheostomy tube back into the stoma. b. hold oxygen tubing in front of the stoma. c. use a bag-valve mask device to gently ventilate the patient. d. cover the stoma with your gloved hand. 11. Perform tracheostomy care a. every 4 to 8 hours. b. every 12 to 16 hours. c. every 2 to 3 days. d. once a week. 12. If ventilation through the upper airway is impossible after inadvertent decannulation, ventilate your patient through the a. nose. b. mouth. c. bag-valve mask. d. stoma. 13. Suction a patient with a tracheostomy a. only when he needs it. b. every 2 hours. c. every 4 hours. d. every 8 hours. 14. Limit tracheostomy suctioning to a. 4 or 5 passes for each suctioning session. b. 10 to 15 seconds or less for each suctioning pass. c. 40 seconds for each suctioning pass. d. a suction pressure of 180 mm Hg. 15. Because the tracheostomy tube can affect the patient's ability to swallow, a. keep him on a clear liquid diet. b. provide parenteral nutrition. c. arrange for consultation with a nutritionist. d. suction the tube before and after every meal. 16. What's the maximum acceptable tracheostomy tube cuff pressure? a. 10 mm Hg b. 25 mm Hg c. 50 mm Hg d. 75 mm Hg 17. A complication of low cuff pressure is a. silent aspiration. b. tracheal fistula. c. tracheal erosion. d. esophageal bleeding. 18. High cuff pressure is commonly caused by a tracheostomy tube that's a. too long. b. too short. c. too large in diameter. d. too small in diameter.  Which action will the nurse include when doing tracheostomy care?Apply eye protection. Perform hand hygiene, apply non-sterile gloves. Suction the oropharynx if indicated to remove any pooled secretions before cuff deflation to minimize risk of aspiration. Perform routine tracheostomy tube suction procedure.
When caring for a client with a tracheostomy the nurse would perform?When caring for a client with a tracheostomy, the nurse would perform which recommended action? Clean the wound around the tube and inner cannula at least every 24 hours. Assess a newly inserted tracheostomy every 3 to 4 hours. Use gauze dressings over the tracheostomy that are filled with cotton.
Which action should the nurse take first when performing tracheostomy care?Which nursing action must be taken first? The first nursing action for a patient following an airway procedure is to assess the patient's respiratory status; this requires auscultation of the lungs. Suction is not needed if the lungs are clear to auscultation.
What are eight important safety measures when caring for the client with tracheostomy?Perform dressing changes and tracheostomy care every 8 hours and as needed. Use sterile technique for tracheostomy suctioning. Use clean technique for tracheostomy care. Use humidified oxygen or air.. Tracheostomy ties must be secure.. Secure new ties before removing old ties.. Assess patient for restlessness/confusion.. |
Which action would the nurse complete when caring for a client with a tracheostomy
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