Double cannula: outer cannula acts as sleeve for inner cannula. Inner cannula can be removed for cleaning. Fenestrated tubes: have small opening in outer cannula that allows some air to escape through larynx A one-way valve box can be fitted into the tube opening allowing air to be inhaled through trach opening, but the valve closes when patient exhales allowing air to pass through larynx so patient can talk Trachs
o Obturator : insertion guide o Cuffed tracheostomy tube: small balloon encircling end Reduces chance of aspiration Risk of necrosis if overinflated d/t pressure on trachea Used if patient requires mechanical ventilation o Foam‑cuffed tracheostomy tube: sponge material at end o Allows for compression and expansion of the cuff with tracheal movement o Minimal pressure exerted on tracheal wall, decreasing risk of tissue damage or necrosis Trachs cont.
ASSESS PATENT AIRWAY!!!!!!! Before suctioning to assess the need What are s/s that patient needs suctioning? Afterward to verify that the procedure successfully cleared the airways Tracheal suctioning how do we do it? Nursing Management: Tracheostomy – PATENT AIRWAY
Clean the stoma daily. Replace the slit gauze pad around the tube frequently. Have two people help change the ties. Prepare the new ties before loosening the old ones. Hold the tube securely in place while the ties are loose. Stand to the side of the stoma when providing care. Home Care of a Tracheostomy
Teach patient to swallow to maintain adequate nutritional status. Practice with soft or semisolid foods. Supervise initial practice till swallowing without choking is mastered. Offer encouragement for each effort. See nutritional considerations pg 286 Eating After Tracheostomy
Psychological support Appropriate encouragement and practice Continued reassurance is needed both verbally and by actions that show the nurse is aware of the pt’s apprehension and readily available should help be needed Impaired communication: Will need means of communication: i.e. pad and pencil, dry erase Passey-Muir speaking tracheostomy valve Esophageal speech Swallow air and then move it forceably back through esophagus, then coordinate lip and tongue movements with sound produced by the air passing over vibrating folds of the esophagus Implementation: Tracheostomy
Rehabilitation May need to wear a scarf when going outside in the cold. . . WHY? Evaluation Community care Home care Extended care Other Nursing Considerations
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- Fall '19
- Common cold, cancer of the larynx, Nasopharyngitis