Campus Collusion
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Upper Respiratory ProblemsMedical Surgical Nursing

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What should you do if a tracheostomy cuff pressure is too high or low?
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Add or remove pressure to the pilot tubing using a syringe and stopcock, then verify pressure is within acceptable range using a manometer.
What should be reported to the physician related to care of an inflated tracheostomy cuff?
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An inability to keep the cuff inflated or the need to use progressively larger volumes of air. The trachea may have dilated requiring larger tubing, or the inflation valve may be damaged
A crack in the inflation valve of a cuff of a tracheostomy can be temporarily managed by clamping the tubing with a _________, however, it should be changed within __________.
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A hemostat can clamp it, the tubing should be changed within 24 hours.
When using a fenestrated tracheostomy tube, a patient should be assessed for aspiration prior to removing the inner cannula. How is this assessed?
Show Answer
Deflate the cuff and note any coughing. Have the patient swallow grape juice or water with blue food coloring added (approximately 30 mL of liquid). When the patient coughs, or is suctioned, observe secretions for coloring.
A nurse should not insert a decannulation plug in a fenestrated tracheostomy tube until...
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The cuff is deflated and the inner cannula removed. Otherwise, the patient could go into respiratory arrest
A __________ tracheostomy tube has two tubings, one leading to the cuff and one leading to an opening above the cuff, allowing air from an air source to flow up and over vocal cords.
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Speaking
How long should a patient wait for a stoma to close around a speaking tracheostomy tube and begin using it?
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2 days
If a patient with a speaking cuff wants to actually speak, the port should be connected to oxygen set for the lowest flow, typically ______ L, that allows for speech.
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4-6 L
What happens if oxygen flow rates are too high for a patient with a tracheostomy?
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Mucosal dehydration
How does a patient speak when using a speaking tracheostomy?
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They cover the port adapter. They should speak in short sentences, longer ones causes the voice to become a whisper
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Which type of tracheostomy tube requires no cuff monitoring?
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Bivona Fome Cuff/a trach with a foam filled cuff
What is the procedure for cuff inflations of a trach with a foam filled cuff?
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Withdraw all air from the cuff prior to insertion using a 20 mL syringe. Cap the pilot balloon to prevent reentry of air. Insert it, remove cap and allow it to passively inflate
A ______ should be placed on a trach tube with a foam filled cuff to alert staff.
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A tag to alert staff not to use air on the tubing or cuff
Which type of trach tube is a good choice for patients who require an inflated cuff at home?
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A trach tube with a foam filled cuff
How often should a tracheostomy with a Bivona-Fome Cuff be changed when used in a home setting for a patient on mechanical ventilation?
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Once a month
How often should a tracheostomy with a foam filled cuff be removed and assessed for integrity and ease of inflation?
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Daily
What conditions indicate a foam filled cuff is no longer intact or requires new tubing?
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If it is hard to deflate, the tubing needs to be changed If it has air with aspirates, it is no longer patent
How often should a patient be assessed to determine if they need their tracheostomy tube suctioned?
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Every two hours
What are indications that a patient needs their tracheostomy tube suctioned?
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Coarse crackles or rhonchi over large airways, moist cough, increase in peak inspiratory pressure while on a mechanical ventilator, restless/agitation accompnaied by a decreased SpO2 or PaO2
T/F All patients with a tracheostomy should be routinely sunctioned (q2h) to maintain a patent airway.
Show Answer
False, they shouldn't be routinely suctioned if they are able to clear their own secretions with coughing
How large should a suction catheter for a tracheostomy be?
Show Answer
No more than 1/2 the lumen of the trach tube
  
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