Name: JR Oquendo Set Time: 0830-0930

Worksheet #5 Week Tracheostomy Care Skill Preparation Worksheet

(SUBMIT IN THE Learning Hub Assignment drop box before 0830 Wednesday
Week 16)
Patient Scenario
Mr. Terry Madison is a 75 year-old man and Mrs. Jamie Dixon is a 51 year old woman who have both had neck
surgery for cancer and have a tracheostomy tube in situ. Although conscious, he/she is unable to communicate
verbally. His/Her respirations are noisy and you assess him to determine whether he/she should be suctioned. You
also note that his/her tracheostomy ties and dressing are moist from secretions.
1. What data is important to collect when  Assess for sign and symptoms of infection on the stoma,
assessing Mr. Madison/Mrs Dixon? current pulmonary infections, risk for aspiration,
bleeding, WOB, SOB, O2 saturation, RR, and adventitious
sounds upon auscultation
 Medical history of respiratory distress and COPD

2. How will you gather important information  Assess for sign and symptoms of infection on the stoma,
from Mr. Madison/Mrs Dixon? current pulmonary infections, purulent discharge,
bleeding, WOB, SOB, O2 saturation, RR, and adventitious
sounds upon auscultation
 Put in a referral for SLP for an swallowing assessment for
risk of aspiration
3. What emergency equipment should be  Suction equipment
available at the bedside?  Oxygen equipment with humidification
 Emergency bag
o Two replacement tracheostomy tubes (one of the
same size, and one a smaller size than the current
tube)
o Obturator and spare inner cannula
o 10 ml syringe
o Tracheal tube exchanger
o Tracheal dilators
o Sterile gloves
o Water-soluble lubricant
o If the open stoma is below the sternal notch, an
endotracheal tube as per the ENT physician
4. What data would suggest the need for  Assess for secretions, increased respiratory rate, WOB,
suctioning? SOB, decreased oxygen saturation, noisy respiration,
crackles upon auscultation
5. What specific measures must be taken prior  Ensure emergency equipment at bedside
to suctioning to minimize complications  Follow suction protocol usually around (80~120mmHg)
related to the procedure? and use of aseptic technique

6. How would you prevent hypoxemia during  Ensure to monitor patient oxygen saturation throughout
suctioning? suctioning
 Ensure to use suction between 10~15sec each and allow
patients to breath in between
7. When would it be important to suction Mr.  Ventilation is compromised/blocked due to foreign
Madison/Mrs Dixon’s nasopharynx? obstruction
 Remove secretions such as mucus

8. When suctioning, you note thick, tenacious
secretions. What nursing interventions
should be implemented?
9. What data should be documented after
completing Mr. Madison/Mrs Dixon’s
tracheostomy care?
10. Why is it important to deflate the cuff if a
cuffed tracheostomy is capped?
11. What emergency measures should be
implemented if the:
11.1. Tracheostomy tube falls out
11.2. Airway obstructs
11.3. Patient experiences cardiac or
respiratory arrest
 To stimulate the cough reflex
 Tenacious secretions could potentially be signs of
infections therefore, assess and report to physicians for:
o Redness/swelling/inflammation around the
trach
o Sweeping
o Increased secretions or purulent drainage
o Fever or elevated temp >38oC
o Abnormal breath sounds
o Impaired gas exchange/Decreased oxygen
saturation
 Document suction procedure, patient reaction, amount
of secretion (thickness and color), if normal saline was
instilled, and if sputum samples were sent to the lab.
 Signs and symptoms of infection, bleeding, appearance,
pain, respiratory distress, and obstruction
 Dressing change
 Was inner cannula replaced or just cleaned (chart
solution used to clean and exudate found)
 An inflated cuff would prevent patient from breathing or
prevent any airflow in the upper airway
 Tracheostomy tube falls out
o Partial:
o Deflate cuff if inflated
o Remove inner cannula and insert obturator
o Reinsert tube while holding obturator in place
o Remove obturator and replace inner cannula
o Check correct placement:
 Feel air movement from tube
 Check O2 saturation
 Ensure patient breathing returns
o Ensure tie tapes are secure and cuff is inflated
o Complete:
o Maintain tracheal airway and ventilation with
bag tracheostomy mask
o Protect airway from foreign-body aspiration
o If stoma is <7 days old, use tracheal dilators to
maintain stoma potency
o If not ventilating close stoma and ventilate with
bag and face mask with 100% o2 until code team
arrives
 Airway obstruction
o Place pt supine position to expose neck and check for
tube dislodgement
o Ventilate with ambu-bag but do not force air entry
o Then try suction and instillation of normal saline to
clear cannula
 o Remove inner cannula if suction catheter does not
pass, check patency with new inner cannula
o Ensure deflate cuff
o Call code if unable to ventilate
 CALL CODE
 Try to ventilate patient with the protocol and procedure
above until code team arrives