Tracheostomy

Prepared by:
Krizza S. Camano

PRE TEST

1. The nurse needs to suction a clients tracheostomy. Which client position does the nurse use to
promote deep breathing and coughing during suctioning?
a) sims position
b) supine position
c) side-lying position
d) semi-fowlers position
2. The nurse is performing tracheal suctioning. Which action is essential to prevent hypoxemia during
suctioning?
a. Removal of oral and nasal secretions.
b. Encouraging the client to deep breathe and cough.
c. Administer 100% oxygen before suctioning.
d. Auscultate the lungs.
3. The nurse is caring for a male client who recently underwent a tracheostomy. The first priority when
caring for a client with a tracheostomy is:
A.Helping him communicate
B.Keeping his airway patent
C.Encouraging him to perform activities of daily living
D.Preventing him from developing an infection
4. It is use for clients needing long term airway support
a. Tracheostomy
b. Colostomy
c. Bronchoscopy
d. endoscopy

5. What are the goals of tracheostomy care?

a. To maintain patent airway
b .To maintain skin integrity
c. to prevent infection
d. To prevent displacement
e. All of the above
6. On daily cleaning of a tracheostomy, the client coughs and displaces the tracheostomy tube. The nurse could
have avoided this by
A)placing an obturator at the clients bedside
B)having another nurse assist with the procedure
C)fastening clean tracheostomy ties before removing old ties
D)Withdraw catheter in a circular motion
7. Why does tracheostomy usually performed?
a. to bypass an obstructed upper airway;
b. to clean and removesecretionsfrom the airway;
c. to more easily, and usually more safely, deliver oxygen to the lungs.
d. All of the above
8. This is/are the Early Complicationsthat may arise during thetracheostomy procedure or soon thereafter
include:
a. Bleeding
b. pneumothorax
c. pneumomediastinum
d. A & B only
e. All of the above

9. The risks associated with tracheostomies are higher in which of the following groups of patients?
a. children, especially newborns and infants
b. smokers
c. alcohol abusers
d. diabetics
e. B &C only
f. All of the above

1. D
If not contraindicated, before suctioning a tracheostomy, the client is placed in semi-Fowlers
position to promote deep breathing, maximum lung expansion, and productive coughing. In this
position, gravity pulls downward on the diaphragm, which allows greater chest expansion and lung
volume. The lateral position, the supine position, or the Sims position is unlikely to allow for easy
visualization of the tracheostomy or easy access of the suction catheter; in addition, the supine
position increases the risk of client aspiration.

2. C
-100% oxygen is given before and after suctioning to prevent hypoxemia.

3. B
Maintaining a patent airway is the most basic and critical human need. All other interventions are
important to the clients well-being but not as important as having sufficient oxygen to breathe.
4. A.
- A tracheostomy is an opening into the trachea through the neck. A tube is usually inserted in this
opening and thus an artificial airway is created.
5. E
- those are the goals why performing tracheostomy care is important
6. C.
Fastening clean tracheostomy ties before removing old ones will ensure that the tracheostomy is
secured during the entire cleaning procedure. The obturator is useful to keep the airway open only
after the tracheostomy outer tube is coughed out. A second nurse is not needed. Changing the
position may not prevent a dislodged tracheostomy.

7. D

Atracheostomy is usually done for one of three reasons:

to bypass an obstructed upper airway;
to clean and removesecretionsfrom the airway;
to more easily, and usually more safely, deliver oxygen to the lungs.
All tracheostomies are performed due to a lack of air getting to the lungs. There are many reasons why
sufficient air cannot get to the lungs.

8.E.

Early Complicationsthat may arise during thetracheostomy procedure or soon thereafter include:
Bleeding
Air trapped around the lungs (pneumothorax)
Air trapped in the deeper layers of the chest(pneumomediastinum)
Air trapped underneath the skin around the tracheostomy (subcutaneousemphysema)
Damage to the swallowing tube (esophagus)
Injury to the nerve that moves the vocal cords (recurrent laryngeal nerve)
Tracheostomy tube can be blocked by blood clots, mucus or pressure of the airway walls. Blockages can
be prevented by suctioning, humidifying the air, and selecting the appropriate tracheostomy tube.

9. F.
high risk groups:

children, especially newborns and infants

smokers

alcohol abusers

diabetics

immunocompromised patients

persons with chronic diseases or respiratory infections

persons taking steroids or cortisone

Post test
1. The nurse has completed tracheostomy care for a client whose tracheostomy tube has
a nondisposable inner cannula. Immediately before reinserting the inner cannula,
which is the best nursing action for the nurse to complete?
a) rinsing it in sterile water
b) suctioning the clients airway
c) tapping it against a sterile basin
d) drying it with loosely woven gauze
2. A tracheostomy tube is inserted in a patient who is in respiratory distress as a result
of pneumonia. The family asks why the tube is inserted. What should the nurse
include when explaining to the patient and family? The purpose of a tracheostomy
tube is to
a. Decrease the clients anxiety by increasing the size of the airway.
b. Provide increased cerebral oxygenation thereby preventing further respiratory
depression.
c. Facilitate nursing care since tracheal tubes have fewer side effects than
nasotracheal tubes.
d. Provide more controlled ventilation and ease removal of secretions the client is
unable to handle.

3. An adult is about to have a tracheostomy performed. Which action is of highest priority for the
nurse before the procedure is done?
a. Establishing means of postoperative communication.
b. Drawing blood for serum electrolytes and blood gases.
c. Inserting an indwelling catheter and attaching it to dependent drainage.
d. Doing a surgical prep of the neck and upper chest wall.
4. A female client has a tracheostomy but doesnt require continuous mechanical ventilation. When
weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the
tube for:
A. 5 to 60 seconds.
B. 5 to 20 minutes.
C. 30 to 40 minutes.
D. 45 to 60 minutes
5. Nurse Julia is caring for a client who has a tracheostomy and temperature of 103 F (39.4 C).
Which of the following interventions will most likely lower the clients arterial blood oxygen
saturation?
A.Endotracheal suctioning
B. Encouragement of coughing
C. Use of cooling blanket
D. Incentive spirometry

6. While changing the tapes on a tracheostomy tube, the male client coughs and the tube is dislodged.
The initial nursing action is to:
a. Call the physician to reinsert the tube.
b. Grasp the retention sutures to spread the opening.
c. Call the respiratory therapy department to reinsert the tracheotomy.
d. Cover the tracheostomy site with a sterile dressing to prevent infection.
7. Delayed Complicationsthat may result after longer-term presence of a tracheostomy include:
a. tracheomalacia
b. tracheo-esophageal fistula
c. Development of bumps (granulation tissue) that may need to be surgically removed before
decannulation (removal of trach tube)
d. C only
E. All of the above
8. Which of the following techniques is correct for tracheostomy care of a client at home?
a. Septic
B. Antiseptic
c. Medically aseptic
d. Surgically aseptic

1. C
After washing and rinsing the inner cannula, the nurse taps it dry to remove large water
droplets; then, the nurse inserts the cannula into the tracheostomy and turns it clockwise to lock
it into place. The nurse avoids shaking the inner cannula to prevent contamination. A wet cannula
should not be inserted into a tracheostomy because water is a lung irritant. Suctioning is not
performed without an inner cannula in place. Fine-mesh sterile gauze may be used to dry the
inner cannula because it is less likely than loosely woven gauze to deposit debris on the cannula.
2. D
- This is the purpose of a tracheostomy. The client may become less anxious when she is no
longer hypoxic. However, relief of anxiety is not the purpose of a tracheostomy tube.
3. A
-A tracheostomy makes a client unable to speak. Other means of communication will be
necessary.
4. B
-Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, and
then gradually lengthen this interval according to the clients respiratory status. A client who
doesnt require continuous mechanical ventilation already is breathing without assistance, at
least for short periods; therefore, plugging the opening of the tube for only 15 to 60 seconds
wouldnt be long enough to reveal the clients true tolerance to the procedure. Plugging the
opening for more than 20 minutes would increase the risk of acute respiratory distress because
the client requires an adjustment period to start breathing normally.

5. A.
- Endotracheal suctioning removes secretions as well as gases from the airway and lowers the
arterial oxygen saturation (SaO2) level. Coughing and incentive spirometry improves oxygenation
and should raise or maintain oxygen saturation. Because of superficial vasoconstriction, using a
cooling blanket can lower peripheral oxygen saturation readings, but SaO2 levels wouldnt be
affected
6. B
- Grasp the retention sutures to spread the opening.
7. E

Delayed Complicationsthat may result after longer-term presence of a tracheostomy include:

Thinning (erosion) of the trachea from the tube rubbing against it (tracheomalacia)
Development of a small connection from the trachea (windpipe) to the esophagus (swallowing tube)
which is called a tracheo-esophageal fistula
Development of bumps (granulation tissue) that may need to be surgically removed before
decannulation (removal of trach tube) can occur
Narrowing or collapse of the airway above the site of the tracheostomy, possibly requiring an
additional surgical procedure to repair it
Once the tracheostomy tube is removed, the opening may not close on its own. Tubes remaining in
place for 16 weeks or longer are more at risk for needing surgical closure

8. C
at home, the procedure of tracheostomy is clean or medically aseptic because of the cost and
difficulty of performing a completely sterile procedure.