Unit 1: Trachs and Pegs

About how long can we go without oxygen before damage starts to occur?
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About how long can we go without oxygen before damage starts to occur?
3 minutes.
What is a very serious complication we worry about in terms of gas exchange and nutrition in a stroke patient?
The risk of aspiration.
Why might a dementia patient struggle with nutrition and gas exchange management?
It is common for dementia patients to simply forget to eat, and when the dementia gets serious enough, even forget how to clear their throat if it's necessary to maintain a patent airway.
What is a PEG tube?
A percutaneous endoscopic gastrostomy tube - it is used to provide nutrition to the body when nutrition is otherwise compromised.
What is the difference between a tracheostomy and an endotracheal tube?
A tracheostomy enters the airway through the trachea itself and an endotracheal tube enters the lungs through the mouth.
What is one risk factor of an endotracheal tube that is not as prevalent in a tracheostomy?
The endotracheal tube has a higher infection risk because it passes through the mouth itself, where a lot of bacteria live; tracheostomies bypass the mouth completely.
What is the purpose of a pilot balloon on a trach?
To keep the airway patent or clear of obstruction including secretions.
What is the purpose of a tracheostomy?

(Quiz Question)
To maintain a more permanent airway.
What is the purpose of suctioning a tracheostomy?

(Quiz Question)
To keep the airway clear.
What supplies will the nurse need to perform sterile tracheal suctioning?

(Quiz Question)
1. Gloves
2. Suction Catheter
3. Patient
4. Pulse Oximeter
How many seconds does the nurse suction the patient? (Quiz Question)10 seconds.What data does the nurse need to continually assess when performing tracheal suctioning? (Quiz Question)1. The secretions being removed. 2. The patient's response during the process. 3. The patient's pulse oximetry.What does the PEG tube bypass? (Quiz Question)1. Mouth 2. EsophagusWhat assessment data would the nurse gather to let them know the patient needs suctioned? (Quiz Question)1. The patient is coughing. 2. The patient is having increased agitation. 3. The patient's O2 saturation is decreasing.Which teaching would a nurse include with a client who is learning how to self-administer gastrostomy tube feedings? (Quiz Question)Administering water after the feeding is completed.A child receives a gastrostomy tube feeding every 6 hours. What is the priority nursing intervention? (Quiz Question)Encourage the child to continue to sit up post feeding.A client is being prescribed an Advair (Fluticasone Propionate/Salmeterol) Inaler, 2 puffs daily. This is a new medication. What education would the nurse want to ensure the client understands prior to discharge? (Quiz Question)You will want to rinse your mouth after taking this medication.Match the alarm with the cause: High pressure alarms are caused by __________. Low pressure alarms are caused by __________. (Quiz Question)High pressure alarms are caused by kinked tubing. Low pressure alarms are caused by tubing disconnections.Match the alarm with the correct intervention: We __________ to address high pressure alarms. We __________ to address low pressure alarms. (Quiz Question)We unkink the tubing to address high pressure alarms. We reconnect the tubing to address low pressure alarms.The nurse is assessing a patient who has a tracheostomy with a trach mask connected to humidified O2. The patient has the following vital signs and assessment data: 1. HR: 88 2. O2 Saturation: 87% on 45% FIO2 3. Temperature: 102.7 Axillary 4. Skin color appropriate for race. 5. Crackles in the bases. 6. Wheezes in the uppers. 7. Coughing. 8. Patient keeps mouthing unknown words. 9. Secretions visible at trach site and saturated dressing. What is the nurses priority intervention? (Quiz Question)Sterile SuctioningA patient is taking oral Prednisone 7.5mg BID for 5 days after a pneumonia diagnosis. What teaching would the nurse want to ensure the patient has before being sent home with this prescription? (Quiz Question)1. Make sure to wash hands frequently. 2. Can cause difficulty sleeping.The nurse is assessing a patient who has a tracheostomy with a trach mask connected to humidified O2. The patient has the following vital signs and assessment data: 1. HR: 88 2. O2 Saturation: 87% on 45% FIO2 3. Temperature: 102.7 Axillary 4. Skin color appropriate for race. 5. Crackles in the bases. 6. Wheezes in the uppers. 7. Coughing. 8. Patient keeps mouthing unknown words. 9. Secretions visible at trach site and saturated dressing. What data did the nurse collect that led to the intervention? (Quiz Question)1. O2 saturation: 87% on 45% FIO2. 2. Secretions visible at trach site and saturated dressing. 3. Tracheostomy with a trach mask connected to humidified O2.The patient is prescribed inhaled Fluticasone (Flovent HFA) and inhaled Albuterol (Ventolin HFA) for asthma. How will these medications be administered? (Quiz Question)First administer the albuterol and then 5 minutes later administer the fluticasone.Why would we give Albuterol prior to Fluticasone?Knowing which inhaler is a fast bronchodilator versus and longer acting corticosteroid is important in giving inhalers. Patients are often on multiple inhalers. Give the quick acting bronchodilator first, and when it has had time to open the lungs, give the corticosteroid so it can get deeper into the lungs improving its effectiveness.The nurse is assessing a patient who has a tracheostomy with a trach mask connected to humidified O2. The patient has the following vital signs and assessment data: 1. HR: 88 2. O2 Saturation: 87% on 45% FIO2 3. Temperature: 102.7 Axillary 4. Skin color appropriate for race. 5. Crackles in the bases. 6. Wheezes in the uppers. 7. Coughing. 8. Patient keeps mouthing unknown words. 9. Secretions visible at trach site and saturated dressing. What is the nurses priority concept? (Quiz Question)Gas exchange.A child comes into the school nurse, and wheezes are audible without a stethoscope. The child is complaining of shortness of breath. The nurse gives 2 puffs of the child's Symbicort (Budesonide/Formotrtol Fumarate Dihydrate) inhaler, gave the child of sip of water, spoke in a calm reassuring voice and monitors the child for 15 minutes. What did the nurse do wrong? (Quiz Question)Gave 2 puffs of the child's Symbicort (Budesonide/Formotrtol Fumarate Dihydrate) inhaler.Why would we refrain from giving a child Symbicort with wheezes in their lungs and complaints of shortness of breath?Symbicort is not a rescue inhaler. The nurse needed to give Albuterol for the sudden onset of an asthma attack. Giving a sip of water is appropriate to rinse the mouth, although the nurse may need to wait until the child's symptoms improve and monitoring after giving an inhaler is important to assess whether or no the intervention was effective.How is in-line suctioning different than sterile suctioning?In-line suctioning is a closed system.Why is it important to close the suction valve when we're done suctioning a patient?It might allow the patient to activate the suctioning when it's not in use.When do you know you have gone far enough when inserting suctioning tubing on a tracheostomy patient?You meet resistance or the patient coughs.When sterile suctioning, what solution do we use to help assist in suctioning a tracheostomy patient?Normal saline.Fill in the blanks: The nurse will want to __________ the __________ with the __________ water to get a __________ mixture when performing trach cares.The nurse will want to mix the Hydrogen Peroxide with the sterile water to get a 50/50 mixture when performing trach cares.What is the primary purpose of inner cannula care?To ensure the trach stays parent.Fill in the blank with the correct term: A tracheostomy is inserted through an opening in the neck called a __________.Stoma.What supplies do you need to complete tracheostomy cares and change trach ties?1. A second nurse or partner. 2. Saline solution. 3. New drain sponge.What is the most important thing to remember when changing tracheostomy ties during trach cares?Never let go of the trach (this is why we need two people to perform this care, so one can hold the trach in place while the other performs the cares).What is the first thing we do prior to administration of medications via a PEG tube?Check for residual to see what hasn't yet been absorbed.How much fluid do we flush before and after PEG tube medication administration?Approximately 30 mLs.What is alarm fatigue?Alarm fatigue is essentially hearing alarms so often that we almost become "immune" to hearing them, and don't always respond to them timely - this increases the risk for patient harm and injury if we ignore alarms.What is the purpose of ventilator alarms?To alert caregivers of the potential for harm due to the ineffective delivery of treatment to the patient.What do high pressure alarms signal?There is some kind of obstruction or blockage to the flow of air.What do low pressure alarms signal?There is some kind of leak in the system.What is the first priority action when a ventilator alarm is sounding?Assess the status of the patient.What do we need to ensure is with a tracheostomy patient at all times?A new trash and a resuscitator bag in the instance a trach were to become dislodged or stop working.What are tracheostomy tubes measured in?Trachs are sized in millimeters - we need to know how big a tracheostomy tubing is, because when we suction, the measurement of the catheter tubing is to be half the size of the inner cannula diameter.What kind of outlets should ventilators be plugged into?Always the red emergency outlets - this is in the case the facility were to lose power, the generator will still provide electricity to the red outlets.What are some of the necessary criteria a patient has to present in order to be weaned from a tracheostomy?1. Their prognosis has to be good prior to consideration of removal - is the trach necessary for their survival? 2. The patient has to be able to swallow successfully without aspirating. 3. The patient has to maintain an oxygen level high enough for life, even through the night.