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Nursing:
doi: 10.1097/01.NURSE.0000358573.79112.f4
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How to care for a patient with a tracheostomy

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INSTRUCTIONS How to care for a patient with a tracheostomy

TEST INSTRUCTIONS

* To take the test online, go to our secure Web site at http://www.nursingcenter.com/ce/nursing.

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* Registration deadline is August 31, 2011.

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PROVIDER ACCREDITATION

Lippincott Williams & Wilkins, publisher of Nursing 2009 journal, will award 2.0 contact hours for this continuing nursing education activity.

Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Lippincott Williams & Wilkins is also an approved provider of continuing nursing education by the District of Columbia and Florida #FBN2454. Lippincott Williams & Wilkins home study activities are classified for Texas nursing continuing education requirements as Type 1. This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.0 contact hours.

Your certificate is valid in all states.

GENERAL PURPOSE To provide nurses with an overview of the nursing care for a patient with a tracheostomy. LEARNING OBJECTIVES After reading the preceding article and taking this test, you should be able to: 1. Identify indications for a tracheostomy. 2. Differentiate between ST and PDT. 3. Describe nursing interventions for a patient with a tracheostomy.

1. A patient may need a tracheostomy due to

a. nasal polyps.

b. bronchodilation.

c. esophageal fissures.

d. long-term mechanical ventilation.

2. Current guidelines recommend a tracheostomy instead of an ET tube

a. to lower the risk of complications.

b. for patients needing any type of mechanical ventilation.

c. for patients needing an artificial airway for more than 21 days.

d. for patients needing an artificial airway for 10 days or less.

3. Advantages of a tracheostomy over an ET tube include

a. less risk of infection.

b. less need for direct patient care.

c. improved patient comfort.

d. greater cost-effectiveness.

4. Which statement is true about PDT?

a. It's also called an open tracheostomy.

b. It can be performed with local anesthesia.

c. Any patient with an ET is a candidate for PDT.

d. PDT must be performed in an OR.

5. One benefit of PDT over ST is

a. lower risk of inadvertent decannulation.

b. less need for humidification.

c. lower costs.

d. less suctioning requirements.

6. An absolute contraindication to PDT is

a. tracheal obstruction.

b. unfavorable neck anatomy.

c. need for assistive ventilation.

d. need for emergency airway management.

7. Uncuffed tracheostomy tubes

a. provide aspiration protection.

b. don't allow for airway clearance.

c. facilitate positive-pressure ventilation.

d. are used mostly for infants and children.

8. Adjustable flange tracheostomy tubes

a. are used for long-term placement.

b. have an opening in the tube's posterior portion.

c. are appropriate for patients with large necks.

d. allow for assessment of the patient's ability to breathe.

9. Which of the following is a long-term complication of ST?

a. pneumothorax

b. tracheal necrosis

c. posterior tracheal wall injury

d. air embolism

10. If inadvertent decannulation has occurred, call the emergency response team and

a. force the tracheostomy tube back into the stoma.

b. hold oxygen tubing in front of the stoma.

c. use a bag-valve mask device to gently ventilate the patient.

d. cover the stoma with your gloved hand.

11. Perform tracheostomy care

a. every 4 to 8 hours.

b. every 12 to 16 hours.

c. every 2 to 3 days.

d. once a week.

12. If ventilation through the upper airway is impossible after inadvertent decannulation, ventilate your patient through the

a. nose.

b. mouth.

c. bag-valve mask.

d. stoma.

13. Suction a patient with a tracheostomy

a. only when he needs it.

b. every 2 hours.

c. every 4 hours.

d. every 8 hours.

14. Limit tracheostomy suctioning to

a. 4 or 5 passes for each suctioning session.

b. 10 to 15 seconds or less for each suctioning pass.

c. 40 seconds for each suctioning pass.

d. a suction pressure of 180 mm Hg.

15. Because the tracheostomy tube can affect the patient's ability to swallow,

a. keep him on a clear liquid diet.

b. provide parenteral nutrition.

c. arrange for consultation with a nutritionist.

d. suction the tube before and after every meal.

16. What's the maximum acceptable tracheostomy tube cuff pressure?

a. 10 mm Hg

b. 25 mm Hg

c. 50 mm Hg

d. 75 mm Hg

17. A complication of low cuff pressure is

a. silent aspiration.

b. tracheal fistula.

c. tracheal erosion.

d. esophageal bleeding.

18. High cuff pressure is commonly caused by a tracheostomy tube that's

a. too long.

b. too short.

c. too large in diameter.

d. too small in diameter.

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