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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
To stimulate the cough reflex
8. When suctioning, you note thick, tenacious Tenacious secretions could potentially be signs of
secretions. What nursing interventions infections therefore, assess and report to physicians for:
should be implemented? 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
9. What data should be documented after Document suction procedure, patient reaction, amount
completing Mr. Madison/Mrs Dixon’s of secretion (thickness and color), if normal saline was
tracheostomy care? 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)
10. Why is it important to deflate the cuff if a An inflated cuff would prevent patient from breathing or
cuffed tracheostomy is capped? prevent any airflow in the upper airway