Questions and Answers
What is the main purpose of performing a tracheostomy?
Which part of the tracheostomy tube is primarily responsible for maintaining the airway open?
What is the function of the obturator in a tracheostomy procedure?
Which of the following statements is incorrect regarding the cleaning of a tracheostomy?
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How does a tracheostomy help in airway clearance?
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What is a common occurrence for patients with new tracheostomy tubes within the first few days post-procedure?
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What is one characteristic of pediatric tracheostomy tubes smaller than size 4?
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Why are older adults more prone to skin breakdown with tracheostomy care?
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What does Central Venous Pressure (CVP) reflect?
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Which of the following is a direct measurement obtained using a central venous catheter?
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What is a common insertion site for a central venous catheter due to its high success rate?
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Which of the following indicates that central venous pressure can be monitored?
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When are routine tracheostomy tube changes typically performed after a tract has formed?
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What is a necessary item for closed continuous irrigation in addition to irrigation tubing?
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Which item is used to temporarily occlude the catheter during irrigation?
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If the irrigating solution does not flow freely during intermittent irrigation, which action should be taken first?
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What must be used to access a needleless port during irrigation?
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What should be inspected in the drainage tubing if there is less output than the infused irrigation solution?
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Which option is NOT typically included in an open intermittent irrigation setup?
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In closed intermittent irrigation, what could indicate the need for further assessment?
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What item is essential for both closed intermittent and continuous irrigation setups?
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What is one advantage of using brushless scrubbing for surgical hand hygiene?
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Why is using a brush for surgical hand scrub discouraged?
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What area of the sterile gown is considered sterile?
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When should a nurse don a sterile gown in relation to other protective gear?
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What is the primary purpose of wearing a sterile gown?
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In what type of situations would nurses wear sterile gowns?
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What is a reason the circulating nurse typically does not wear a sterile gown?
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Which areas of a sterile gown are not considered sterile?
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Which type of compounds are primarily bacteriostatic and fungistatic?
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What is the recommended scrub time according to AORN?
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Which compound is noted for having resistance against most strains of pseudomonas?
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What does AORN state about the use of a scrub brush for surgical hand scrubs?
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Which QAC is commonly used as an antiseptic?
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Chloroxylenol has what characteristic compared to chlorhexidine?
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Based on CDC recommendations, what is said about traditional 10-minute scrubs?
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Which compound has only fair activity against mycobacterium tuberculosis?
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Study Notes
Tracheostomy Overview
- A tracheostomy involves inserting a 51- to 76-mm (2- to 3-inch) tube into the trachea through the neck.
- It is essential for maintaining a patent airway in patients needing long-term management due to obstruction or extended intubation.
- Purposes include clearing mucus, preventing infection, promoting healing, enhancing comfort, and preventing displacement.
Parts of Tracheostomy Tube
- Outer Cannula: Encases the trachea; features a flange for securing around the neck.
- Inner Cannula: Fits within the outer tube, removable for cleaning, and has a locking mechanism to prevent displacement.
- Obturator: A guide for inserting the tube, ensuring smooth placement.
Patient Considerations
- Pediatric Patients: Shorter necks complicate stoma cleaning; tubes smaller than size 4 typically lack an inner cannula.
- Gerontologic Considerations: Older patients may have fragile skin, increasing risks of breakdown due to secretions or pressure.
Central Venous Pressure (CVP)
- CVP measures blood pressure in the thoracic vena cava and right atrium, indicating blood return and heart pumping ability.
- Acquired through a central venous catheter inserted into large veins.
CVP Indications
- Assessing right ventricular function, systemic fluid status, and rapid infusions.
- Administering hypertonic solutions and serial venous blood assessments.
Insertion Sites for CVP
- Internal Jugular Veins: Preferred for high success rates and lower complication risks.
Equipments for CVP Procedures
- Requires sterile solutions, gloves, irrigation syringes, and clamps to regulate flow rates.
Unexpected Outcomes in Irrigation
- Inspect for clots, sediment, and kinks.
- Notify healthcare providers if solutions do not return or if pain or distention occurs.
Quaternary Ammonium Compounds (QACs)
- Composed of nitrogen linked to four alkyl groups, effective as antiseptics, particularly alkyl benzalkonium chlorides.
- Primarily bacteriostatic but can be microbicidal at high concentrations.
Antiseptic Agents
- Triclosan: Inhibits various bacteria; however, resistance exists in some strains.
- Chloroxylenol: Less effective than chlorhexidine; not classified safe and effective by FDA due to insufficient data.
AORN and CDC Recommendations
- Scrub times of 3-4 minutes achieve acceptable germ reduction, eliminating the need for traditional 10-minute scrubs.
- Brushless scrubbing is advised to minimize skin damage.
Surgical Hand Scrubbing
- AORN discourages the use of brushes as it increases skin cell shedding and creates areas for bacterial growth.
- Only use brushes for nails and visibly soiled areas.
Gowning Protocol
- Sterile gowns shield against contamination in sterile fields.
- Gowns should be donned after masks and caps, and only specific areas of the gown are sterile.
Purpose of Sterile Gown
- To exclude skin contaminants and protect against cross-contamination during procedures.
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Description
This quiz covers the fundamental aspects of tracheostomy, including its purpose, maintenance of airway patency, and management of secretions. It is essential for healthcare professionals dealing with long-term airway management and patient care.
