Tracheostomy Procedures and Care

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Questions and Answers

What is the main purpose of performing a tracheostomy?

To provide long-term airway management (correct)

To enhance vocalization capabilities

To increase lung capacity

To prevent blood flow to the lungs

Which part of the tracheostomy tube is primarily responsible for maintaining the airway open?

Neck plate

Outer cannula (correct)

Inner cannula

Obturator

What is the function of the obturator in a tracheostomy procedure?

To assist in inserting the tracheostomy tube (correct)

To secure the inner cannula in place

To ensure comfort during the procedure

To prevent mucus accumulation

Which of the following statements is incorrect regarding the cleaning of a tracheostomy?

The outer cannula does not require cleaning. Signup and view all the answers

How does a tracheostomy help in airway clearance?

By providing access for suctioning mucus Signup and view all the answers

What is a common occurrence for patients with new tracheostomy tubes within the first few days post-procedure?

Bloody secretions Signup and view all the answers

What is one characteristic of pediatric tracheostomy tubes smaller than size 4?

They do not contain an inner cannula. Signup and view all the answers

Why are older adults more prone to skin breakdown with tracheostomy care?

They may have more fragile skin. Signup and view all the answers

What does Central Venous Pressure (CVP) reflect?

The amount of blood returning to the heart. Signup and view all the answers

Which of the following is a direct measurement obtained using a central venous catheter?

Central venous pressure Signup and view all the answers

What is a common insertion site for a central venous catheter due to its high success rate?

Internal jugular vein Signup and view all the answers

Which of the following indicates that central venous pressure can be monitored?

By threading a catheter into a large vein Signup and view all the answers

When are routine tracheostomy tube changes typically performed after a tract has formed?

Weekly Signup and view all the answers

What is a necessary item for closed continuous irrigation in addition to irrigation tubing?

IV pole Signup and view all the answers

Which item is used to temporarily occlude the catheter during irrigation?

Screw clamp or rubber band Signup and view all the answers

If the irrigating solution does not flow freely during intermittent irrigation, which action should be taken first?

Notify the healthcare provider Signup and view all the answers

What must be used to access a needleless port during irrigation?

Luer-Lok syringe without needle Signup and view all the answers

What should be inspected in the drainage tubing if there is less output than the infused irrigation solution?

For signs of kinks and clots Signup and view all the answers

Which option is NOT typically included in an open intermittent irrigation setup?

Closed irrigation solution Signup and view all the answers

In closed intermittent irrigation, what could indicate the need for further assessment?

Presence of pain during irrigation Signup and view all the answers

What item is essential for both closed intermittent and continuous irrigation setups?

30- to 60-mL irrigation syringe Signup and view all the answers

What is one advantage of using brushless scrubbing for surgical hand hygiene?

It is less caustic and abrasive to the skin. Signup and view all the answers

Why is using a brush for surgical hand scrub discouraged?

It can damage the skin, encouraging bacterial growth. Signup and view all the answers

What area of the sterile gown is considered sterile?

The area from the waist to the collar and sleeves. Signup and view all the answers

When should a nurse don a sterile gown in relation to other protective gear?

After performing surgical handwashing. Signup and view all the answers

What is the primary purpose of wearing a sterile gown?

To exclude the skin as a contaminant and prevent cross contamination. Signup and view all the answers

In what type of situations would nurses wear sterile gowns?

When assisting at the sterile field in major procedures. Signup and view all the answers

What is a reason the circulating nurse typically does not wear a sterile gown?

They do not handle sterile objects. Signup and view all the answers

Which areas of a sterile gown are not considered sterile?

The back of the gown and under the arms. Signup and view all the answers

Which type of compounds are primarily bacteriostatic and fungistatic?

Quaternary Ammonium Compounds Signup and view all the answers

What is the recommended scrub time according to AORN?

Three to four minutes Signup and view all the answers

Which compound is noted for having resistance against most strains of pseudomonas?

Triclosan Signup and view all the answers

What does AORN state about the use of a scrub brush for surgical hand scrubs?

It leads to increased skin cell shedding. Signup and view all the answers

Which QAC is commonly used as an antiseptic?

Benzalkonium chloride Signup and view all the answers

Chloroxylenol has what characteristic compared to chlorhexidine?

It is less quick acting. Signup and view all the answers

Based on CDC recommendations, what is said about traditional 10-minute scrubs?

They lead to skin damage and are unnecessary. Signup and view all the answers

Which compound has only fair activity against mycobacterium tuberculosis?

Triclosan Signup and view all the answers

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.