Tracheostomy Care (12 Questions)

1. You are receiving M. Lapointe, a 56-year-old patient transferred from the ICU with a newly created tracheostomy (3 days post-op). Before the patient arrives in the room, you are checking the safety equipment at the bedside to ensure you are prepared for an accidental decannulation.

Question:
In addition to a suction source and catheters, oxygen, and an Ambu-bag (Bag-Valve-Mask), which specific items must be taped to the head of the bed or readily visible? *
2. Mme Dubois, 68 years old, has a chronic tracheostomy. You enter the room to perform your morning assessment. Mme Dubois appears comfortable, her respiratory rate is 18 breaths/min, and her oxygen saturation is 96%. You hear faint, coarse upper airway sounds, but she is able to cough effectively and clear secretions into her mouth.

Question:
Based on these findings, what is the appropriate nursing action regarding suctioning? *
3. M. Gagnon, a 72-year-old patient with pneumonia and a tracheostomy, requires suctioning. His oxygen saturation has dropped to 89%, and he is coughing weakly. You have set up your sterile field.

Question:
Which action represents the correct, safe technique for open tracheal suctioning? *
4. Mme Tessier is recovering from a stroke and has a cuffed tracheostomy tube. The speech therapist recommends using a Passy-Muir Valve (speaking valve) to allow her to vocalize. You are preparing to place the valve on the hub of the tracheostomy tube.

Question:
What is the critical safety step the nurse must take before attaching the speaking valve? *
5. You are performing tracheostomy care for M. Roy. When you remove the old dressing, you notice the skin around the stoma is red, macerated (soggy), and has a small amount of green, foul-smelling drainage.

Question:
In addition to obtaining a culture swab as ordered, what is the most appropriate nursing intervention? *
6. Mme Caron had a tracheostomy placed 12 hours ago. She calls you to the bedside complaining of a feeling of "heaviness" in her neck. Upon palpation of the skin around the stoma and upper chest, you feel a "crackling" sensation, similar to touching Rice Krispies or bubble wrap.

Question:
What condition does this finding indicate? *
7. You are changing the soiled Velcro tracheostomy ties for M. Fortin, who has a fresh tracheostomy (post-op day 4). M. Fortin has a strong cough reflex. You are working alone today.

Question:
What is the safest method to change the ties to prevent accidental decannulation? *
8. Mme Boucher is being treated for a severe respiratory infection. She has thick, tenacious (sticky) secretions coming from her tracheostomy. You notice the pressure on the ventilator is increasing (High Pressure Alarm), suggesting increased resistance.

Question:
What is the priority nursing intervention to manage the secretions and prevent a mucous plug obstruction? *
9. M. Lemieux, 48 hours post-tracheostomy, has a violent coughing spell. The tracheostomy tube shoots out of the stoma and lands on the bed sheets. M. Lemieux begins to gasp for air, and the stoma appears to be collapsing.

Question:
What is the priority nursing action? *
10. Mme Giroux is starting oral feedings (pureed diet) for the first time since her tracheostomy. The cuff is currently deflated to facilitate swallowing.

Question:
Which instruction should the nurse give the patient to minimize the risk of aspiration during swallowing? *
11. M. Savard, 65 years old, has had a permanent tracheostomy for 3 weeks following treatment for laryngeal cancer. While you are providing suctioning care, M. Savard has a violent coughing fit. The tracheostomy ties, which were slightly loose, fail to hold, and the entire tracheostomy tube is expelled and falls onto the patient's chest. M. Savard begins to panic and gasp for air. You have a replacement tube and emergency equipment at the bedside.

Question:
What is the correct priority sequence of actions to re-establish the airway? *
12. Mme Rochefort, 42 years old, is admitted to the trauma unit with multiple rib fractures on the right side following a car accident. Two hours after admission, she calls the nurse complaining of sudden, severe shortness of breath and chest pain. Upon assessment, her vital signs have deteriorated: Heart Rate 135 bpm, Blood Pressure 85/50 mmHg, and O2 saturation 82% on 100% non-rebreather mask. You note absent breath sounds on the right side and distended neck veins. Crucially, you observe that her trachea is shifted noticeably to the left side of her neck.

Question:
Based on the tracheal deviation and hemodynamic instability, which life-threatening complication does the nurse suspect? *