Airway management practice challenge 1,2,3
CHALLENGE 3: You are working on a medical-surgical unit. One of your clients is a 64-year-old woman admitted to the intensive care unit with an exacerbation of chronic obstructive pulmonary disease. She was intubated and placed on a mechanical ventilator. There were complications in weaning her from the ventilator, so a tracheostomy tube was placed 2 days prior to her arrival on your unit. You are performing an assessment on one of your other clients when the assistive personnel comes to tell you that your client in room 105 has just coughed and her tracheostomy tube is migrating outward from the stoma. Assessment You enter room 105 to find your client agitated, attempting to get out of bed, and pointing to her throat. You try to calm her down and assist her to a supine position in bed so that you can assess her airway and check for respiratory distress. You glance at the monitor, which shows a blood pressure of 130/75 mm Hg, a heart rate of 92/min, and an oxygen saturation of 89%. You quickly estimate that her respiratory rate is about 28/min.
***Which of the following actions should you implement? Attempt to reposition the tracheostomy tube. HISTORY: You attempt to slide the tracheostomy tube back into the stoma but you meet resistance and the tube moves completely out of the stoma. Because the tracheostomy tract is not yet mature after just 48 hr, you recognize that tube dislodgment is an emergency and you call out for assistance. ***Which of the following actions should you take next? Extend the client's neck. HISTORY: With the client supine, you extend and support her neck in preparation for re-establishing the airway. Assistance arrives. ***Which of the following is the appropriate nursing action at this time? Use the obturator at the bedside to insert a new tube. HISTORY: With the obturator, you successfully insert a new tracheostomy tube and confirm bilateral breath sounds. ***Which of the following actions should you take next? While an assistant hold the tube in place, secure the tracheostomy ties. HISTORY: You measure your client's vital signs and find them improved and stable. Your client is resting comfortably. You have successfully managed the immediate needs of your client.
CHALLENGE 2: You are working on a medical-surgical unit caring for a client with a new tracheostomy placed less than 48 hr ago. While suctioning the client's airway, you notice a small amount of blood in his secretions. You measure his vital signs. His blood pressure is 130/85 mm Hg, his heart rate is 65/min, his respiratory rate is 20/min, and his oxygen saturation is 94%. The client reports a pain level of 2 on a 0 to 10 scale and was given pain medication 1 hour ago. He is alert, oriented, and communicating by writing on a pad of paper at the bedside.
***Which of the following describes the blood in the secretions? An expected finding for this client at this time HISTORY: Your client activates his call light. When you arrive, he is obviously distressed and pointing to his tracheostomy. You see frank blood oozing from the stoma. While determining that the client's airway is patent, you alert another nurse to notify the surgeon immediately. ***Which of the following is the priority action for this client? Elevate the head of the bed to 90 degrees. HISTORY: The surgeon arrives to assess the client and instructs you to prepare him to return to the surgical suite. He explains the situation to the client and leaves to set up the surgery. ***Which of the following is the appropriate nursing action to maintain airway patency prior to arranging transportation to the surgical suite? Apply sterile gauze around the tracheostomy site. HISTORY: Despite preoperative sedation, your client appears extremely anxious. He writes a question for you on his pad of paper: "Does this bleeding mean I won't be able to have a tube in my neck after all?" ***Which of the following is an appropriate nursing response? "Right now we're going to get you to surgery so that your doctor can stop this bleeding. Then we'll get you comfortable again and see what your options are." HISTORY: The client is agreeable to your action plan and soon after is transported to the surgical suite. He returns to your care few hours later after the surgeon cauterizes a superficial blood vessel. You have successfully managed the immediate needs of your client.
CHALLENGE 1: You are working on a medical-surgical unit. One of the clients you will be caring for is a 45-year-old man who was just transferred from the intensive care unit. He has a history of esophageal cancer and had a tracheostomy tube placed 2 days ago. You measure his vital signs. His blood pressure is 150/95 mm Hg, his heart rate is 110/min, his respiratory rate is 30/min, and his oxygen saturation is 80%. He writes on a piece of paper, "I feel dizzy and it's hard to breathe."
***Which of the following is the priority intervention for this client at this time? Suction the client's airway. HISTORY: You gather the equipment you'll need to perform tracheal suctioning, explain the procedure to the client, and perform hand hygiene. You apply clean gloves, a gown, goggles, and a mask. You open your suction catheter kit and fill a basin with sterile 0.9% sodium chloride. ***Just before suctioning the client's airway, which of the following actions should you perform? Hyperoxygenate the client. HISTORY: You test that your suction apparatus is working by suctioning a small amount of 0.9% sodium chloride solution from the basin. With a sterile glove on your dominant hand, you insert the catheter into the tracheostomy tube. ***As you advance the catheter, you meet resistance and the client begins to cough. Which of the following is the appropriate nursing action? Pull the catheter back about 1 to 2 cm (0.5 to 1 in). HISTORY: You withdraw the catheter appropriately and apply suction, rolling the catheter between your thumb and forefinger while withdrawing it. ***Which of the following lengths of time should you apply suction during this suction pass? 10 seconds HISTORY: While suctioning the client's tracheostomy, you note that his pulmonary secretions are quite thick. ***Which of the following interventions should be added to the client's nursing care plan to help thin secretions? Increase fluid intake. HISTORY: After you have completed the tracheal suctioning, your client writes, "Thank you, I feel much better." You measure his vital signs. His blood pressure is 125/90 mm Hg, his heart rate is 84/min, his respiratory rate is 18/min, and his oxygen saturation is 96%. You have successfully managed the immediate needs of your client.
