Med Surg Ch 25

subcutaneous emphysema

•air in the subcutaneous area; right under the skin. Palpate and you'll feel a weird crackly "rice krispy treat" feeling

tube obstruction

•caused by mucous plug, blood

preventing aspiration while swallowing

- avoid serving meals when the patient is fatigued - provide smaller and frequent meals - provide adequate time, dont hurry them - avoid water and thin liquids, as well as straws - thicken all liquids - keep suction equipment close - suction after cuff deflation to clear the airway and allow comfort during meal - if coughing happens, stop feeding until patient indications airway is clear - assess resp. rate ease of swallowing, pulse ox, and heart rate during feeding - encourage patient to "double swallow" or dry swallow after every bite

tracheotomy postop

- may be bloody but if it is persistent call PCP - listen with stethoscope to hear bilat breath sounds - assess for complications - hourly respiratory assessment - suction mucous and blood - ENURE PATENT AIRWAY!

home oxygen therapy education and management

- social services involved - PFT to determine if they qualify - NO SMOKING - combustible things out of house - no electronic razors

BiPAP

- sometimes used to ween the patient off oxygen - prevents intubation - used for COPD, asthma, hypercarbia, dyspnea - bi level positive airway pressure - alarm goes off when not on properly, have RT look at it - skin breakdown on nose and cheeks - patient might aspirate on vomit, treat nausea immediately

tracheostomy complications

- tube obstruction - tube dislodgement and accidental decannulation - pneumothorax - subcutaneious emphysema - bleeding - infection - tracheomalacia - tracheal stenosis - tracheoesophageal fistula - trachea-innominate artery fistula

trach collar

-goes over trach -delivers oxygen

The nurse is suctioning a client who has an endotracheal tube in place. Which finding indicates that the client is experiencing an adverse effect of this procedure? 1.Cardiac irregularities 2.Oxygen saturation level of 95% 3.A reddish coloration in the client's face Apical pulse rate of 80 beats per minute

1 Rationale: Adverse effects of suctioning include hypoxemia, cardiac irregularities caused by vagal stimulation, mucosal trauma, and paroxysmal coughing. If these occur during the procedure, the procedure is stopped and the client is reoxygenated. Options 2 and 4 are normal findings. A reddish coloration in the client's face may occur during suctioning but should quickly resolve when the suction catheter is removed from the client.

•The nurse knows that an inflated cuff for a tracheostomy is indicated for which client? Select all that apply. 1.A client at risk for aspiration 2.A client who is physically dependent 3.A client who needs to be able to speak 4.A client who requires mechanical ventilation 5.A client who requires assistance with activities of daily living

1,4 Rationale: For clients who require a tracheostomy, the primary health care provider may choose to use an inflated cuff. This is indicated for clients who are at risk for aspiration and who require mechanical ventilation. Inflated cuffs exert pressure on the tracheal mucosa. Inflated cuffs cannot be used for clients who need to speak; a fenestrated-type of cuff needs to be used in order for the client to be able to speak. A client who is physically dependent and who requires assistance with activities of daily living are not indications for this type of cuff.

what % of oxygen do ventilators provide

100%

what % of oxygen is room air

21%

A client seeks treatment in an ambulatory clinic for hoarseness that has persisted for 8 weeks. Based on the symptom, the nurse interprets that the client is at risk for which disorder? 1.Thyroid cancer 2.Acute laryngitis 3.Laryngeal cancer 4.Bronchogenic cancer

3 Rationale: Hoarseness is a common early sign of laryngeal cancer, but not of thyroid or bronchogenic cancer. Hoarseness that persists for 8 weeks is not associated with an acute problem, such as laryngitis.

The nurse is caring for a client with a newly placed tracheostomy. Which emergency equipment should be available at the bedside? Select all that apply. 1.Tongue blade 2.Endotracheal tube 3.Tracheostomy tube 4.Tracheostomy insertion tray 5.Manual resuscitation bag with face mask

3,4,5 Rationale: When a new tracheostomy is placed, the nurse must plan for accidental dislodgement. Emergency equipment at the bedside would include an additional tracheostomy tube, an emergency tracheostomy tray (in case of difficulty placing the new tracheostomy), and a manual resuscitation bag with a face mask to ventilate the client during tube replacement. Options 1 and 2 are not necessary equipment for the client with a newly placed tracheostomy.

what L of oxygen must be humidified

4 L and above

simple mask

40-60% 5-8L/min

nasal cannula

44% oxygen 1-6L/min low or high flow

partial rebreather

60-70% 6-11L/min

Non-rebreather mask

90% and above 10-15L/min patient will probs have to be put on a vent

What is the nurse's best first action when a client receiving continuous oxygen therapy by nasal cannula for an acute respiratory problem is becoming increasingly confused? A. Increasing the oxygen flow rate B. Documenting the observation as the only action C. Notifying the primary health care provider immediately D. Repositioning the client from a high-Fowler to a low-Fowler position

A Cerebral hypoxia is a cause of confusion and a sensitive indicator that the client needs more oxygen and action is needed. Untreated or inadequately treated hypoxemia is life threatening. Although you would want to notify the health care provider of the change in the client's condition, the best action is to first increase the oxygen flow rate and then notify the physician.Changing the client's position to less upright, would not improve gas exchange.

Which changes in a client receiving oxygen therapy at 60% for more than 24 hours alert the nurse to the possibility of oxygen toxicity? A. Decreased PaCO2 B. Client report of increased dyspnea C. Production of thick, white, frothy sputum D. Client demand to remove the mask

A Oxygen toxicity damages the alveolar membrane, stimulating the formation of a hyaline membrane, and impairing gas exchange. Clients become increasingly more dyspneic and hypoxic.The PaCO2 would increase, not decrease. The production of thick, frothy, white sputum is unrelated to oxygen toxicity. The client's demand to remove the mask is not specific to oxygen toxicity.

Which change in the condition of a client with chronic obstructive pulmonary disease (COPD) who is receiving supplemental oxygen indicates to the nurse that an increase in the fraction of inspired oxygen (FiO2) may need to be increased? A. Restlessness has increased over the past hour. B. Client reports increased mouth dryness. C. Heart rate has decreased from 90 to 82 beats/min. D. Blood pressure has changed from 106/80 to 110/70.

A The nurse needs to assess the client who has recently become restless for the need to increase this client's FiO2. This client may be exhibiting symptoms of hypoxemia including restlessness. Additional symptoms of hypoxemia include increased heart rate and blood pressure, oxygen desaturation, cyanosis, restlessness, and dysrhythmias.A heart rate decrease to 82 beats/min and not cause for alarm or a change in FiO2. The change in blood pressure is a positive indicator of reasonable perfusion and gas exchange. Mouth dryness is not an indicator of poor gas exchange and the need for more oxygen.

Which oxygen delivery device will the nurse consider best to meet the needs to apply for a newly admitted client who requires high-flow oxygen therapy after suffering facial burns and smoke inhalation? A. Face tent B. Nasal cannula C. Venturi mask D. Nonrebreather mask

A The nurse will initially select a fact tent for this client. A client with smoke inhalation and facial burns who requires high-flow oxygen must initially be placed on a face tent because this is the only noninvasive high-flow device that will minimize painful and contaminating contact with burned facial tissue.Although a Venturi mask and a nonrebreather mask are high-flow oxygen delivery devices, they are snugly fitted on the face, which can be painful and can introduce infection to compromised facial skin. A nasal cannula is not a high-flow device.

For which problem in a client with a tracheostomy will the nurse collaborate with the speech-language pathologist (SLP) member of the interprofessional team? A. Ensuring effective communication B. Determining the proper cuff pressure C. Identifying early indications of infection D. Assessing for vocal cord damage

A One of the many roles of the SLP is helping health care professionals work with clients who have communication problems to find the most effective means of maintaining communication. They also may be involved in assessing clients for aspiration risk. They are not involved in vocal cord assessment (primary health care provider responsibility), infection assessment, or determining correct cuff pressure (respiratory therapist responsibility).

Which statements made by a client going home with a tracheostomy indicate to the nurse the need for further teaching about correct tracheostomy care? (Select all that apply.) A) "I can only take baths, but no showers." B)"I will be unable to wear a necklace." C)"I should put cotton or foam over the tracheostomy hole." D)"I will have to learn to suction myself." E) "I will notify my primary health care provider if my secretions develop a foul odor." F)"I can put normal saline in my tracheostomy to keep the secretions from getting thick."

A, B, C, F Need for teaching is indicated when the client says that only baths and no showers can be taken. The client is permitted to shower with the use of a shower shield over the tracheostomy, which prevents water from entering the airway. Also, the client does not instill anything into the artificial airway unless prescribed. The client would not put cotton or foam over the tracheostomy hole; this action may cause airway obstruction. The stoma may be covered loosely with a small cotton cloth or light scarf to protect it during the day. This filters the air entering the stoma, keeps humidity in the airway, and enhances appearance.The client is correct when commenting about learning to suction self, and will be taught clean suction technique to use at home. Also, foul-smelling secretions or drainage indicates possible infection and needs to be reported to the primary health care provider.

Which statements regarding noninvasive positive-pressure ventilation (NPPV) are true? (Select all that apply.) A)Can only be used safely by alert clients. B)Risk for ventilator-associated pneumonia is reduced but still present. C)An endotracheal tube is required for oxygen therapy. D)Masks must have a tight seal for effective ventilation. E)The system operates with either room air or oxygen. F)Vomiting with potential aspiration can occur.

A, D, E, F The NPPV technique uses positive pressure to keep alveoli open and improve gas exchange without the dangers of intubation, such as ventilator-associated pneumonia. NPPV can deliver oxygen or may use just room air. Masks must fit tightly to form a proper seal. Pressure can cause gastric insufflation, which can lead to vomiting and the potential for aspiration. Thus, NPPV is recommended only for use with on alert patients who have the ability to protect their airway.

Tracheomalacia

•constant pressure from the tracheostomy tube cuff, causing tracheal erosion of the cartilage •Call respiratory •If patient is eating, we will see food in the secretions •Notice that it will take more air in the cuff to keep it inflated (if it took 7 mLs of air to inflate the cuff, and now it is taking 12, nurse needs to investigate) •Suction and look at the secretions, are they getting bigger?

Which problem does the nurse suspect when a client who has been receiving 50% oxygen by Venturi mask for 2 days now has crackles and decreased breath sounds on auscultation? A. New-onset asthma B. Absorptive atelectasis C. Bronchiolar infection D. Stasis pneumonia

B Absorptive atelectasis occurs when high oxygen levels are delivered that causes nitrogen dilution when oxygen diffuses from the alveoli into the blood. The alveoli collapse, which is detected as crackles and decreased breath sounds on auscultation. The problem is in the alveoli, not the airways. Although decreased breath sounds accompany pneumonia, crackles are not present with the increased density.

Which best practice technique will the nurse use when suctioning a client's tracheostomy tube place earlier today? A. Applying suction only during insertion of the catheter B. Hyperoxygenating the client before and after suctioning C. Ensuring each suction pass lasts no longer 30 seconds D. Suctioning repeatedly until the secretions are is clear

B The client needs to be preoxygenated/hyperoxygenated with 100% oxygen for 30 seconds to 3 minutes to prevent hypoxemia. After suctioning, the client needs to be hyperoxygenated for 1 to 5 minutes, or until the client's baseline heart rate and oxygen saturation are within normal limits.Repeat suctioning can be performed as needed for up to three total suction passes. Any additional suctioning will cause or worsen hypoxemia. Applying suction during insertion is inappropriate because suction makes advancement of the suction tube difficult and is traumatic to the airway. Suction is applied only when the suction tube is removed. Suctioning for 30 seconds is too long and can cause or worsen hypoxemia; a suction pass should last 10 to 15 seconds.

Which nursing action will the nurse take to prevent harm from disruption of oxygen therapy for the client receiving low-flow oxygen by simple facemask? A. Keeping a small cylinder of oxygen at client's bedside stand for emergency use in case the central oxygen delivery system fails B. Changing to a nasal cannula during meals C. Sealing the edges of the mask to the client's skin with a water-soluble lubricant. D. Ensuring that the flaps are closed over the exhalation ports

B The facemask covers the client's mouth and must be removed during meals. Use of the nasal cannula when the client eats prevents hypoventilation or hypoxemia from the facemask being of during mealtimes.Sealing the mask does not ensure disruption of oxygen therapy. A simple facemask does not have flaps over the exhalation ports. Central oxygen delivery system failure is a unit or facility problem that could happen anywhere; however, tank oxygen is not kept at clients' bedsides for this potential emergency.

For which situation will the nurse take immediate action to prevent harm for a client with pneumonia who is receiving 100% oxygen via a nonrebreather mask? A. Sputum is now rust-colored. B.Oxygen reservoir deflates during inspiration. C. Crackles are present in the lung bases. D. Skin is pink and flushed.

B The nurse takes action immediately if the reservoir bag is deflated. Suffocation can occur if the reservoir bag deflates, kinks, or if the oxygen source disconnects. The nurse needs to remove the device, refill the reservoir, and then reapply the mask.It is anticipated that the client's color is now pink. The client's color is expected to improve (from ashen or gray to pink) because of an increase in PaO2 level. Crackles in lung bases are an expected finding in a client with pneumonia, as is expectorating rust-colored sputum.

Which action will the nurse take to prevent harm from tracheal stenosis in a client after tracheostomy? A. Using commercial tube holders instead of standard tracheostomy ties B. Securing the tube in a midline position C. Assessing bilateral breath sound every 2 hours D. Ensuring maximum cuff pressure

B Tracheal stenosis, a narrowed tracheal lumen, is caused to scar tissue formation from irritation. Two methods of preventing this complication is to keep the tube from moving in the trachea and to maintain proper cuff pressure. Securing the tube in the midline position is critical regardless of whether the tube is secured with commercial tube holders or standard tape ties. Although assessing breath sounds bilateral is an important action whenever a client has a tracheostomy, but does not prevent harm from tracheal stenosis.

Which assessment has the highest priority for the nurse to make when caring for a client who had a tracheostomy placed yesterday? Which of these assessments is essential for the nurse to make? A. Examining the color and consistency of secretions B. Measuring the cuff pressure C. Observing for tachypnea D. Checking arterial blood gas values

C It is essential for the nurse to assess the client for tachypnea. Tachypnea can indicate hypoxia.Assessing secretions, checking arterial blood gas values, and measuring cuff pressure are all appropriate interventions, after assessing airway and breathing.

Which action will the nurse take first when a client has just arrived in the postanesthesia care unit (PACU) following a successful tracheostomy procedure? Which nursing action must be taken first? A. Cleaning the tracheostomy inner cannula and stoma B. Observing for indications that suctioning is needed C. Auscultating lung sounds D. Changing the tracheostomy dressing immediately

C The first step of the nursing process and nursing action for a client following an airway procedure is to assess for a patent airway by auscultating the client's lungs and assessing the client's respiratory status.Suction is not needed if the lungs and airways are clear to auscultation. Although cleanliness is important, the PACU nurse will not typically perform this procedure immediately after the tracheotomy is created, unless copious secretions are blocking the tube.Performing a dressing change is done every 8 hours or per hospital policy. The PACU nurse will perform this if the dressing is soiled or bloody, but assessment of airway must be performed first.

What action does the nurse take first when a client who has a "do not resuscitate" (DNR) order and a nonrebreather oxygen mask, has labored breathing? A. Only provide comfort to the client. B. Notify the chaplain and the family member of record. C. Ensure that the tubing is patent and that oxygen flow is high. D. Initiate the Rapid Response Team (RRT).

C The nurse needs to first ensure that the tubing is patent and that the O2 flow is high. Labored breathing and ultimately suffocation can occur if the reservoir bag on a nonrebreather mask kinks, or if the oxygen source disconnects or is not set to high-flow levels.The chaplain and the family member of record would not be notified until assessment confirms that death is imminent at this time. The RRT team can be called but the client may not want to be intubated, as indicated in the DNR orders. The RRT needs to know the client's wishes when they arrive. Comforting the client must be done but is not the first action by the action.

Which actions will the nurse take to reduce risk for aspiration for a client with a tracheostomy? (Select all that apply.) A)Inflating the tracheostomy cuff during meals B)Encouraging water with meals C)Teaching the client to "tuck" the chin down in the forward position to swallow D)Maintaining the client upright for 30 minutes after eating E)Encouraging frequent sipping from a cup F)Providing small, frequent meals

C, D, F Interventions that must be noted in the client's plan of care include having the client remain upright for at least 30 minutes after eating to reduce the chance of aspiration. Also, making sure that small frequent meals are available for the client. Shorter and more frequent intervals of eating tire the client less and also reduce the chance for aspiration. Teaching the client how to tuck the chin down in the forward position helps to open the upper esophageal sphincter and again reduces the risk of aspiration.Sipping from a cup is contraindicated. Liquids are consumed using a spoon to ensure that the client is attempting to swallow only small volumes of liquid. Controlled small amounts of thickened liquids are given. Thin liquids such as water should be avoided because they are easily aspirated. The tracheostomy cuff needs to be deflated because an inflated tube narrows the upper esophageal sphincter opening, which increases the risk for aspiration.

what disease process do patients have that live with hypercarbia

COPD

Which blood gas value indicates to the nurse that a client is experiencing hypercarbia? A. Bicarbonate = 20 mEq/L B. pH = 7.33 C. PaO2 = 80 mm Hg D. PaCO2 = 60 mm Hg

D The low pH, the elevated carbon dioxide level, and the low oxygen concentration all indicate that the client is experiencing poor gas exchange and has acidosis. The low pH and the low oxygen concentration could occur without hypercarbia. Only the elevated carbon dioxide concentration confirms hypercarbia.

What is the nurse's best response to a client who smokes and is being discharged home on oxygen states, "My lungs are already damaged, so I'm not going to quit smoking?" A. "Tell me more about why you think quitting wont's help you." B. "For safety, lower your oxygen flow rate when you smoke." C. "The progression to damage to your lungs can be slowed if you stop smoking now." D. "For now, let's discuss why smoking around oxygen is dangerous."

D The nurse's best response is to ask the client to discuss why smoking around oxygen is dangerous. The nurse would use this opportunity to educate the client about the dangers of smoking in the presence of oxygen. Although knowing the benefits of quitting smoking could be helpful for this client, safety is the most important issue at this time. Decreasing the oxygen flow rate while smoking still poses a safety risk.

What is the nurse's best response when a client who is concerned about getting a tracheostomy says, "I will be ugly, with a hole in my neck?" A. "Your family and those who love you won't care." B. "It won't take you long to learn to manage." C. "But you know you need this to breathe, right?" D. "The hole can be hidden with a light scarf."

D The nurse's best response is to suggest some strategies to cover the tracheostomy. This statement recognizes the client's concerns and explores options for dealing with the effects of the procedure.Reiterating the reason for the tracheostomy, suggesting that the client's loved ones won't care, and telling the client that he or she will learn to live with the tracheostomy are insensitive responses and minimize the client's concerns.

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. A 50 year old who is 1 day postoperative from abdominal surgery and is receiving 2 L oxygen by nasal cannula. B. A 55 year old was admitted yesterday with pneumonia and is receiving antibiotics and oxygen through a nasal cannula. C. A 45 year old who is being discharged with a new prescription for home oxygen therapy by nasal cannula. D. A 60 year old admitted 2 hours ago who has a 90-pack-year smoking history and is receiving 50% oxygen by Venturi mask.

D There is insufficient data to determine if this client is stable. The client is at risk for oxygen toxicity and must be assessed frequently.The postoperative client is receiving the low oxygen therapy typical for anyone having postoperative therapy who has no other respiratory problems. The client who meets discharge criteria does not require frequent assessment. Although the client with pneumonia will require more frequent assessment than a client who does not require oxygen therapy, the client wearing the Venturi mask must be assessed first.

t-piece

Delivers desired FIO2 for tracheostomy, laryngectomy, ET tubes Ensures humidification through creation of mist Mist should be seen during inspiration and expiration

what are the manifestations of oxygen toxicity

Dyspnea, non-productive cough, chest pain beneath the sternum; can also see GI upset and crackles on auscultation

can you use oral suction equipment for suctioning an artifical airway

NO can cause infection

how often do you change humidification systems

Q24

how often do you check the skin on patient's ears, back of the neck, and face for break down and tissue integrity

Q4-8

how often to clean cannula and mask (and how to clean?)

Q4-8 with clear, warm water

how often to perform oral care and to check for signs of dry mucous membranes or impaired tissue integrity

Q8 and PRN

what is a flow meter

Visual indicator of liters per minute flow of oxygen and nitrous set to a certain level that provides a certain concentration/percentage of oxygen to the patient

Trachea-innominate artery fistula

•due poorly position tube causes necrosis and erosion of the innominate artery •See the artery pulsing by the trach •Medical emergency •Call Rapid Response •Need to get the pt. to surgery •If patient starts to hemorrhage before surgery, take the tube out and apply pressure and get them to OR ASAP!

Tracheal stenosis

•scar tissue is starting to develop, and it is narrowing the trachea •Increased coughing, non-productive because they can't cough it up (Too narrow), and difficulty breathing

absorption atelectasis

alveolar collapse that occurs when high concentrations of oxygen are given and oxygen replaces nitrogen in the alveoli; if airway obstruction occurs, the oxygen is absorbed into the bloodstream and the alveoli collapse. new onset crackles, decreased breath sounds

what are the 3 body systems that make up the process of tissue perfusion

cardiovascular respiratory hematologic

tracheotomy tube dislodgement and accidental decannulation

•If decannulation of trach in the first 72 hours of insertion, that is a huge emergency; the stoma is not yet mature •Have materials bedside in case •Extend patient's neck and open the stoma with Kelly (curved) clamp; this is a sterile procedure •Make sure patient has airflow and look, listen, feel for respirations; bilateral breath sounds

oxygen toxicity

•Oxygen that we are delivering is greater than 50% given continuously for more than 24-48 hours •Reduced tissue integrity •DAMAGES LUNG

Hypoxia

decreased tissue oxygenation

aerosol mask

delivers high-flow, high-humidity oxygen therapy

hypercarbia

elevated arterial carbon dioxide levels in the body

how often do you change cannula and masks

every 7 days

what is FiO2

fraction of inspired oxygen

what happens if a patient cannot maintain oxygen levels?

go through all the devices, still cannot then go to BiPAP then intubate

is airway suction continuous or intermittent?

intermittent

how to prevent decannulation during tracheostomy care

keeping the old ties on the tube while applying new ties or holder

suctioning the artificial airway

literally the trach suction check off

Hypoxemia

low levels of oxygen in the blood

what do you use to lubricate the patient's nostrils, face and lips to relieve the drying effects of oxygen

nonpretroleum cream

CPAP

patient can wear their personal machine, but equipment must be checked "continuous airway pressure" delivers same amount during inhalation and exhalation

what happens after respiratory distress or a code

patient will be intubated and placed on a ventilater

Face tent

provides oxygen to the nose and mouth without the discomfort of a mask

Decannulation

removal of trach

hazards with oxygen therapy

smoking cigs can severely burn face oven safety combustible cleaning supplies no electric razors

what do you first do when a patient codes

start compressions

tracheostomy

stoma that results from tracheotomy, may be temporary or permanent

tracheotomy

surgicial incision into trachea for purpose of establishing an airway

why are BiPAP and CPAP patients NPO

they are not stable and the airway is not patent, airway is more important than food at the moment

tracheotomy operative period

trach is secured with sutures, my involve trach ties, chest x-ray is done to insure proper placement

how does NPPV work

uses positive pressure to keep alveoli open and improve gas exchange without airway intubation

what oxygen delivery system is the most precise

venturi mask

focused assessment of patient with tracheostomy

• Note the quality, pattern, and rate of breathing: • Within patient's baseline? • Tachypnea can indicate hypoxia. • Dyspnea can indicate secretions in the airway. • Assess for any cyanosis, especially around the lips, which could indicate hypoxia. • Check the patient's pulse oximetry reading. • If oxygen is prescribed, is the patient receiving the correct amount, with the correct equipment and humidification? • Assess the tracheostomy site: • Note the color, consistency, and amount of secretions in the tube or externally. • If the tracheostomy is sutured in place, is there any redness, swelling, or drainage from suture sites? • If the tracheostomy is secured with ties, what is the condition of the ties? Are they moist with secretions or perspiration? Are the secretions dried on the ties? Is the tie secure? • Assess the condition of the skin around the tracheostomy and neck for tissue integrity. Be sure to check underneath the neck for secretions that may have drained to the back. Check for any skin breakdown related to pressure from the ties or related to excess secretions. • Assess behind the faceplate for the size of the space between the outer cannula and the patient's tissue. Are any secretions collected in this area? • If the tube is cuffed, check cuff pressure. • Auscultate the lungs. • Are a second (emergency) tracheostomy tube and obturator available?

indications for a tracheostomy

•Acute airway obstruction •Airway protection •Trauma •Burns •Head/neck/thyroid surgery •Paralysis •GBS cause paralysis •Inability to be weened from the vent

Tracheoesophageal Fistula

•Erosion at the posterior wall of the trachea creating a hole between the trachea and the anterior esophagus •People at risk are with the trach and NG tube

what can cause infection with oxygen therapy

•Humidified air is a great breeding source for bacteria

tracheotomy preop

•Planned tracheostomy •Communication- let the patient know, maybe eventually they will get a speaking valve; prepare patient and family for the communication barrier •Recovery process •Trach care- cleaning, changing the cannula, strap, and dressing, suctioning •Teaching the process of trach care