Tracheostomy Care ? emergency care, routine care Early complications: bleeding, pneumothorax, air embolism, aspiration, subcutaneous or mediastinal emphysema, recurrent laryngeal nerve damage, and posterior tracheal wall penetration Long term complications: airway obstruction, infection, rupture of innominate artery, dysphagia (difficulty swallowing), tracheoesophageal fistula, tracheal dilation, and tracheal ischemia and necrosis Emergency care: Always keep an extra, unopened, sterile trach in the room in case the patient decannulates themselves; NEVER put obturator in stoma if patient decannulates themselves, this will asphyxiate the patient; jaw tilt/chin thrust the patient in order to keep stoma open Routine care: semi-fowlers position, caution with analgesia and sedative agents due to the risk of suppressing patient?s cough reflex, provide an effective means of communication, decrease apphrension, suctioning when necessary based on assessment with sterile equipment, cuff pressure maintained between 15-25 mm Hg ? should be monitored every 8 hours by attaching a handheld pressure gauge to the pilot balloon of the tube or by using the minimal leak volume or minimal occlusion volume technique. Aerosol treatments and Chest Physiotherapy Aerosol treatments Can cause bronchospasm and irritation ? should be used sparingly and with caution when patient is receiving chest physiotherapy treatments Can deliver oxygen concentrations of 30-100% at 8-10 L/min, offers patient good humidification and adequate FiO2 levels, aerosol mist must be available for patient during entire inspiratory phase Chest physiotherapy Includes: postural drainage, chest percussion and vibration, breathing retraining, and teaching effective coughing techniques Other ways to facilitate secretion removal: adequate hydration and air humidity Postural drainage Uses specific positions that allow the force of gravity to assist in the removal of bronchial secretions, the secretions are then removed by coughing or by suctioning if patient is unable to cough Nurse auscultates lung sounds before and after to identify areas of concern and effectiveness of treatment Nurse administers bronchodilators and mucolytic agents prior to postural drainage to improve drainage ? oxygen may need to be administered during procedure Usually performed 2-4 times/day before meals and at bedtime; patient should remain in each position for 10-15 minutes, should breathe slowly through nose and out slowly through pursed lips Nurse provides patient with an emesis basin, sputum cup, and paper tissues Following procedure, nurse should assess and document the character of sputum, patients color, and pulse Oral care should be performed afterwards
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