السبت، 23 يونيو 2018

66-Tracheostomy

About
Surgical procedure performed ( tracheotomy) to bypass the upper airway with insertion of a tube to maintain ventilation.
Assess
Upper airway obstruction, stridor, inability to breathe
Complications
Bleeding, pneumothorax, airway obstruction, air embolism, aspiration, infection, fistula, nerve damage, dysphagia, tracheal ischemia, dilation
Diagnosis
  • Ineffective airway clearance related to increased mucous secretions.
  • Impaired verbal communication related to endotracheal tube.
  • Risk for infection.
  • Impaired gas exchange related to impaired airway.

Goals
  • The client will maintain a patent airway.
  • The client will have adequate oxygenation.
  • The client will identify other ways to communicate if impaired.

Interventions
  • Assess vitals, airway, pulse-oximetry, tolerance to procedure, ventilation requirements, suctioning requirements.
  • Monitor respiratory status and lung sounds.
  • Provide suctioning using sterile technique to remove secretions.
  • Provide writing utensils and communication alternatives at bedside.
  • Encourage client to use different ways to communicate if unable to verbally communicate.
  • Monitor for infection and teach patient signs and symptoms to report indicating infection.
  • Monitor cuff pressure every shift and maintain between 15 and 25 mm/hg or as ordered by physician.
  • Implement aspiration precautions.
  • Teach client techniques to manage trach at home.

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