[Expert Solution]: Case Study: The Patient with a Tracheostomy…

Case Study: The Patient with a Tracheostomy The nurse is caring for a 75-year-old man who was admitted for laryngeal cancer and surgery. The patient was transferred from the ICU several days ago. He has a tracheostomy and the tracheostomy collar is in place. He is receiving high-flow oxygen at 8L/min. In the shift report, the nurse learns that the patient is alert and oriented to person, place, and time. He can feed himself and independently perform most basic ADLs. He appears to be anxious and is having difficulty coping with the tracheostomy. He has a large amount of yellow mucous secretions from the tracheostomy and a specimen has been sent for culture and sensitivity. He is increasingly resistant to tracheostomy care and suctioning, although the need to deal with the excessive secretions has been explained to him. He expresses in written notes how frustrated he is by his inability to communicate verbally. His pulse is 85 beats/min; blood pressure is 135/60; respirations 20/min; temperature 100 degrees F; pulse oximetry reading 95%. 1. A patient has a recent tracheostomy. What equipment does the nurse ensure is kept at the bedside? (Select all that apply) Check, bold, or highlight responses A. Ambu bag. B. Pair of wire cutters C. Oxygen tubing D. Suction equipment E. Tracheostomy tube with obturator 2. List complications associated with tracheostomy. 3. What assessment findings would accompany an airway obstruction related to the patient’s excessive secretions? 4. List interventions to prevent obstruction. 5. Nursing interventions to prevent infection in patients with humidified oxygen include which actions? (Check, bold, highlight the correct response) A. Use sterile normal saline to provide moisture. B. Drain condensation into the humidifier. C. Drain condensation from the water trap. D. Maintain a sterile closed system at all times. 6. Explain the prevention of tissue damage that could occur because the patient has a tracheostomy. 7. What assessment findings indicate that the patient should be suctioned? 8. Discuss special considerations for this older patient who has a tracheostomy. 9. Describe nursing interventions and several alternative communication methods to try with this patient. 10. To prevent accidental decannulation of a tracheostomy tube, what does the nurse do? (Check, bold, highlight the correct response) A. Obtain an order for continuous upper extremity restraints. B. Secure the tube in place using ties or fabric fasteners. C. Allow some flexibility in motion of the tube while coughing. D. Instruct the patient to hold the tube with a tissue while coughing.