...Tracheostomy Care Nison Vo Evergreen Valley College Tracheostomy Care In this paper I will compare and contrast between EBP (evidence based practice) and SCVMC’s (Santa Clara Valley Medical) policy regarding tracheostomy care/suctioning. Current EBP states that “the patient's respiratory status must remain the focus, and no set schedule should exist for tracheostomy suctioning” (Schreiber 123). SCVMC’s policy states that RN’s (registered nurses) and LVN’s (licensed vocational nurses) should suction tracheostomies depending on the doctors’ orders and as needed by the patient based on assessment/status. All in all, SCVMC’s policy does principally coincide with the current EBP discussed in this paper, which would aid in providing...
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... Past Medical History: Unknown Current Hospitalization: Currently admitted to medical-surgical unit , in the weaning phase of his tracheostomy care. He has required suctioning every four hours for a moderate amount of thin, tan secretions. Allergies: No known drug allergies Medications: None. Code Status: Full Code Social/Family History: Employed as a mail carrier; Divorced: has two adult children who live out of town, but visit frequently. Latest Assessment: Vital Signs: HR 82, BP 124/75, RR 14, SPO2 98% on 36% tracheostomy collar, T 99 Cardiovacular: Normal sinus rhythm Respiratory: Breath sounds with ronchi bilaterally; equal expansion, trach tube intact, and insertion site clean and dry. GI: normal bowel sounds, PEG tube intact dressing dry GU: WNL Extremities: equal bilaterally, strong peripheral pulses Neurological: Alert and oriented to time, place and person, pupils equal and reactive to light and accommodation Pain: no complaints of pain Learning objectives * Perform assessment on the patient * Demonstrates appropriate tracheal suctioning techniques, including ongoing assessment of respiratory status * Intervenes appropriately to resolve acute respiratory distress in patient with tracheostomy Preparation questions: 1. What are some of the indications for a tracheostomy? * Prolonged intubation during the course of a critical illness * Severe neck or mouth injuries * Long term unconsciousness or coma, ...
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...Introduction A tracheostomy (commonly known as a trach) is a surgically created hole in the windpipe (trachea) that allows air to enter the lungs. A tracheostomy procedure is performed when the normal route for breathing is blocked or impaired. Since the mouth and nose are no longer used for breathing, saliva and mucus build up in the trachea and must be removed by suctioning. Removing mucus and other fluids keeps the airway clear and helps the baby breathe. Tracheostomies should be suctioned at least 2 times a day. You may need to suction your baby's trach tube more often if: You hear noisy breathing from a buildup of mucus or saliva in the trachea. You are directed to do so by your baby's health care provider. What supplies do I need? Suction catheter....
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...Introduction A tracheostomy tube, or trach tube, is a flexible tube that is placed in the main airway (trachea) that leads down to the lungs. A tracheostomy allows your baby to breathe without using his or her nose or mouth. A trach tube may be needed if: Your baby’s airway is blocked by swelling, injury, tumor, a foreign body, a vocal cord problem, or severe narrowing of the trachea. Your baby needs long-term breathing assistance (ventilation). Your baby has excess airway mucus or other fluids (secretions) requiring frequent suctioning. If your baby has a trach, you must follow certain safety measures to keep your baby safe and free of infection. What are some tracheostomy tube safety measures? Always carry the emergency travel-sized trach kit for your baby when you...
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...Introduction: A tracheotomy is a surgical procedure to create an opening in the neck at the front of the windpipe (trachea). A tube is inserted into the opening and connected to an oxygen supply and /or ventilator to assist with breathing. Fluid may accumulate in the throat and windpipe and the removal through the opening is allowable. Dawson (2014) states nurses caring for patients with tracheostomy require an appreciation of the breadth of knowledge needed to provide individual and safe care. A tracheostomy may be performed as: • An emergency procedure - if someone is unable to breathe following an injury or accident. • A planned procedure - to assist someone who is unable to breath as part of treatment in intensive care, or due to a long-term condition such as laryngeal cancer etc....
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...|CognitiveLevel||3rd Ed. Page References| |Recall|Application|Analysis|Totals|| I. PATIENT DATA EVALUATION AND RECOMMENDATIONS|11|14|1|26|| A. Review Data in the Patient Record|4|||4|| 1. Patient history e.g.,• present illness• admission notes• respiratory care orders• medication history• progress notes• diagnoses• DNR status• patient education (previous)|||||pp 33, 82, 47| 2. Physical examination relative to the cardiopulmonary system e.g., vitalsigns, physical findings|||||pp 33-35, 35-45, 47, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177| 3. Laboratory data e.g.,• CBC• electrolytes• coagulation studies• culture and sensitivities• sputum Gram stain|||||pp 45-47| 4. Pulmonary function results|||||pp 47, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197| 5. Blood gas results|||||pp 47, 124-126, 126-127, 127-128, 151-153, 153-155, 156-158, 158-163| 6. Imaging studies e.g.,• radiograph• CT• MRI|||||pp 33-45, 47, 151-153, 175-177| 7. Monitoring data|||||| a. fluid balance|||||pp 139-140| b. pulmonary mechanics e.g., maximum inspiratory pressure, vitalcapacity|||||pp 47, 139, 191-194, 194-196| c. respiratory e.g.,• rate• tidal and minute volume• I:E|||||pp 47, 139, 191-194, 194-196| d. pulmonary compliance, airways resistance, work of breathing|||||pp 47, 137-139, 141-143| e. noninvasive e.g.,• pulse oximetry• VD/VT• capnography• transcutaneous O2 / CO2|||||pp 20-21, 47, 137-139, 167-172, 172-175| 8. Cardiac monitoring|||||pp 35-45, 158-163| ...
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...Tracheostomies * Short-term reasons: * Anaphylactic shock * Trauma * Choking * Impaired airway baby drinking bleach throat is now swollen impairing airway needs trach * Croup cause upper airway swelling * If they couldn’t be intubated need an airway asap * Long-term reasons: * Syndrome have TEF an opening between trachea and esophagus unable to breathe * Cancer post surgery * Congenital abnormalities * Neuromuscular d/o’s MS, CP, spinal Cord injury or muscular dystrophy * Brain trauma/tumor or brain genetic disease (brain tells lungs to breathe so if its not working you’re not going to breathe) ***In pedi, there is only one cannula because if not the child will be taking the cannula out all day*** * Cuff will keep trach in place and will prevent aspiration. * Can be cuffed or uncuffed depending on the situation. * Keep scissors at bedside in case you need to cut the ties. ***DO NOT LET TRACH KID BE AROUND THE CHALKBOARD*** PARTICLES CAN ENTER THE TRACH. * Put a filter on the trach if the child will be outdoors. * What kind of trach is most likely to be used in pedi? * Shiley 3.5, 4.0, 4.5 or 5.0 (the whole point is to always have a smaller half size replacement at the bedside at all times) * Example: Your patient currently has a 4.0 trach, need to have a 3.5 at bedside in case kid pulls out current trach. * Kids...
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...Tub bath taken. Patient able to bathe self, but needed assistance getting in and out of tub. Skin on both legs dry and flaking; patient reports severe itching. Emollient lotion applied after bath. Patient states itching is less now. (Tub Bath or shower) After complete bed bath, provided back massage using pétrissage and friction. Patient reported muscle tension and rated pain a 4 before back massage; reported muscle relaxation and rated pain a 2 after back massage. Skin is moist, pink, and intact with no bruises, swelling, or redness. After back massage, patient’s respirations decreased from 20 to 16 per minute and pulse decreased from 78 to 70 beats per minute. (Back Massage) Complete bed bath given. Patient unable to assist but cooperative with turning. Skin on both legs dry and flaking, complains of severe itching. Bath oil added to bath water. Emollient lotion applied after bath. States itching is less after bath. (Complete or Partial Bed Bath) Perineal care given. Patient unable to assist but cooperative with positioning. No redness, drainage, or open areas noted. Patient complained of mild itching before perineal care. Patient reports reduced itching after perineal care. (Perineal care for Female Pt) Perineal care given. Patient unable to assist but cooperative with positioning. External genitalia show no signs of redness, swelling, or drainage. Indwelling catheter is intact and draining clear amber urine. Patient denies pain but states that he feels...
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...Respiratory homeostasis Mechanical ventilation, supplemental oxygen artificial airway (endotracheal tube, tracheostomy tube, oral pharyngeal airway) extra- corporeal membrane oxygenation or CO2 elimination diaphragmatic...
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...Charting / Documentation Guide Nursing documentation should be clear, timely, accurate, reflective of observations, permanent and legible. This is a guide and not a complete list. Always follow policies in place at your facility. Medicare Documentation • Must reflect need/reason for skilled care • Must reflect Standard of Care • Describe intervention(s) • Describe resident’s response to intervention(s) • Daily evaluation of progress or lack of progress • Resident response to skilled therapy • ADL function • Changes in condition • Change Care Plan ASAP after change in condition • Notification to MD and family Respiratory/Pneumonia Medicare Documentation • Must reflect need/reason for skilled care • Daily vital signs • Daily and PRN O2 sat level • Daily and PRN lung sounds • SOB with exertion, when sitting at rest or when lying flat • Resident’s response to interventions and skilled therapy • Progress or lack of progress • Change in condition • Change Care Plan ASAP after condition change • Notification to MD and family Bladder and Bowel • Indicate status: always continent, occasionally incontinent, frequent- ly incontinent, always incontinent • Indicate if has catheter (indwell- ing or condom, intermittent), uri- nary ostomy, or no urine output • Toileting program in progress or attempted and outcome • Constipation? Which interventions used, and results? Anticoagulant Therapy Medicare Documentation...
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...DEVON K. WILLIAMS 6649 Federal Hall Street Plano, Texas 75023 214 450 5578 or amala8799@aol.com |Objective: To be a part of an integral part of a dynamic health care team providing quality nursing care to clients and their families. | EDUCATION | Trinity Valley Community College, Kaufman, TX Associate Degree- Nursing -Expected 2012 | | Samuel Merritt College, Oakland, CA Master-Physician Assistant 2001 | | California State University, Hayward, CA Bachelor of Science - Biology 1999 | | | | | ADN Student Clinical Experience |Fall 2009 |Medical Center of Plano, Plano Texas. Clinical time split between telemetry floor and women’s services. | | |Obstetric Rotation – Labor & Delivery, newborn nursery, and postpartum rotation performed at Wilson N. | | ...
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...MANAGING PATIENTS WITH OXYGENATION AND PERFUSION PROBLEMS Erica Schultz Breckinridge School of Nursing NU 230 Mrs. John September 23, 2015 MANAGING PATIENTS WITH OXYGENATION AND PERFUSION PROBLEMS As we may know, oxygen is one of the most vital elements that we need to live and function. Cells and tissues depend on oxygen to perform their roles, but some cells such as brain cells and heart muscle cells, are very dependent on oxygen (Ignatavicius & Workman, 2013). Without this crucial element, our body begins to suffer and our cells begin to die. We will learn the process of breathing and how taking a simple breath fuels these cells, to what to look for and how to confirm when a person is not getting enough oxygen, emergency treatments for these situations, and nursing considerations that can be implemented for these patients. The source of the oxygen for all body cells and tissue is the air that we breathe into our lungs (Ignatavicius & Workman, 2013). Breathing is an involuntary action that most people do not have to think about to perform. With each breath that we take, our body performs specific steps so that our body stays healthy and alive. It all begins with inspired oxygen from the environment entering the body through your mouth or nose and it moves down your respiratory tubes which includes the trachea, bronchi, and bronchioles, and then into the air sacs of the lungs. Once the oxygen is in the air sacs, it then moves across the alveolar capillary membrane...
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...Name And Student Number (Bolded)Course, Semester, Year | SITI ROHAIDA BINTE RAHMAT12B057ZADVANCE DIPLOMA IN NEUROSCIENCE, 2012 | Managing Client with Cerebrovascular Disease Introduction Stroke is a part of a cardiovascular disease that occurs when the supply of blood or oxygen to the brain is disrupted by a blockage in the artery or when there is usually a trauma that causes spontaneous bleeding in the brain (Duncan, Zorowitz & Lambert, 2005). Bleeding in the brain, is referred to as a haemorrhagic stroke which results from either ruptured blood vessels or due to an abnormal vascular structure such as arterio-venous malformation. Although stroke can be classified into two different categories (ischemic and haemorrhagic), one should note the indispensable relationship between the two. This would be later explained at a greater detail into the case study. The following would be a brief introduction of my chosen case study. Emergency Department A 22 year old gentleman was brought to the Emergency Department at 1235hrs on 28th October 2012 via ambulance. Patient was unresponsive upon arrival, GCS= 3, E1V1M1, bilateral pupils non-reactive to light and slight epistaxis noted. History obtained from eye-witnesses stated that patient just finished boxing practice and complained of severe giddiness before fainting shortly after and never regained consciousness. On arrival at Emergency Department, patient was sent for a CT (computed tomography) Brain with chest and cervical...
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...EDUCATION Critical thinking and analysis: a model for written assignments Sharon L Edwards W hat is critical analysis? In the author’s personal experience this question has been answered by the following statement: ‘It is being critical of the literature.’ However, this does not answer the question. A literature search also failed to provide any information on critical analysis. The justification for developing a model for critical analysis, however, was not solely the lack of available literature. Other reasons included: to provide a definition of the terms; and to help both educationalists and students interpret the concepts involved. Nurse educationalists and nursing students lack a clear understanding of the critical processes and this could severely diminish the profession’s ability to articulate issues that are imperative to the advancement of nursing practice in the future. This article recommends a model of critical analysis that can be used by students and educationalists. It suggests that critical thinking and analysis are interrelated and complementary, but not synonymous. It gives examples of the model’s components in order to clarify their meaning. The model will hopefully give students a premise on which to base their assignments, and nurse educationalists will be able to incorporate it into their teaching practice. It will also provide an element of reality to critical analysis which will prevent it from becoming so abstract and idealistic as to render...
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...Chapter 1 Nursing Images throughout History 1) The angle of mercy 2) The handmaiden 3) The battle-ax 4) The naughty nurse 5) The military image A. Nurses on the battlefield * Hospitalers – specialized soldiers who at the end of battle returned to the outposts to care for the sick and injured * Army nursing service – organize nurses and hospitals and coordinate supplies for the soldiers during the Civil War * Clara Barton a. Provided care in tents set up close to the fighting b. Did not discriminate c. Establishment of the American Red Cross * Harriet Tubman – helped slaves escape to freedom on the underground railroad * Walt Whitman – a poet * Louisa May Alcott – an author * Dorothea Dix – union’s superintendent of female nurses during the Civil War B. Nurses fighting diseases * Florence Nightingale d. Epidemiology – the study of the distribution and origins of disease e. Air, light, nutrition, and adequate ventilation and space assist the patient to recuperate * Lillian Wald & Mary Brewster f. Founded the Henry Street Settlement in NY to improve the health and social conditions of poor immigrants g. Improve health and prevent illness by promoting safe drinking water, adequate sewage facilities, and proper sanitation Florence Nightingale (1820-1910) ...
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