A patient with a tracheostomy has a new order for a fenestrated ...

[codyclark]

A patient with a tracheostomy has a new order for a fenestrated tracheostomy tube. Which action should the nurse include in the plan of care in collaboration with the speech therapist?
 
  a. Leave the tracheostomy inner cannula inserted at all times.
  b. Place the decannulation cap in the tube before cuff deflation.
  c. Assess the ability to swallow before using the fenestrated tube.
  d. Inflate the tracheostomy cuff during use of the fenestrated tube.

Question 2

A nurse who is caring for patient with a tracheostomy tube in place has just auscultated rhonchi bilaterally. If the patient is unsuccessful in coughing up secretions, what action should the nurse take?
 
  a. Encourage increased incentive spirometer use.
  b. Encourage the patient to increase oral fluid intake.
  c. Put on sterile gloves and use a sterile catheter to suction.
  d. Preoxygenate the patient for 3 minutes before suctioning.

[fauacakatahaias]

Answer to Question 1

ANS: C
Because the cuff is deflated when using a fenestrated tube, the patient's risk for aspiration should be assessed before changing to a fenestrated tracheostomy tube. The decannulation cap is never inserted before cuff deflation because to do so would obstruct the patient's airway. The cuff is deflated and the inner cannula removed to allow air to flow across the patient's vocal cords when using a fenestrated tube.

Answer to Question 2

ANS: C
This patient needs suctioning now to secure a patent airway. Sterile gloves and a sterile catheter are used when suctioning a tracheostomy. Preoxygenation for 3 minutes is not necessary. Incentive spirometer (IS) use opens alveoli and can induce coughing, which can mobilize secretions. However, the patient with a tracheostomy may not be able to use an incentive spirometer. Increasing oral fluid intake would not moisten and help mobilize secretions in a timely manner.