Case Analysis : Tracheostomy Care

Mrs. Helen Bessler, mother of George Bessler, was hospitalized 16March2015 and underwent surgery of the right lung on 17March2015. She had cancer of the right lung that required removal of two lobes and a section of the superior vena cava.

ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).

L.M. is a 75-year-old female who suffers from severe dementia and lives in a SNF. She was diagnosed with lung cancer in 2005 and as a result had a right upper and middle lobectomy. She also has a history of severe emphysema. L.M. has had several pneumonic infections and has an allergy to Pneumovax. She has a recurrent aspiration risk and received a tracheostomy and a PEG tube in January 2012.

INDICATIONS FOR SURGERY: The patient is a 62-year-old Caucasian male who has pneumonia. The patient has been on a ventilator for over 2 weeks and appears to require long-term ventilator. The patient is undergoing tracheostomy for this purpose.

When the organs fail the only option is a transplant. With lungs there is only a 50% rate of a five year survival rate after a lung transplantation involving the end-stage respiratory disease. With such a drastic survival rate a study was completed to determine if patients could have a better outcome. This study was done to help determine effective methods to enhance lung transplants before surgery; the Doctors placed the recipients on bi-level positive airway pressure ventilation (BIPAP.) “BIPAP is a noninvasive mode of ventilation administered through a tight-fitting mask to assist spontaneously breathing patients”

One of the most important things to maintain a trauma patients airway is ensuring that you have adequate help around (Stephens, 2011). This is important because there are many different tasks that must be delegated in maintaining this persons airway. Some of these processes include opening the airway, suctioning the airway, inserting the proper adjunct, and maintaining

The aim of this paper is to critique the research article, “Accidental Decannulation Following Placement of a Tracheostomy Tube” published in Respir Care (White, Purcell, Urquhart, Joseph, and O’Connor, 2012). The article wants to find out the causes of increased rate of mortality and morbidity due to accidental decannulation following tracheostomy place in long-term acute care hospitals (LTACH). This paper seeks to evaluate the strengths and weaknesses of this research process to establish its efficiency and practicality.

The purpose of faculty training in the nursing profession is to provide program evaluation to examine evidence-based practice in a simulation of care and provide safe nursing practice. Patients with a tracheostomy are high risk and have numerous problems for nurses to find because of respiratory problems. In addition, understanding the facility policy regarding tracheostomy care, the faculty must possess specific knowledge and skills to provide satisfactory care. Evidence-based research has provided the organization for nurses to improve nursing care standards and practice regarding tracheostomy care (Schreiber, 2015). On the other hand, the patient simulation laboratory (SIM lab) coincides with this setting because it uses state-of-the-art

As a respiratory therapist having the patient breathing is the number one priority. But when the patient is in bad condition the chance of the patient not being able to breath on their own is high. This is when a life support machine comes in, there are four different types of life support machines. The first one is a ventilator, this is the most important, this is what helps the patient to breath; the ventilator is forcing air into the patient's lungs. Having a ventilator on a patient is when the RT is seen the most because the RT has to intubate the patient. Intubation is the placement of a plastic tube that goes down into the trachea to maintain an open airway for oxygen to enter. The ventilator not only pushes oxygenated air into the lungs but it also monitors every breath the patient takes while

Respiratory therapists have one of the most exciting and gratifying careers within the medical field. Unfortunately as with any other job or career, it doesn’t come without having challenging times. Respiratory therapists work along-side physicians and are highly trained to treat patients with any sort of lung concern or breathing complications. This job requires hands on care, and deals with life and death daily. One specific scope of this field involves caring for patients (of all ages) attached to mechanical ventilation. It is the respiratory therapists’ responsibility to remove assistive ventilation to patients with written order from the doctor; which ultimately results in death of the patient (Keene, Samples, Masini, Byington).

From investigation in health practices, ventilator associated pneumonia caught my attention. “Ventilator Associated Pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units. Most episodes of VAP are thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. Aspiration of gastric secretions may also contribute, though likely a lesser degree. Tracheal intubation interrupts the body’s anatomic and physiologic defenses against aspiration, making mechanical ventilation a major risk for Ventilator Associated Pneumonia. Semi-recumbent positioning of mechanically ventilated patients may help reduce the incidence of gastroesophageal reflux and lead to a decreased incidence of VAP. The one randomized trial to date of semi- recumbent positioning shows it to be an effective method of reducing VAP. Immobility in critically ill patients leads to atelectasis and decreased clearance of bronchopulmonary secretions. The accumulation of contaminated oropharyngeal secretions above the endotracheal tube cuff may contribute to the risk of aspiration. Removing these

Teamwork and Collaboration: Overall, Tracheotomy was one person's job. At the hospital I would collaborate with other nurses to clean the inner cannula, and to put restraint on Mr. Harrison's wrist to prevent Mr. Harrison from pulling the tracheotomy. I would work together with Mr. Harrison or his family member, and find ways for him to quit smoking.

Maintain a closed chest drainage system; tape all connections and secure tubing carefully at the insertion site with adhesive bandages

Nose and mouth warm and moisten the air that travels through them. It also helps with clearing out mucus secretion. Exclusion of the nose and mouth means a buildup of secretion in the oxygen cap. So, it is crucial to suction out secretions and clear the inner cannula carefully for any blockage or build up. Nurses have a huge responsibility when it comes to tracheostomy. They have to keep it clean, clear out secretions and care for surrounding tissue. They also have to consider about providing the individual with some way of

Tracheostomys may be required for long term control of excessive bronchial secretions, particularly in those with reduced consciousness or to maintain an