Nursing 211

N211: Health Differences Across the Lifespan I of 148 use if trach accidentally removed. Ensure oxygen and air flowing into the airway is humidified; notify respiratory therapist if water bottle attached to oxygen flow meter runs low. Teach coughing and deep breathing to reduce the risk of atelectasis and pneumonia. Perform respiratory assessments, including breath sounds at regular intervals, minimally every four hours. Monitor and document oxygen saturation and/or arterial blood gas results. Suction client as indicated; hyperoxygenate client before and after suctioning. Suction for no more than 10 seconds at one time. Assess nature of secretions (purulent secretions indicate infection). Assess stoma for redness or signs of infection; assess for and report subcutaneous emphysema (subcutaneous air, also called crepitus). Perform trach care every 8 hours; use normal saline for cleaning site and inner cannula unless facility policy differs. Change trach ties daily and more often if soiled. Provide alternate means of communication (word or picture board, writing pad) if client cannot talk because of cuff inflation. If client has order for oral intake while trach is in place, inflate cuff to reduce risk of aspiration and sit client upright during meals and for one hour after meals. Before capping with Passey-Muir valve or plugging trach as final stages of weaning before trach removal, ensure fenestrated trach is in use and that cuff, if present, is deflated. Complications short term includes tube dislodgement (accidental removal), tube obstruction. Long term complications include tracheomalacia (tracheal dilation and erosion from high cuff pressure), tracheal stenosis (tracheal lumen narrowing from scar formation secondary to cuff irritation), tracheal-innominate artery fistula (erosion of lateral wall of trachea into artery caused by pressure from distal end of tube). Lung Surgeries are operative techniques that are performed to diagnose and treat certain types of pulmonary conditions. Procedures include pneumonectomy, lobectomy, wedge resection and segmentectomy. Pneumonectomy is removal of the lung through posterolateral or anterolateral thoracotomy. A chest tube drainage system is not required because there is no lung left to re-expand. Fluid accumulation is desired in the empty space to prevent mediastinal shift. Lobectomy is performed more often than pneumonectomy because it involves removal of less tissue. Lobectomy involves removal of the lobe of the lung through a thoracotomy. A chest tube drainage system is required to re-expand the remaining lung portions. Wedge resection is a small, localized section of lung tissue is removed, usually a wedge or pie slice. A chest tube drainage system is required to re-expand the remaining lung portion. ©2012 Achieve Page 80

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