Well, falls do happen, but for the same patient to fall twice is a little much. If ALL of the proper precautions were taken and the patient still managed to get out of bed and fall... believe it or not that does happen as well. If the proper precautions were not taken though, knowing that the patient had already fallen once, and knowing that the patient's BP dropped when she got up... well, that's pretty poor care, yes indeedy.
Letting her lay in her own poop is also poor care. If she let someone know that she had to go to the bathroom, someone should have come to assist her ASAP. If she can't talk, someone should have been checking on her regularly to make sure her needs were met, or someone should have went straight to her room when she rang her callbell.
Respiratory therapists tend to get awfully busy. Trachs get yucky stuff in them. Nonetheless, if the situation was getting emergent, as in, the thing was so full of gunk that the pt. was going into distress, and/or 02 sats were going down, the nurse should have called the RT again and let him/her know the situation was getting emergent, or perhaps even just come in the room and suctioned the trach herself. Nurses do get taught to do sterile suctioning in school, though they may rarely use the technique. I know *I* never liked to!!!