Flatlander 6,577 Views
Joined: Jul 21, '12;
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Patients may have trachs because of their disease process which creates secretions. Due to a weakened state or the advancement of their disease they are no longer able to cough, spit or swallow as others would. They are probably colonized with every bacteria imaginable which will rise occasionally for sputum producing infection.
If anybody here has ever had PNA or bronchitis, it may seem like you are coughing up stuff for weeks or months later. Your body is just able to rid itself of the secretions more effectively. You also don't have a plastic hollow tube amplifying the sound of the secretions which may sound like a bucket full but really might be just a tiny but annoying amount that takes effort to clear the tube.
The other reason for a trach is chronic aspiration or impaired swallow. These patient will of course end up with more secretions, and infections, as they aspirate their own saliva. Cuffed trachs also do NOT prevent aspiration. They only slow down the inevitable or create one very nasty mess around or on the cuff. This is why some trachs now have subglottic suction ports just like the ETTs which are supposed to prevent VAP.
Patients can sometimes be weaned to a small trach and one without a cuff for them to be able to cough up and expel or swallow the secretions in a natural way despite a large piece of plastic.
And then there is even a bigger reason for secretions than the trach itself. That is over zealous "really deep" suctioning every two hours whether they need it or not and just because it is a check in the box. Also, the way some are taught is to push the catheter in until you meet resistance and that resistance is tissue which becomes irritated. BE CAREFUL when suctioning.
Most humidification systems are inadequate and cold air blowing around a trach can also be just irritating. Using a little donut heater on the top of a bottle or having 10 foot of tubing to lose whatever heat was produced is just not going to do much except irritate especially if the person has any asthma or reactive airway component. There is newer technology available for humidification systems which can prevent some of these issues. When the humidification is inadequate, patients retain secretions regardless of how vigorously you suction and that will lead to an infection and more secretions.
Poor patient hydration is also another factor which cause secretions to thickend and put them at risk for infection and more secretions.
Finally, there is malpositioning of the trach or excessive movement which created irritation. Care is not given when securing the trach or when turning them or just allowing the humidifier circuit to dangle heavily pulling the trach into a poor fit. The trach then irritates the wall of the trachea. BE CAREFUL of the trach's position.
Usually when a patient is in control of his or her own trach or is alert enough to tell his provider to be careful, they will have less secetions.
The trach itself gets an undeserved bum rap but then the most efficient trach for preventing colonization was the one made with real silver.
If there is no local refresher course available, I would suggest getting a copy of the latest edition of the Saunders Comprehensive Review and a copy of the latest edition of one of the photo atlases of nursing procedures for self study. Once you have put some time in reviewing these books, seek out an understanding employer if employment is your goal. There is nothing like on the job training to get going with improving job skills. An employer will put you in touch with the staff development person who will assist you in your goals and will also talk to your immediate supervisor so they know what your situation is. Best wishes.
Older New Nurses --- stand tall, put that chin out, square those shoulders & remember --- We have stuff that those young nurses don't have & that is Life Experience. We will stay our ground, keep our job. We don't call in unless we REALLY are sick or we REALLY have emergency. We don't pop around job to job just because we are fussy & "it isn't fun". We know work is work -- sometimes we get to love our job, sometimes not. We don't expect to love everyone, but we know how to get along with everyone because we don't sweat the small stuff. We don't go running to the boss whining about this & that - we work. We are stable, we are reliable, we are dependable & we work weekends!!!! Please do not let the Bull-Crap of "ageism" suck you in --- Stand Your Ground & Let your interviewers know you are valuable BECAUSE of your age!!! And one more plus --- at 53 you won't have to worry about me being on maternity leave! Wisdom balances out young impetuous workers every time.
Not only are you not too old, Hell no, you're not too old! I'm 58 also (and male, to boot), and graduate with my BSN (Fast Track) in 31 days 21 hours 32 minutes. If you want it, you can do it. Get a grip, make up your mind, and full steam ahead (and no, steam power is not a reference to age)! It ain't easy, it ain't quick, and it does involve an on-going trip outside your comfort zone. You will have plenty of times ahead to question your own sanity, and you will definitely not be one of the gang, but if you want it, I think you will find the reward equal to the effort. Good luck!
I hope you are right, but like so many Americans, I am having a very difficult time believing any information that comes from the CDC or NIH these days. My first tendency is to call BS.
Wow, just WOW! What on earth was that nurse thinking??? Why would she get on a plane, with a fever, when she knew she had been exposed???? I hate to throw a fellow nurse under the bus, but if that is true she deserves to be.
Just watched the speech from Ohio. I've read every comment on this thread and others and did not know until now that the 70-some healthcare providers who were known to be exposed to Duncan were still going about their lives as usual.
So I gather they are still working and taking care of patients? The news pundits who are so outraged that fellow fliers were possibly exposed when Amber Vinson flew to Ohio with a low grade fever are just going to pass out when they find out the other 70-some are still WORKING...with PATIENTS!
This is not going to be contained until the CDC, hospitals who put $ before common sense, and the PTB get their heads out their asses and crack down!!!
The CDC should have been in Dallas within 2 hours of that positive lab report. According to the CDC article from 12/10/2013 that I read somewhere on an allnurses ebola thread there was a regional ebola resource place set up in Houston. What were THEY doing?
Moving forward, we nurses need to stand together and speak up for WHAT WE KNOW.
This is far worse than a lack of response to hurricane damage. This is going to be a NIGHTMARE.
I hope that some news reporter is reading THIS post and picks up the ball.
So, my hospital has been having so called "informative meetings". I went to one today. It consisted of 4, maybe 5 slides with info any of us could have gotten from the internet. We were told that regular PPE is just fine and when I asked about why CDC workers you see on the news wear Hazmat suits, it was a distinctly uncomfortable moment. I expressed concern about those flimsy face shields we have and about the fact that the man in Texas had projectile vomiting and diarrhea. That's when I started to get semi dirty looks from administration,lol. All in all, not a confidence inspiring event.
My facility is screwed.
I heard today that in Africa, over 200 doctors and nurses have succumbed to Ebola. Here's an article about that from August 2014. It is worse today of course.
Flatlander - thanks for that post. Lots of good info.
Our government is messing up here . . . . and usually I'm a fan of the CDC but not today.
On Ebola, Obama Gets an F
How dare they blame the nurse when they give her inadequate equipment, a flimsy gown, mask. No respirator, no safety suit, her whole body wasn't even covered and then dealing with intubation and dialysis, and profuse body fluids. Too bad she can't sue them for putting her in this dangerous situation. As others have stated Ebola is a level 4 biohazard and should be met with a positive pressure hazmat body suit and respirator, even decontamination showers to make sure their is no virus on the suit before taking it off! They should be using the 4 hospitals in the country that have the necessary safety equipment. Also they were drilled and instructed before caring for the Ebola patients complete with a buddy system, unlike the rest of us. Even in Africa workers are sprayed down with bleach before taking off their safety equipment. A flimsy gown and mask just doesn't cut it! Also ending air travel to and from West Africa till this is contained is long overdue! What is this someone's idea of an experiment to see how Ebola would react in America. Why are we being put needlessly at risk! Also I don't want to worry about my pet being euthanised and my house being invaded to decontaminate it!
The govt should be paying hospitals to buy the hazmat suits and respirators for their staff and providing adequate training to protect us and the borders should be closed already so more people aren't needlessly exposed to Ebola in America! Honestly if I could afford to quit I would do so rather than be put in this position of risking my life with inadequate equipment and training. As long as the borders are open we will be at risk. I'm not worried about millions dying, I am worried about how many health care workers are going to die from this and how many others exposed between the Ebola patients and their healthcare workers. Now we have thousands of Americans in the military being exposed to Ebola and I wonder how many of them are going to need to be medivaced back to the states for treatment. It is only a matter of when and how many that remains to be seen!
I hope the National Nurses United are strong enough to get action throughout the countries hospitals since the govt and CDC haven't been of much use. The CDC telling people a simple mask and gown is enough! What a big fat lie! I would like to see the head of the CDC gowning up in a simple mask and gown taking care of these patients and see if he gets it? He knows damn well it is not safe and a gown and mask are not enough to protect us!
Mileage is for skilled intermittent home health (visits) with multiple patients. Main objective post hospitalization is to prevent readmission. It sounds like you are doing private duty which is 4-16 hours shifts on a single case. And yes if your patient is hospitalized and you are oriented to a single case, you are out of luck. Many of these patients can be inpatient for weeks to months.
We do have lots of suggestions. Here are some of the responses you may hear: 1) that's a great idea, write up a proposal and present it and then we'll let you know; 2) we have to clear that with HR and administration; 3) we've tried that before; and 4) that is not going to happen
All self-defeating, non supportive and placed in a bureaucracy that allows good ideas to wither on the vine. Transformational, innovative energetic people/leaders are needed to support and allow nurses to do what comes naturally solve problems and improve efficiency and save money. Makes one think that these items are not as important as we are led to believe.
One time our administrator opened ours to find a dried-out piece of chicken that one of the SNF patients had put in it, evidently to express his/her displeasure at the quality (or lack thereof) of the food.
Yeah, but people keep flushing it.
Thanks for the advice and I agree with you 100%, I can not afford to wait for a hospital offer and from my own expericence LTC are verry challenging. I am interviewing with the Home Health Care Agency tommorow. I heard that they do pay mileage reimbursement, they have benefits and they have on the job training which you train with another nurse, they also provide a I Phone and and tablet, the down side I hear is that their is a lot of paper work involve, I would perfer to work at an hospital but so far this is my first interview since graduation.
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