Patient with recurrent aspirations

[StudentNurse12345]

Hi there,

Just need some help with prep work. I have a patient with a diagnosis of recurrent aspirations who has a trach (a shiley with if cuffed, deflated and corked), and is also on TPN. I'm triing to come up with my day and some priorities for this patient as well as understanding their diagnosis. They have a history of COPD,GERD, HTN, ex smoker, diabetes. Also had hypoxemia 2 degree to aspiration pnemonia.

I was thinking that for some priorities would be a resp assessment (making sure that there are no crackles and if there are asking them to cough to try to get them out), monitoring resp status, also looking at the PICC site.

I haven't really worked with TPN or trachs. Any tips?

Thanks in advance.

[KelRN215, BSN, RN]

What are the important things to know for patients with trachs? Are there any particular safety checks you need to do because of the trach? Why does this patient have a trach? Will he be able to cough to clear his secretions or will you need to do something else in that regard?

Do you know why this patient is on TPN? Is he on it continuously? Is there anything in particular that needs to be done with the PICC line during your shift?

[StudentNurse12345]

For patients with trachs it is important to make sure that there is trach equipment is at the bedside just incase of accidental decannulation and that there is proper oxygen and suction at the bedside. I think this person has a trach because they are unable to get out the secretions at the bottom of their lungs. If he is not able to clear his secretions with coughing I would have to suction the trach.

I think this patient is on TPN because of his reccurent aspirations and I guess wouldn't be able to eat and get the proper nutrients. He is on it continuously. For the PICC line I am going to be looking for any signs of inflammation or infection.