Tracheostomy question

[KatieLisa]

So... if a patient with tracheostomy has wheezing and he has prn ventolin, would you suction and administer the prn ventolin, or would you just suction/administer ventolin and then evaluate?

Thanks in advance for your assistance.

[Wuzzie]

Your question doesn’t make sense. You’re doing the same intervention in both options.

[KatieLisa]

I meant do you do both, or do you just suction or just administer the ventolin. I know ventolin is a prn med for wheezing for some of our patients and wheezing is also one of the reasons we are taught to suction. But what if the patient who has prn ventolin also has a tracheostomy and you hear wheezing? so do we just suction? administer ventolin? do both? Sorry if it's a stupid question.

[Wuzzie]

I can only tell you what I would do and it may clash with what you are being taught. You need to think about what’s happening physiologically to cause the wheezing. I would listen to breath sounds and if all I heard was wheezing would give the Ventolin. Suctioning doesn’t fix wheezing. If I heard wheezing and other lung sounds that led me to believe the airways weren’t clear then I’d suction first followed by the Ventolin.

[KatieLisa]

Oh, i didn't know you could hear two abnormal breath sounds at the same time. So, you would suction if you heard wheezing and crackles, but you'd just give ventolin if it was just wheezing? That's weird because my readings says you would suction. Is it also possible to hear wheezing, or some other abnormal lung sounds, and decreased breath sounds at the same time? and in that case would you do both?

Thanks. Sorry for the stupid questions, I'm just trying to learn.

[Wuzzie]

You need to go by what your books says. Your questions aren’t stupid but I hesitate to say anything else as it might confuse you.

[Wuzzie]

I feel like I kind of left you in the lurch. I will be glad to answer your questions if you promise to run them by your instructor. I don’t want you failing a test. But I’m going to make you do some work so you really grasp the concept. First question. Tell me what causes wheezing.

[NICU Guy, BSN, RN]

9 minutes ago, Wuzzie said:

I feel like I kind of left you in the lurch. I will be glad to answer your questions if you promise to run them by your instructor. I don’t want you failing a test. But I’m going to make you do some work so you really grasp the concept. First question. Tell me what causes wheezing.

I agree. Baby steps is best to avoid confusing the OP.

[KatieLisa]

On 2/10/2019 at 8:30 PM, Wuzzie said:

I feel like I kind of left you in the lurch. I will be glad to answer your questions if you promise to run them by your instructor. I don’t want you failing a test. But I’m going to make you do some work so you really grasp the concept. First question. Tell me what causes wheezing.

I know it's caused by narrowing of airways due to inflammation.

It's actually first semester articles and guides about trachs that I'm reading. But you are right, we are always supposed to go by the book.

[Wuzzie]

You’re right. So knowing this how would suctioning help the inflammation?

[KatieLisa]

I would think the inflammation was being caused by something irritating the airway (ie. the secretion that needs to be suctioned). But you said suctioning wouldn't help with wheezing, so I'm a bit confused.

[Here.I.Stand, BSN, RN]

Real-world thoughts:

You suction if you hear secretions. (AND the pt is unable to clear them on their own. If the pt has a strong cough and can fire their secretions across the room, no need to stick a tube in there.)

No secretions = nothing TO suction... but that suction catheter will irritate the hell out of that airway.... which doesn’t help anyone breathe.

If there are secretions, that is adding another mechanism of airway obstruction, along with the constriction — and the medicine doesn’t make them go away. Sputum has to be physically removed.

Do you know anyone with asthma? They have wheezing and treat it with albuterol — but the wheezing is not necessarily accompanied by a productive cough. I mean if they have pneumonia yes, you can expect to see secretions. But a teenager who has been healthy, but left her albuterol at home and skied a 5k in -10F weather (true story)? She had plenty of wheezing with a dry airway.

A trach is a surgical airway — a hole cut to allow the insertion of a plastic or metal tube. The native respiratory system south of the trach functions like any other respiratory system; sometimes we have a dry cough, sometimes a productive one. Sometimes our muscles are strong enough to clear our airway, sometimes they need a bit of help. Assess your patient first and foremost.