Tracheostomy question

Nursing Students Student Assist

Published

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.

Wheezing is the physiologic narrowing of the airways (usually the small terminal ones but it sometimes can be heard in the large airways) due to constriction or inflammation. The only way to eliminate wheezing is to relax the airways or decrease the inflammation. We do this with medications such as albuterol and steroids.

When you suction where does the tip of the suction catheter stop?

Up Vote Up Vote ×
16 hours ago, Here.I.Stand said:

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.

Thanks for the response. Really appreciate it. -:)

Up Vote Up Vote ×
6 hours ago, Wuzzie said:

Wheezing is the physiologic narrowing of the airways (usually the small terminal ones but it sometimes can be heard in the large airways) due to constriction or inflammation. The only way to eliminate wheezing is to relax the airways or decrease the inflammation. We do this with medications such as albuterol and steroids.

When you suction where does the tip of the suction catheter stop?

about 6 inches til you reach the carina and feel resistance is when you stop advancing? Then you pull back a bit and begin suctioning.

Up Vote Up Vote ×

Very good. Now what part of the airway anatomy is the tip of the catheter in?

FTR: It may seem like I’m talking to you like you’re an idiot but I do NOT think that. I want you to process the information in small bits so that your brain forms a bigger picture. This is how critical thinking in nursing works, taking in lots of data and putting it together. It won’t take long until you’ll be able to do it in a flash.

Up Vote Up Vote ×
On 2/16/2019 at 12:08 AM, Wuzzie said:

Very good. Now what part of the airway anatomy is the tip of the catheter in?

FTR: It may seem like I’m talking to you like you’re an idiot but I do NOT think that. I want you to process the information in small bits so that your brain forms a bigger picture. This is how critical thinking in nursing works, taking in lots of data and putting it together. It won’t take long until you’ll be able to do it in a flash.

The trachea?

Oh no, that's fine. I have friends with moms or older siblings who are nurses that do this to them all the time. I've always envied it actually.

1
Up Vote Up Vote ×
+ Add a Comment