Laica A.

Luneta

BSN III

CASE SCENARIO

TRACHEOSTOMY CARE MANAGEMENT

Question No. 1

As a nurse to the patient, what will be your immediate intervention?

The immediate intervention is first the assessment. Assess thee breathing by listening and
feeling for breathing at the mouth and tracheostomy. The first priority is the airways, based on
the scenario the patient has signs of airway obstruction which are the hypoxia with absence of
chest movement despite inscreased respiratory effort. Oxygen administration should be
performed neither to the mouth or nose. If the tracheostomy tube is cuffed, it should be deflated
to insert the oxygen through the nose or mouth. Then, the inner canula should be removed.
Lastly, it is important to check the tracheostomy position if it is patent or misplaced. This can be
done by passing a suction catheter through the tracheostomy tube. If the suction catheter cant be
passed then the tube is not in the proper position or it is in the trachea position of the patient so
let the patient speak to test if the tube is in right position.

Question No. 2

No, positive pressure veltilation should be administered only if the position of the
tracheostomy tube in the trachea is there. Based on the scenario, the patient may have a false
tract by incorrect replacing of the trahceostomy tube in the stoma. This can be a cause of
obstruction of the trachea or idicrectly due to bleeding and swelling. This may worsen the airway
obstruction and make the intubation difficult.

Question No. 3

Based on the story, what you should do next?

The next thing to do is to remove the tracheostomy tube. If its not workingm remove it
out. The failure to act in this kind of situation can result to hypoxia or even death. Oxygenation
and ventilation orally is effective but remember to cover the tracheostomy site during
oxygenation and ventilation via oral route. If the patient's respiratory distress and oxygenation
has no improvements, oral intubation is indicated. Notify the doctor and document the findings,
assesment and ongoing intervention plans.