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Situations that may call for a tracheostomy include: Medical conditions that make it necessary to use a breathing machine (ventilator) for an extended period, usually more than one or two weeks. Medical conditions that block or narrow your airway, such as vocal cord paralysis or throat cancer.
All tracheostomy patients must have suction equipment and emergency supplies at the bedside. Emergency equipment is usually in a clear bag on an IV pole attached to the patients bed. A tracheostomy patient must be assessed every two hours to determine if suctioning is required.
Indications for emergent tracheostomy include: Acute upper airway obstruction with failed endotracheal intubation (foreign body, angioedema, infection, anaphylaxis, etc.) Post-cricothyrotomy (if a cricothyrotomy has been placed it should be immediately formalized into a tracheostomy once an airway has been secured)
The tracheal stoma in the immediate post-operative period requires regular assessment and wound management including once daily dressing change following cleaning of the stoma area or more frequently if required. The comfort of the patient is imperative throughout the post-operative period.
The priority assessment in the care of a patient with a tracheostomy focuses on airway and breathing. These assessments supersede the nurses assessments that may also be necessary, such as nutritional status, speech, pain, and swallowing ability.
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Nursing care plan goals and objectives for a client who had undergone tracheostomy include maintaining a patent airway through proper suctioning of secretions, providing an alternative means of communication, providing information on tracheostomy care, and preventing the occurrence of infection.
In general, the trach tubes with an inner cannula must be cleaned regularly to prevent the buildup of dried mucus. The skin around your stoma and your neck must also be cleaned 2-3 times a day to remove dried mucus and to avoid excess moisture on your neck that can cause a rash.
Nurses provide tracheostomy care for clients with new or recent tracheostomy to maintain patency of the tube and minimize the risk for infection (since the inhaled air by the client is no longer filtered by the upper airways). Initially a tracheostomy may need to be suctioned and cleaned as often as every 1 to 2 hours.

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