Accidental decannulation/dislodgement is an emergency: in a mature stoma reinsert with the obturator; if unable, ventilate over stoma or mouth and call for help.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A child with asthma uses a peak expiratory flow meter at home. The reading falls in the red zone (less than 50% of the personal best). Which instruction should the nurse reinforce with the family?
Answer: B. A red-zone peak flow reading signals a medical alert: the child should take the prescribed quick-relief (short-acting beta agonist) medication and seek medical care immediately. Continuing routine activity, doubling the controller, or waiting to recheck delays needed treatment.
Question 2 of 3
A client passes a renal calculus and reports severe flank pain radiating to the groin. Nursing care includes:
Answer: B. Provide pain relief, encourage fluids (unless contraindicated) to help pass the stone, strain all urine to capture the stone for analysis, and monitor output. Restricting fluids and discarding urine are incorrect.
Question 3 of 3
A home care nurse reviews the chart of a client receiving warfarin. The most recent INR is 5.8. What is the nurse's PRIORITY action?
Answer: B. A therapeutic INR for most indications is about 2 to 3. An INR of 5.8 is critically high and places the client at serious risk for bleeding, so the nurse must withhold the dose and notify the provider. Continuing the dose or adding aspirin would increase bleeding risk.
Keep the streak going with more questions like these, each with a full rationale.
What is tracheostomy care?
Care keeps the airway patent and clean, prevents infection, and protects against accidental dislodgement, which is an emergency. Key principle: the airway always comes first (ABCs), and a replacement tube and obturator stay at the bedside.
Key points to remember
- Keep a same-size and a smaller spare trach tube, obturator, and an Ambu bag at the bedside at all times.
- Suction first if needed, then perform trach care using sterile technique (clean the inner cannula or replace if disposable).
- Secure new ties before removing old ones; allow one to two fingers of slack under the ties.
- Provide humidified oxygen/air because the trach bypasses the natural humidifying upper airway.
- Clean the stoma and inner cannula with sterile saline; avoid letting cleaning solution or hydrogen peroxide irritate the stoma.
- Hyperoxygenate before suctioning and suction only on withdrawal, no longer than 10 to 15 seconds.
Nursing priorities
- Assess airway patency and breath sounds; suction when secretions are present (not on a fixed schedule).
- Maintain sterile technique during inner cannula and stoma care.
- Hold the faceplate stable while changing ties and tie new ties before cutting old ones.
- Provide humidification and adequate hydration to thin secretions.
- Keep emergency equipment (obturator, spare tubes, Ambu bag) at the bedside.
Labs & values
Patient teaching
- Cover the stoma loosely when going outside and during dusty activities; never let water enter it (no swimming).
- Keep skin around the stoma clean and dry and watch for redness or drainage.
- Increase fluids to keep secretions thin and know how to suction at home.
Red flags: report now
- Accidental decannulation/dislodgement is an emergency: in a mature stoma reinsert with the obturator; if unable, ventilate over stoma or mouth and call for help.
- Increasing respiratory distress, stridor, or inability to pass a suction catheter signals obstruction; act immediately.
- Subcutaneous emphysema (crepitus around the neck) or bright-red bleeding from the stoma must be reported now.
References
Clinical references for this topic
