2-38
2-38. TRACHEOSTOMY NURSING CARE
a. Preparatory Nursing Measures. In addition to routine preparation of the patient unit for postoperative care, the following measures should be planned in advance.
(1) The patient will require constant attendance for at least the first 48 hours. The nursing personnel must remember two important things: the patient's life depends upon a clear airway, and the patient will have a temporary loss of voice. Therefore, the patient must be observed closely for airway patency and immediate action taken when any adverse signs or symptoms are present. The patient will feel anxious about his inability to communicate with his voice. Always have the call bell available to the patient. Devise a temporary means of communication such as writing notes or using flash cards so that the patient may communicate his needs to the nursing personnel.
(2) For the first few days postoperatively, the patient should be kept in a room where the temperature and humidity can be maintained at optimum levels. Increased temperature and humidity will help to reduce the tracheal irritation that results when inspired air has bypassed the natural warming and moisturizing of the nasopharyngeal airway.
(3) The patient's room should be supplied with a variety of equipment necessary to the care of the patient. Such things include suction equipment, a spare tracheostomy tube set, and sterile dressing material.
b. Postoperative Nursing Measures. In addition to routine postoperative nursing care, the following nursing actions should be noted.
(1) Always apply basic principles of aseptic technique when caring for the incision and the airway. When suctioning, use separate set-ups for pharyngeal and tracheostomy suctioning.
(2) Constantly observe the patient for signs of respiratory obstruction such as restlessness, cyanosis, increased pulse, or gurgling noises during respiration.
(3) Watch closely for bleeding from the incision, and look for blood in the aspirated secretions when suctioning.
(4) Be alert for choking or coughing when the patient swallows. This may indicate damage to the esophagus with leakage of swallowed material into the trachea.
