Ati Nursing Skill Template Tracheostomy Care

ATI Nursing Skill Template: Tracheostomy Care – A Comprehensive Guide

Tracheostomy care is a critical nursing skill, requiring meticulous attention to detail and a thorough understanding of both the procedure and potential complications. This comprehensive guide utilizes the ATI nursing skill template format to break down the process, ensuring safe and effective tracheostomy care for your patients. We will cover assessment, planning, implementation, and evaluation, incorporating best practices and addressing potential challenges. This guide aims to enhance your understanding and proficiency in providing this essential aspect of respiratory care.

I. Assessment

Before initiating tracheostomy care, a thorough assessment is paramount. This ensures patient safety and allows for individualized care planning.

A. Patient History and Baseline Data

• Review the patient's chart: This includes reviewing the physician's orders, the reason for the tracheostomy, the type of tracheostomy tube in place (cuffed vs. uncuffed, inner cannula presence), and the patient's medical history (allergies, bleeding disorders, respiratory status).
• Assess respiratory status: Observe respiratory rate, rhythm, depth, and effort. Note any signs of respiratory distress, such as increased work of breathing, use of accessory muscles, or cyanosis. Auscultate lung sounds for adventitious breath sounds (wheezes, crackles, rhonchi). SpO2 monitoring is crucial. Document baseline SpO2 levels.
• Assess the tracheostomy site: Inspect the stoma site for signs of infection (redness, swelling, purulent drainage), bleeding, or skin irritation. Note the condition of the skin surrounding the stoma.
• Assess the tracheostomy tube: Note the type and size of the tube. Check for any mucus accumulation or obstruction within the tube. Assess for tube displacement or looseness.
• Assess patient’s level of consciousness and ability to communicate: Patients with tracheostomies may have varying levels of cognitive function. Assess their ability to follow directions and communicate their needs.
• Assess patient’s pain level: Use a validated pain scale (e.g., numeric rating scale, FACES pain scale) to assess pain level.

B. Gather Supplies

Before beginning the procedure, gather all necessary supplies. This proactive approach minimizes interruptions and ensures a smooth, efficient process. Essential supplies include:

• Clean gloves: Multiple pairs for proper hand hygiene.
• Sterile gloves: For direct contact with the tracheostomy site and tube.
• Sterile saline solution: For cleaning the inner cannula and suctioning.
• Suction catheter (appropriate size): Select a catheter smaller than the tracheostomy tube lumen to avoid trauma.
• Suction apparatus with appropriate pressure settings: Typically, pressure should be set at less than 120 mmHg.
• Tracheostomy tube obturator (if applicable): For replacing or reinserting the tracheostomy tube.
• Clean gauze pads: For cleaning the stoma site and absorbing secretions.
• Hydrogen peroxide (optional): Some facilities utilize hydrogen peroxide for cleaning the inner cannula, but others may prefer sterile saline. Follow your institution’s protocol.
• Tracheostomy dressing materials: This may include a tracheostomy dressing, tape, or ties.
• Lubricant (water-soluble): To facilitate insertion of suction catheter.
• Specimen container (if necessary): For collecting specimens for culture and sensitivity testing.
• Oxygen saturation monitor: For continuous monitoring of SpO2.
• Pulse oximeter: To monitor SpO2 levels during the procedure.
• Appropriate personal protective equipment (PPE): As per facility policy and infection control protocols.

II. Planning

The planning phase involves developing a care plan tailored to the individual patient’s needs.

A. Goals

• Maintain a patent airway.
• Prevent infection.
• Promote comfort.
• Educate the patient and family on tracheostomy care.
• Identify and address potential complications promptly.

B. Interventions

Based on the assessment, develop interventions to address identified problems. Examples include:

• Suctioning: Plan for the frequency of suctioning based on the patient's needs (auscultate for adventitious sounds and monitor SpO2 levels).
• Cleaning the inner cannula: Plan to clean the inner cannula as per facility protocol.
• Changing the tracheostomy dressing: Plan to change the dressing as needed or per facility protocol.
• Monitoring for signs of infection: Plan to monitor the stoma site and surrounding skin regularly for signs of redness, swelling, pain, or purulent drainage.
• Providing humidification: Plan to provide humidification to the patient, either through a humidifier or by nebulization.
• Patient and family education: Plan to educate the patient and family on tracheostomy care, including suctioning, cleaning, and dressing changes.

III. Implementation

This section details the steps involved in providing tracheostomy care. Remember to always adhere to aseptic techniques and your facility’s specific protocols.

A. Hand Hygiene

Perform thorough hand hygiene before and after the procedure.

B. Donning PPE

Don appropriate PPE according to facility protocols and the potential for exposure to infectious materials.

C. Suctioning

• Hyperoxygenate the patient: Administer supplemental oxygen before suctioning to prevent hypoxemia.
• Insert the suction catheter: Gently insert the catheter, rotating it as you advance. Avoid excessive force.
• Apply intermittent suction: Apply suction while withdrawing the catheter. Avoid prolonged suctioning.
• Monitor SpO2 levels: Closely monitor SpO2 levels throughout the procedure.
• Assess the amount and character of secretions: Document the amount, color, and consistency of the secretions.

D. Cleaning the Inner Cannula (if applicable)

• Remove the inner cannula: Carefully remove the inner cannula, using sterile gloves.
• Clean the inner cannula: Clean the inner cannula using sterile saline or hydrogen peroxide (as per facility protocol) and a brush.
• Rinse and dry the inner cannula: Thoroughly rinse and dry the inner cannula before reinserting it.
• Reinsert the inner cannula: Carefully reinsert the inner cannula into the outer cannula.

E. Cleaning the Stoma Site

• Clean the stoma site: Gently clean the stoma site with sterile saline and gauze pads, moving from the center outward.
• Assess the skin: Assess the skin around the stoma for any signs of irritation or infection.
• Apply a fresh dressing: Apply a clean, dry tracheostomy dressing as needed.

F. Securing the Tracheostomy Tube

Ensure the tracheostomy tube is securely in place and the ties are not too tight or too loose.

G. Documentation

Meticulous documentation is essential. Record all aspects of the procedure, including:

• Date and time of the procedure.
• Type and amount of secretions obtained during suctioning.
• Assessment of the stoma site and surrounding skin.
• Patient's response to the procedure (e.g., SpO2 levels, respiratory status, pain level).
• Any complications encountered.

IV. Evaluation

Continuous evaluation is critical to ensure the effectiveness of the tracheostomy care plan.

A. Monitor for Complications

• Infection: Monitor for signs and symptoms of infection, such as increased redness, swelling, purulent drainage, fever, and increased white blood cell count.
• Bleeding: Monitor for bleeding from the stoma site.
• Tube occlusion: Monitor for signs of tube occlusion, such as decreased breath sounds, increased respiratory distress, and increased work of breathing.
• Tube displacement: Monitor for signs of tube displacement, such as coughing, shortness of breath, and changes in respiratory status.
• Skin breakdown: Monitor for signs of skin breakdown around the stoma site.

B. Patient Response

Evaluate the patient's response to the intervention. This includes monitoring their respiratory status, comfort level, and ability to communicate.

C. Revision of the Care Plan

Based on the evaluation, revise the care plan as needed. This may involve adjusting the frequency of suctioning, changing the type of dressing, or adding other interventions.

V. Patient and Family Education

Thorough patient and family education is essential for successful home tracheostomy care. Teach them:

• Suctioning techniques: Demonstrate and allow practice under supervision.
• Cleaning the inner cannula: Explain the procedure and importance of asepsis.
• Changing the tracheostomy dressing: Show them how to change the dressing properly.
• Recognizing signs of complications: Educate them on the signs and symptoms of infection, bleeding, tube occlusion, and tube displacement.
• Emergency procedures: Teach them what to do in case of tube dislodgement or other emergencies.
• Humidification: Explain the importance of humidification and how to maintain it.

This comprehensive guide provides a framework for safe and effective tracheostomy care using the ATI nursing skill template. Remember that this information is for educational purposes and should not replace institutional policies and procedures. Always consult your facility's guidelines and seek clarification from experienced healthcare professionals when needed. Consistent adherence to best practices ensures optimal patient outcomes and minimizes the risk of complications. Continuous learning and skill refinement are vital in the ever-evolving field of respiratory care.