Tracheostomy is a surgical procedure in which an opening is done into the trachea to prevent or relieve airway obstruction and/or to serve as an access for suctioning and for mechanical ventilation and other modes of oxygen delivery (tracheostomy collar, T-piece).
A tracheostomy can facilitate weaning from mechanical ventilation by reducing dead space and lowering airway resistance. It also improves client comfort by removing the endotracheal (ET) tube from the mouth or nose.
The tracheostomy is preferred over an ET when an artificial airway is needed for more than a few days. Methods can be instituted for the client to eat and speak, as well.
Nursing Care Plans
Nursing care objectives for a client who had undergone tracheostomy includes 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.
Here are five (5) nursing care plans (NCP) for tracheostomy:
- Ineffective Airway Clearance
- Impaired Verbal Communication
- Deficient Knowledge
- Risk for Impaired Gas Exchange
- Risk for Infection
Ineffective Airway Clearance: Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.
May be related to
- Copious secretions
- Decreased energy and fatigue
- Presence of artificial airway: tracheostomy
- Thick secretions
Possibly evidenced by
- Abnormal breath sounds (crackles, rhonchi)
- Dyspnea
- Ineffective cough
- Increased breathing effort: nasal flaring, intercostal retractions, use of accessory muscles
- Shortness of breath
- Tachypnea and/or changes in breathing pattern
Desired Outcomes
- Client will maintain a clear, open airway as evidenced by normal breath sounds, normal rate and depth of respiration, and ability to effectively cough up secretions.
| Nursing Interventions | Rationale |
|---|---|
| Assess changes in BP, HR, and temperature. | Tachycardia and hypertension may be related to an increased work of breathing. As the hypoxia and/or hypercapnia become severe, BP and HR drop. Fever may develop in response to retained secretions. |
| Assess respirations: note the quality, rate, rhythm, nasal flaring, and any increased use of accessory muscles of respirations. | These abnormalities indicate a respiratory compromise. An increase in respiratory rate and rhythm may be a compensatory response to airway obstruction. The breathing pattern may alter to include the use of accessory muscles to increase chest excursion. |
| Auscultate the lungs, noting areas of decreased ventilation and for the presence of adventitious breath sounds. | Decreased or absent breath sounds may indicate the presence of a mucus plug or other airway obstruction; wheezing may indicate partial airway obstruction or narrowing coarse crackles and/or rhonchi may indicate the presence of secretions along larger airways. |
| Assist the effectiveness of cough. Observe the color, consistency, and quantity of secretions. | Abnormalities may be a result of infection, bronchitis, long term smoking, or other conditions. A sign of infection is discolored sputum. Thick, tenacious secretions increase hypoxemia and may be indicative of dehydration. |
| Encourage the client to cough out secretions. If cough is ineffective, Institute suctioning of the airway as needed. | Coughing is the most helpful way to remove most secretions. The client may be able to perform independently. Suctioning removes secretions if the client is unable to effectively clear the airway. Frequent suctioning should be based on the client’s clinical status, not on a present routine, such as every hour. Over suctioning can cause hypoxia and injury to bronchial and lung tissue. |
| Provide warm, humidified air. | A tracheostomy bypasses the nose, which is the body area that humidifies and warms inspired air. A decrease in the humidity of the inspired air will cause secretions to thicken. Also, cool air may decrease ciliary function. Providing humidification of inspired air will prevent the drying and crusting of secretions. |
| Transport the client with portable oxygen, Ambu bag, suction equipment, and extra tracheostomy tube. | Being prepared for an emergency helps prevent future complications. |
See Also
You may also like the following posts and care plans:
Respiratory Care Plans
Care plans about respiratory system disorders:
- Asthma | 4 Care Plans
- Bronchiolitis | 5 Care Plans
- Bronchopulmonary Dysplasia | 5 Care Plans
- Chronic Obstructive Pulmonary Disease (COPD) | 5+ Care Plans
- Cystic Fibrosis | 5 Care Plans
- Hemothorax and Pneumothorax | 3 Care Plans
- Influenza (Flu) | 5 Care Plans
- Lung Cancer | 5 Care Plans
- Mechanical Ventilation | 6 Care Plans
- Near-Drowning | 5 Care Plans
- Pleural Effusion | 6 Care Plans
- Pneumonia | 8+ Care Plans
- Pulmonary Embolism | 4 Care Plans
- Pulmonary Tuberculosis | 5 Care Plans
- Tracheostomy | 5 Care Plans
Further Reading
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans
