Managing a Patient with a Tracheostomy - Assignment Example

Managing a patient with a Tracheostomy Part Introduction The term ‘tracheostomy’ refers to the process of placing in a dwelling tube through surgical opening in the trachea just under the larynx. The surgeons, to help patients overcome the upper airway obstruction, do the implantation of the indwelling tube. It enables patients to obtain mechanical ventilator support and help them to remove tracheo-bronchial secretions, which leads to upper airway obstruction in most cases. Although it is a common method for many medical signs, the nursing staff and the clinical experts must understand the immediate and long-term management procedures to effectively deal with patients having tracheostomy. In order to provide a competent care, changing or continuous cleaning of inner cannula; suctioning of stoma at least three times in a day; and repeated inspection of inner cannula can be duly accepted as a set of basic management procedures to take due care and manage patients with tracheostomy (Morris et al., 2013). Emphasizing the practice guidelines and efficacies of tracheostomy, the primary purpose of this assignment is to critically assess the current clinical priorities along with interventions method adopted by the clinics while serving patients with pulmonary secretions or respiratory problems. Emphasizing these issues, the key objective of this report is to evaluate the clinical practices for tracheostomy, based on a practical case scenario. Moreover, the discussion also explores the key reflective points in the case and discusses them in accordance with the clinical priority and intervention process of the nursing and management procedures for the patients being treated with tracheostomy tubes. Part 2: Discussion Clinical Priorities Based on the understandings developed from the background of the case, it has been perceived that the clinical practices performed to serve patients with pulmonary secretion problems often include tracheostomy. The case has been critically assessed through practical clinical procedures to manage the problem of pulmonary secretions. Through an in-depth understanding of the case, the clinical priorities have been characterized into four major impairments, leading to pulmonary secretion problems. In relation to the case, it has been identified that Mr. Dickson, a retired property manager of 66 years old was diagnosed with four major impairments that have been considered as the clinical priorities of the nursing practices. With reference to the case, the major clinical priorities associated with the case of Mr. Dickson have been critically addressed hereunder. Gas Exchange Impairment due to Inability to Mobilize Secretions. The first priority of the clinical practices has been identified wherein the patient has developed gas exchange impairment because of the immobilization of pulmonary secretions. The impairment is significantly related to major airways obstruction or mismatching of ventilation/per fusion. The problem is further supposed to be mitigated through the application of a mechanical ventilator system to reduce or eliminate air-trapping related difficulties. The priority is also considered as a complex condition for the patients, as it often immobilizes the movement of pulmonary secretions (Bradley, 2009; Keogh et al., 2008). With reference to the case of Mr. Dickson, the patient was experiencing immobilized secretion, which further caused impairment of his gas exchange process. The respiration pattern of the patient has been witnessed as a lower level of SpO2, which was less than 90%. Moreover, due to the obstructed airway of Mr. Dickson, he was also facing severe difficulties in breathing, which substantially lowered his secretion mobilization and further led him to impair gas exchange chamber. Breathlessness due to Impaired Gas Exchange. The second clinical priority of the case has been identified in terms of the breathing problems of Mr. Dickson, due to the impairment of his gas exchange capability. According to the case, the clinical priority has increased substantially, as the patient had to undergo breathing problems, which also increased threats to his life causing major risks for kidney failures and many others (McGrath et al., 2012; Webber-Jones, 2010). With reference to the situation observed in the case, it has been identified that the impaired gas exchange resulted in the breathlessness of Mr. Dickson, which is a basic consequence if a person continuously undergoes lower level of SpO2 as compared to its normal secretion rates (The Prince Henry and Prince of Wales Hospitals and Community Health Services, 2006). Planning for Clinical Practice As depicted in the case scenario, the clinical practice for Mr. Dickson includes an effective set of planning processes in response to the clinical priorities developed. In order to effectively deal with clinical priorities of the patient, the nursing process has developed appropriate set of practices for Mr. Dickson. Correspondingly, a description of the clinical practice plan has been provided hereunder. Maintaining an airway and avoiding the use of Tracheostomy tube Blockage to the Patient. According to the case, it can be observed that the plan of maintaining a patient airway has been developed in order to enable effective mobilization of Mr. Dickson’s secretion process. In addition, the plan of avoiding the use of tracheostomy has been developed, as it can severely influence the patient’s capability to develop his/her cognitive conditions or language deficiencies. Moreover, the process of placing tracheostomy also increases severe complexities on the patients to conveniently communicate with others (Agarwal, 2010). Humidification in Situ. The plan of humidification is also recognized as an effective decision in preventing patients to suffer breathing troubles. The process of humidification of situ often helps clinical practitioners to moisture the breathing filtration process. Moreover, implementation of humidifying in situ further prevents patients’ from having severe dryness in their mucous membranes and helps them to improve secretion capability (Bankhead et al., 2009). The process of humidifying situ in the case of Mr. Dickson has enabled to substantially lower the risk of severe dryness in his mucous membranes and improve his rate of secretion. It has further helped to moisture and to facilitate the filtration process of the patient, which reduced the pain and discomfort experienced by Mr. Dickson during his secretion process, with adequate level of SpO2 supplied. Interventions Considering the intervention, it can be asserted that ‘Tracheostomy’ progression is a process, which is usually applied with the aim of identifying the objective of decannulation. In this regard, it can be claimed that being a patient of airway obstruction and facing problem with secretions can cause greater problems (Morris & et al., 2014; Dawson, 2014; Barnett, 2008). Notably, the tracheostomy intervention process can be implemented more accurately with the assistance of ten steps, as asserted below in the case of Mr. Dickson (Morris & et al., 2014; Regan & Dallachiesa, 2009). Step 1: Determine Hemodynamic Stability. The tracheostomy intervention process usually begins with an estimation of hemodynamic stability. Correspondingly, for Mr. Dickson, suffering from such problems, this tracheostomy intervention process can assist him to gain stability (Morris & et al., 2014; Barnett, 2012). Step 2: Ventilator Independence for More Than 24 Hours. Mr. Dickson, suffering from the disease, need time to stabilize his position that can be performed through the tracheostomy collar. In this case, it can be claimed that some patients need ventilation support as well, to continue with their airway oxidation (Morris & et al., 2014; Healthcare Improvement Scotland, 2007). Step 3: Assess Swallow, Cough Strength, and Aspiration Risk. Contextually, it is essential to assess the adequacy of Mr. Dickson’s cough strength. Moreover, it can be asserted that it is also essential to identify the ability of swallow secretions in Mr. Dickson’s body. In this case, it can be claimed that these are the two most essential mechanisms, responsible for airway protection. However, if the strength of the cough becomes weak, it may initiate risks for the future (Morris & et al., 2014; Higgins, 2009). Step 4: Assess Management of Secretions. Even after that management of secretions, it is highly essential to identify the ability of Mr. Dickson to physically accept Tracheostomy. It is due to this reason that secretions should be thin in order to easily mobilize coughing. Nevertheless, as patients with poor cough strength require more suctioning than that of a patient, who has a strong cough, the same shall be essential in the case of Mr. Dickson (Morris & et al., 2014). Step 5: Assess Toleration of Cuff Deflation. In this step, it is highly essential to assess cuff deflation of Mr. Dickson. Correspondingly, it can be suggested that the patient has been liberated from ventilator. In this regard, the myth of inflated cuff decreases that might further initiates the risk of aspersion for him (Morris & et al., 2014; Morris & Sherif, 2010). Step 6: Change to Cuffless Tube. Regular changes of the Cuffless tube will also be essential to ensure Mr. Dickson’s health. In this regard, it can be asserted that for patients who have the potential of tolerating prolonged cuff, it is essential to change the shaft TTS tube (Morris & et al., 2014; Freeman-Sanderson & et al., 2011). Step 7: Capping Trials. Subsequent to the above-mentioned step, it is highly essential to cap the Cuffless tracheostomy tube. Hence, following the changes of TTS tube, cap standard can be lowered, which can further cause the risk for airway obstruction in the case of Mr. Dickson (Morris & et al., 2014; Freeman-Sanderson & et al., 2011). Step 8: Functional Decannulation. In this step, it is highly essential to attempt “functional decannulation”. Notably, the prolonged capping method is used to identify the ability of the patient. Moreover, it is usually done through physical therapy. Thus, it can be stated that Mr. Dickson, if lacks the ability of tolerance, may require additional capping trials (Morris & et al., 2014; Freeman & Morris, 2012). Step 9: Cough Strength. In this stage, it is highly essential to assess the cough strength of Mr. Dickson, assessing the capacity of peak cough flow. In this regard, capacity and peak cough flow usually measures to estimate the strengths of the patient. For an example, if the vital capacity and peak cough flow are at least 15 mL/kg or at least 160 L/min, continuation of decannulation will be required. On the contrary, if the capacity and peak cough flow are at least 15 mL/kg or at least 160 L/min, the patient will require further capping trials through physical therapy (Morris & et al., 2014; Dennis-Rouse & Davidson, 2013). Step 10: Decannulation. Decannulation is the final step wherein the TTS tube and the cover stoma are removed. Moreover, it is also essential to keep the stoma clean. In this regard, it can be stated that the stoma will assist Mr. Dickson to heal with greater rapidity (Morris & et al., 2014; Morris & et al., 2013). Part 3: Conclusion In accordance with the understanding of the case of Mr. Dickson, it has been critically recognized that development of clinical priorities along with an effective set of planning in response to them can substantially help medical practitioners to deal with patients with secretion problem. The clinical guidelines for dealing effectively with patients undergoing severe problems in their upper airway obstruction have provided a clear demonstration regarding the significance of clinical practices. The clinical priorities witnessed in the case played a significant role for medical practitioners to successfully address the problems with pulmonary secretions of Mr. Dickson. According to the background of the case, it has been observed that the lower capability of mobilizing secretion process has severe impacts on the patient’s gas exchange system. In this regard, the planning for maintaining a patient airway and avoiding the tracheostomy tube blockage can substantially help the patient to reduce the problems associated with upper airway secretion related problems, considering the fact that the second clinical priority also revealed that the impairment of gas exchange has further created breathing problems to the patient. With regard to the first and second clinical priorities, the execution of effective medication, evaluated in the case, can also be considered as an appropriate set of remedial practices adopted by the clinical experts. The evaluation results observed in the case herewith reveals that the execution of suctioning and 5cc sterile normal saline solutions in nebulizer has substantially helped the patient to increase its SpO2 level from 88% to 97%. Moreover, the humidification on 5L using tracheostomy mask has also improved the average heartbeat level of the patient, dropping from 108beats/min to 88beats/min, which further reduces the occurrence of short breathing related problems. The use of tracheostomy stoma care medication has also been recognized to clear the trachea site of the patient and reduce the level of infection existing in his stoma area. In addition, the evaluation results of the patient have also enabled him to improve communication and increase the efficiency of the clinical practices overall. The use of writing on board in terms of communicating with the clinical practitioners has further helped the patients to improve medication functions. With this regard, it can be stated that the case of clinical priorities and practices executed for Mr. Dickson has provided a major understanding to effectively deal with patients having severe tracheostomy related issues. Based on the above discussion, it was observed that the intervention process have improved the ventilator dependence of the patient. In this regard, it can be asserted that in case of medical science, the safety concerns have been improved in case of the intervention of tracheostomy decannulation. Thus, during the medical treatment of Mr. Dickson for his airway obstruction, it is highly essential to apply the tracheostomy intervention process with the aim of improving the situation of airway obstruction. According to the observation, it has also been identified that the intervention process usually needs to be implemented in the ICU. During the intervention process, it is also essential to apply the advanced practice nurses and the involvement of critical care of nurses with the medical team, which will assist in delivering quality respiratory care by physical therapists, occupational therapists and pathologists. Accordingly, the tracheostomy intervention process should be considered for the treatment of Mr. Dickson with greater importance and in a highly sensible manner in the ICU. During the process, it is also highly essential for to evaluate the overall strength of Mr. Dickson regarding rehabilitation. It is equally essential to identify the necessity of the intervention process. Suggestively, before applying the tracheostomy intervention process on Mr. Dickson, it is quite essential to evaluate the risks and needs of the treatment so as to ensure adequate safety of the patient. Simultaneously, the execution of tracheostomy intervention process should be according to the plan. Besides, during the execution of tracheostomy intervention process on Mr. Dickson, it will be essential to ensure the safety concerns of the patient. The same is also applicable in case of psychosocial support. In this regard, it can be claimed that Mr. Dickson, admitted in the ICU shall be highly benefited from these programs, as the tracheostomy intervention process will enhance the chances of successful implementation of the decannulation. Based on the above discussion, it can be inferred that Tracheostomy progression is one of the most important daily assessments for patient suffering from airway obstruction and problem with secretions. In this regard, nurses can motivate as well as encourage the progress of timely decannulation. Thus, it can be stated that the above-mentioned ten steps are highly essential, which will needs implementation without any delay and complication. However, besides the technical measures adopted as per the discussed planning, ethical considerations must also be ensured throughout the care delivering process, which will further contribute to the efficiency of the entire procedure. 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