NAME: KRISTELLA MARIE C.

DESIATA

CASE ANALYSIS

1. In assessing the patient condition breathing is important, the vital signs of the patient are as
follows:
- Pulse – 85 bpm, BP – 135/60 mmHg, RR – 20 bpm, Temp – 100 degrees in Fahrenheit, in
Celsius 37.7 degrees, Pulse Oximetry reading - 95%. Assess the changes in temperature and
pulse; amount, odor, and color of secretions; frequency and severity of cough; degree of
tachypnea or shortness of breath. Assess the rate, rhythm, and depth of respiration, chest
movement, and use of accessory muscles. Auscultate the lungs, noting areas of decreased
ventilation and for the presence of adventitious breath sounds. Assist the effectiveness of
cough. Observe the colour, consistency, and quantity of secretions. The patient is also
having a great deal of anxiety and with this it is very important to provide health teachings
that could ease the feelings of the patient as a result to mechanically ventilated adult
intensive care unit (ICU) patients frequently undergo tracheostomy placement when they
have difficulty weaning from the ventilator or they require long-term ventilator support. We
can also explain to the patient more about tracheostomy that it can maintain patency of the
tube and minimize the risk for infection (since the inhaled air by the client is no longer
filtered by the upper airways). Initially a tracheostomy may need to be suctioned and
cleaned as often as every 1 to 2 hours. After the initial inflammatory response subsides,
tracheostomy care may only need to be done once or twice a day, depending on the client.
Cleveland Clinic (2020) Since the patient is also experiencing pneumonia, and it was mention
that she needs to deal with the excessive sections, my nursing diagnosis would be
Ineffective Airway Clearance since the diagnosis is related to excessive secretions
increased secretions in pneumonia make it difficult to maintain a patent airway.

2. Many patients with a tracheostomy follow a complex care pathway through critical care units to
general wards, and a small proportion are discharged to the community. Most hospitals will
have some wards that routinely care for patients with tracheostomies (NCEPOD, 2014). Outside
of critical care units, patients and staff should be supported by critical care outreach teams and
specialist tracheostomy nurses. A multidisciplinary team should also be available, consisting of
an ear, nose and throat consultant, anaesthetic consultant, specialist tracheostomy nurse (if
available), critical care outreach nurse, speech and language therapist, and physiotherapist, who
will routinely see the patient (National Tracheostomy Safety Project, 2013). Caring for patients
with a tracheostomy can be time-consuming and staffing levels and skill mix should be
considered when a patient with a tracheostomy is nursed on a general ward (National Institute
for Health and Care Excellence, 2014). Ideally, wards should be given 24 hours’ notice to ensure
they are appropriately staffed (NTSP, 2014). Nurses caring for patients with tracheostomies
must be aware of the insertion technique in case they are required to perform an emergency
tube change; percutaneous guide wires should be available in the emergency tracheostomy box
 at the bedside. It is important to know whether a tracheostomy is temporary (weanable) or
permanent (non-weanable), as this will affect the plan of care. Nurses will provide regular
tracheostomy care for patients with temporary tracheostomies, but patients with a permanent
tracheostomy will also require education and training to manage their airway independently,
where possible.

3. Relaxing during an invasive medical procedure is not easy, especially if you are feeling anxious,
just like Mrs Hopkins but following these tips will help Mrs Hopkins through the
tracheostomy procedure. General relaxation techniques such as deep breathing exercises,
meditation and mindfulness are also fantastic ways to keep Mrs Hopkins relaxed. Controlled
breathing is one of the simplest ways nurses can help patients manage their anxiety. Deep
breathing forces the mind, heart and body to slow down, countering the side effects of
stress. Nurses have many options when taking their patients through breathing exercises. We
have to develop the trust of the medical team, by knowing beforehand that you have this trust,
you will enter the situation more put together and in control as well. Trusting your medical
practitioners is down to looking into their credentials, having pre-operative consultations, and
simply accepting that they are trained to do their job. Listen to all the preoperative tips and
instructions provided by your physician, since the patient is 71 years old we can also talk to the
significant others of the patient. The physician should have provided the patient with a lot of
information in terms of what to expect from the procedure, what the patient should do before
it, what to expect during, and what to do afterwards.

References:

 Cheung, N. and Napolitano L. (2014) Tracheostomy: Epidemiology, Indications, Timing,

Technique, and Outcomes. Retrieved October 17, 2020 from
http://rc.rcjournal.com/content/59/6/895\
 Cleveland Clinic (2020) Tracheostomy Care. Retrieved October 17, 2020 from
https://my.clevelandclinic.org/health/treatments/17568-tracheostomy-care
 National Confidential Enquiry into Patient Outcome and Death (2014) On the Right Trach? A
review of the care received by patients who underwent a tracheostomy.
 National Tracheostomy Safety Project (2013) The National Tracheostomy Safety Project Manual.
 National Institute for Health and Care Excellence (2014)  Safe staffing for nursing in adult
inpatient wards in acute hospitals.