Trach and Lary
5 important topics to include in patient education when your patient is going home with a reusable trach.
1. Provide the patient and family the opportunity to express concerns about tracheostomy care.
2. How to get help in an emergency.
3. Communication tools for the patient.
4. Rationale for humidification and adequate fluid intake.
5. Tracheostomy care to include inner cannula change, suctioning, dressing change, corking
It's considered since 1959 as the gold standard in head and neck reconstruction.
What is free flaps
It is the solution used to flush/irrigate the nephrostomy tube.
What is sterile normal saline 5 - 10 ml.
The type of fluid and test to check for pancreatic leak.
What is JP fluid for amylase.
Elevated WBC, elevated lactate, positive cultures, increased temperature, and elevated CRP are all indicators of what complication?
What is sepsis.
The signs and symptoms when a patient is unable to tolerate trach corking.
What are:
1. Increased respiratory rate or heart rate by 20%
2. SpO2 < 90%
3. Presence of in drawing or stridor
4. Respiratory Distress (any 2 of the following)
a. Use of accessory muscles
b. Abdominal Paradox
c. Diaphoresis
d. Marked complaint of dyspnea
e. Persistent coughing
They are the 4 assessments performed to ensure the flap is viable.
What are colour, capillary refill, temperature, and doppler check.
The frequency of changing nephrostomy tube drain-fix dressing, connecting tube, and leg bag.
What is every 7 days.
The type of tube inserted through the skin for abscess drainage, manage leaks, infected hematomas, urinary obstruction, and biliary obstruction.
What is a percutaneous drainage tube.
The 4 abnormal vital signs to anticipate in a patient with sepsis and why.
What are:
1. Febrile (immune response)
2. Tachycardia (Compensatory)
3. Hypotension (vasodilation, decreased perfusion to organs, shunting to major organs)
4. Desaturation/Increased respiratory rate (Compensatory, organ dysfunction due to anti-inflammatory response)
The commonly used free flaps that we see on D6 to reconstruct defects in head and neck cancer surgery.
What are the radial forearm free flap, fibula free flap (FFF), scapular free flap, and pectoralis major myocutaneous
The frequency of irrigating neobladder POD5.
What is every 4 hours.
The full name of the procedure PTC.
What is PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM.
The 3 clinical signs for hypovolemia in a post-operative patient and why.
What are:
1. Hypotension (reduced preload, reduced cardiac output)
2. Tachycardia (increased sympathetic tone)
3. Low urine output (vasoconstriction, blood is shunted to important organs, therefore less is filtered in the kidney and excreted out as urine)
The signs and symptoms of chyle leak in head and neck surgery.
What are JP fluid “milky” color, neck swollen, and elevated triglyceride.
The treatment order given for a patient experiencing hypovolemia and why.
What is intravenous fluid bolus to replace intraoperative fluid loss.