Trach 101
What is the standard frequency for Trach Care
Every 24hrs and PRN
The SpO2 goal for asthma patients (standard).
>90%
What age qualifies for the bronchiolitis pathway?
< 2 years
What is the timing of standard BG checks?
Meals, bedtime, 3AM. no longer than 6hrs without a BG check
What do you do for a first time seizure
code blue
The roles that can perform trach care.
RN, RT, trained caregiver.
Who can administer an Albuterol Aerogen nebulizer?
RN or RT
Your patient scored a 9-12, how often do you assess and suction?
Assess q 1 hr. Suction q2 - 4 hrs.
How do you round short-acting insulin?
Down to the nearest 0.5 unit
Your patient's mom called stating they are having a seizure, what is the first thing you do when you go in the room?
Determine start time of seizure.
What is the frequency trach suctioning must be done.
Q6hr and PRN
When to call an RRT.
>4 hrs on Nebulizer, RS 11-12. signs of deterioration (drowsiness, confusion, silent chest exam, hypercapnia)
Your patient is 9 months old and SpO2 is 87% on room air while sleeping. What do you do?
When do you check ketones and how?
1 BG >500 or 2 consecutive BG >250. use glucometer or urine ketones, whichever is ordered
Your patient is seizing and are hitting the 5 minute mark. What do we give them?
1st line rescue, dose 1. If IV access give Ativan, if no IV give IN Midaz.
The frequency of Trach Change
30 days
How much Oxygen do you use with the Aerogen Nebulizer?
2 L.
If they are desatting, add a nasal cannula.
Your 13month old patient is scoring a 3, getting NP suctioned q4hrs, and has been off oxygen for 8 hrs. The provider is assessing readiness for discharge. What do you say?
Not ready to DC. Patient needs to be off oxygen for 12 hours and nasal suction only (not NP) for 4 hours.
Your patient has an Insulin pump and CGM. They are eating lunch and need insulin. How do you check their BG and give Insulin?
Use the CGM to check insulin. Patient or caregiver gives insulin using the pump, you validate the numbers and document them in eMAR.
Your patient is seizing (known seizure hx). It has been 7 minutes and you have given 1 dose of rescue. They desat to 82%, your give Blow-by oxygen and they come up to 89%. What do you do?
Continue thru seizure pathway protocol.
*No code blue because the DID respond to oxygen!
You are performing trach care and your patient accidentally decannulates, what do you do?!
Replace with same trach. Replace with NEW PRIMARY same size trach (with lube!). Replace with new SECONDARY (smaller size) trach.
Your patient is in phase 4 (8puffs q4) at 10am and received puffs. At 2pm you score the patient a 6. What do you do?
Give puffs! They will stay in the same phase and get 8 more puffs.
Your patient is 15months and 13.2kg. They have been on 2L NC for 90 minutes and continue to desat to 85%. What is the amount of HFNC you will initiate them on during the huddle?
19.8L (so provider to determine if 19 or 20 L). FiO2 between 21% (RA) up to 50% based on SpO2
At 8am you checked BG and your patient ate breakfast, the got insulin to cover BG and carbs. At 10am they had a snack and received insulin to cover carbs. At 11 am they had a snack of 1 egg and 1 piece of cheese. When can they next get insulin to cover their BG?
1 pm. The last insulin was 10am which reset the 3-hr rule. At 11 am they had a snack but didn't get insulin.
When do you call an RRT for a siezure?
Known seizure history with rescue ordered. You have given 1st line doses 1 and 2 and are now giving 2nd line dose 2.