A nurse is caring for a patient with a tracheostomy. The patient suddenly develops bright red bleeding from the tracheostomy stoma, pulsation of the tracheostomy tube in synchrony with the heartbeat, hypotension, and tachycardia. What should the nurse do first?

Choice A rationale:

This response acknowledges the patient's concern and provides a realistic expectation of potential discomfort during the procedure. It offers reassurance that any pain experienced will be brief.

Choice B rationale:

This response is not entirely accurate. While the procedure itself may not cause pain, some patients may experience discomfort during tracheostomy suctioning due to the sensation of suction in the airway.

Choice C rationale:

This response is not appropriate as it exaggerates the potential pain, causing unnecessary distress to the patient.

Choice D rationale:

Administering pain medication solely for the discomfort associated with tracheostomy suctioning is not standard practice. Pain medication should only be given for clinically significant pain or as part of a larger pain management plan.

Choice C rationale:

A fenestrated tracheostomy tube would be the most appropriate choice for a client who is ready to wean from mechanical ventilation and also requires speech therapy. The fenestration in the tube allows the patient to breathe through the upper airway, facilitating the weaning process, and enabling speech by allowing air to pass over the vocal cords. This type of tube is commonly used for patients who have progressed in their recovery and are transitioning to breathing independently.

Choice A rationale:

A cuffed tracheostomy tube with an inflated cuff is more suitable for patients requiring mechanical ventilation or those at high risk of aspiration, rather than a patient who is ready to wean from ventilation.

Choice B rationale:

Uncuffed tracheostomy tubes may be appropriate for patients who can protect their airway and are weaning from mechanical ventilation. However, they would not be the most appropriate choice when speech therapy is also required.

Choice D rationale:

Double-lumen tracheostomy tubes are not typically used for weaning from mechanical ventilation or speech therapy needs. They are employed in specialized situations for independent lung ventilation.

Choice E rationale:

Plastic tracheostomy tubes are commonly used in clinical practice and may be suitable for a patient ready to wean from mechanical ventilation and requiring speech therapy. However, the fenestrated tube is a more specific choice for this scenario.