A nurse is planning care for a client who has a new prescription for parenteral nutrition (PN) in 20% dextrose and fat emulsions. Which of the following is an appropriate action to include in the plan of care?

B. Securing the tracheostomy tube in place with a collar that has hook-and-loop fasteners is a common and effective method. This type of collar provides secure support while allowing for easy adjustment and removal as needed for tracheostomy care. It helps prevent accidental dislodgement of the tracheostomy tube and provides stability for the client.
C. When providing tracheostomy care, it is crucial to maintain a sterile environment to prevent infection. The appropriate steps include wearing sterile gloves while handling the inner cannula and cleaning it with a sterile solution.
A. Placing a gauze pad under the flanges of the tracheostomy tube is not a recommended practice. The use of gauze pads under the flanges can increase the risk of infection, interfere with the proper fit and function of the tracheostomy tube, and cause pressure ulcers or skin irritation.
D. Using full-strength hydrogen peroxide to cleanse the skin around the stoma is not recommended. Hydrogen peroxide can be irritating to the skin, cause tissue damage, and delay wound healing. Instead, the nurse should use a mild, non-irritating antiseptic solution or sterile saline to cleanse the skin around the stoma.

C. Endotracheal suctioning is crucial for maintaining a patent airway in clients with an endotracheal tube who may have secretions obstructing their airway. This procedure directly impacts the client's ability to breathe and is often performed on an urgent basis to prevent respiratory distress or failure.
A. Enteral feeding is important for providing nutrition to clients who cannot eat by mouth, but it is not immediately life-threatening. This procedure can usually be scheduled and does not require urgent attention compared to issues involving airway or breathing.

B. Urinary catheter care is necessary to prevent infections and ensure proper urinary drainage, but it is not typically an urgent procedure unless there is a blockage or another complication that immediately impacts the client’s health.
D. Wound irrigation is important for preventing infection and promoting healing, but it is not as immediately critical as ensuring a patent airway. It can usually be performed after more urgent needs are addressed.