When teaching home tracheotomy care to caregivers of a child with a tracheostomy tube, which of the following topics are essential to include in teaching? Select all that apply.

Maintaining a cool, dry environment to promote airway patency.

Having emergency tracheostomy equipment available at all times.

Changing the tracheostomy tube per ordered frequency.

Monitoring thickness and color of secretions.

Answer and Explanation

Correct Answer : B,C,D

Choice A rationale

While maintaining a cool, dry environment can be comfortable for the child, it is not specifically related to tracheostomy care. Humidity can actually be beneficial for a child with a tracheostomy, as it helps to keep the airway moist and prevent mucus from becoming too thick.

Choice B rationale

Having emergency tracheostomy equipment available at all times is crucial. This should include a spare tracheostomy tube of the same size and one size smaller, suction equipment, and a bag-valve-mask device. In case of a problem with the tracheostomy tube (such as blockage or accidental dislodgement), it is important to have the necessary equipment immediately available.

Choice C rationale

Changing the tracheostomy tube at the ordered frequency is important to prevent blockage and infection. The frequency will depend on various factors, including the type of tracheostomy tube and the child’s specific condition.

Choice D rationale

Monitoring the thickness and color of secretions can help to detect infections or other complications. Changes in secretions can be an early sign of problems such as tracheitis or pneumonia.

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Correct Answer is B

Explanation

Choice A rationale

A pO2 of 75, pCO2 of 40, and HCO3 of 28 would be within normal limits for an infant. This would not typically be expected in an infant with a history of bronchopneumonia, as this condition often causes hypoxemia (low blood oxygen levels)78.

Choice B rationale

A pO2 of 55, pCO2 of 50, and HCO3 of 30 would indicate respiratory acidosis, which can occur in conditions like bronchopneumonia. The low pO2 indicates hypoxemia, while the high pCO2 indicates hypercapnia (excessive carbon dioxide in the bloodstream). The increased HCO3 is a compensatory mechanism to try to maintain the pH balance.

Choice C rationale

A pO2 of 75, pCO2 of 40, and HCO3 of 24 would be within normal limits for an infant. This would not typically be expected in an infant with a history of bronchopneumonia.

Choice D rationale

A pO2 of 55, pCO2 of 50, and HCO3 of 24 would indicate respiratory acidosis without compensation. However, in a chronic condition like bronchopneumonia, some degree of compensation (increased HCO3) would typically be expected.

A. Pulse of 160, oliguria, sunken fontanels, and an admission weight of 30 lbs. B. Pulse of 180, furrowed tongue, mottled skin, and an admission weight of 28 lbs. C. Pulse of 120, dry mucous membranes, pale, and an admission weight of 30.2 lbs. D. Pulse of 150, poor skin turgor, oliguria, and an admission weight of 29.5 lbs.

Correct Answer is D

Explanation

Answer: D. Pulse of 150, poor skin turgor, oliguria, and an admission weight of 29.5 lbs. Rationale:

Choice A: A pulse of 160 is slightly elevated for a 3-year-old (normal range is 90-140 bpm), but not significantly so. Oliguria (decreased urine output) is a common sign of dehydration. However, sunken fontanels are typically seen in infants with severe

dehydration and not necessarily present in moderate cases. An admission weight of 30 lbs is irrelevant for assessing dehydration.

Choice B: A pulse of 180 is significantly elevated and suggests potential tachycardia, which can be a sign of severe dehydration or other underlying conditions. While a furrowed tongue can occur with dehydration, it's not specific enough. Mottled skin can be caused by various factors and isn't a definitive sign of moderate dehydration.

Admission weight alone isn't indicative of dehydration.

Choice C: A pulse of 120 is within the normal range for a 3-year-old. Dry mucous membranes are a common sign of dehydration. However, pale skin can be caused by various factors and isn't specific to dehydration. Admission weight alone isn't indicative of dehydration.

Choice D: A pulse of 150 is slightly elevated, potentially indicating dehydration or other factors. Poor skin turgor is a key assessment finding in moderate dehydration. It refers to the skin's slow return to its original shape after being pinched, indicating a lack of fluid. Oliguria is a common sign of dehydration, suggesting decreased fluid intake or output. An admission weight of 29.5 lbs might be slightly lower than the child's baseline weight due to dehydration, but weight alone shouldn't be used to diagnose dehydration.

Therefore, considering the combination of a slightly elevated pulse, poor skin turgor, oliguria, and a potential decrease in weight, choice D presents the most likely assessment findings in a child with moderate dehydration.

It's important to remember that a comprehensive assessment, including history, physical examination, and potentially laboratory tests, is crucial for diagnosing and classifying the severity of dehydration in children.

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When teaching home tracheotomy care to caregivers of a child with a tracheostomy tube, which of the following topics are essential to include in teaching? Select all that apply.

Nursing Test Bank

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