Tracheostomy questionnaire cough by benbenzhou

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									                   Tracheostomy Work book
 In support of Care of a Child/Young Person with Tracheostomy
                          Competency

Patients name………………………………

Carers name………………………………..                  Date    /    /

Section 1
Carer to understand the reasons for tracheostomy.
Please label the diagrams




List the functions of the areas you have labelled
a)…………………………………………………………………………….
b)………............................................... …………………………………
c)……………………………………………………………………………..
d)……………………………………………………………………………..
e)……………………………………………………………………………..
f)………………………………………………………………………………
g)……………………………………………………………………………..
h)……………………………………………………………………………..
i)………………………………………………………………………………
j)………………………………………………………………………………


Liz Herd June 2005                                               1
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What is a tracheostomy?.......................................................................
………………………………………………………………………………
………………………………………………………………………………

Where is ………….tracheostomy situated?
………………………………………………………………………………..

Why does ……………… have a tracheostomy?
………………………………………………………………………………
………………………………………………………………………………

What type of tracheostomy is …………………?
          Permanent       temporary (please underline)

Please label diagram below




List the functions of the areas you have labelled in simple or
physiological terms
a)……………………………………………………………………………...
b)……………………………………………………………………………..
c)………………………………………………………………………………
d)……………………………………………………………………………..
e)……………………………………………………………………………..
f)………………………………………………………………………………
When caring for ……….. what is your priority?
………………………………………………………………………………..

Liz Herd June 2005                                                                           2
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What would happen if …………… tracheostomy accidentally fell out?
………………………………………………………………………………...

Section 2
Carer to understand the psychological implications of having a
tracheostomy.

How would you speak to ……………….?
………………………………………………………………………………
………………………………………………………………………………

List 3 words that would describe how you would talk to ……………….
parents/carers.
a)…………………………
b)…………………………
c)…………………………

Does …………………have speech?              Yes        No

In a short paragraph describe how you feel a tracheostomy affects
a)……………..
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
……………………………………………………………………………….
b)Parents …………………………………………………………………..
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
……………………………………………………………………………….
c)Siblings……………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
d)other people who meet …………….
………………………………………………………………………………
………………………………………………………………………………
……………………………………………………………………………

Liz Herd June 2005                                                  3
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Does………………..
a) accept his/her tracheostomy with no concerns
b) get “fed up” with it some times
c)resent having to have one and with he did not have to have one
d) affect his/her speech and make him/her frustrated
(please underline most appropriate)

How does …………….acceptance /lack of acceptance affect the care
you give?
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………..

Does the tracheostomy affect …………….body image?
Yes            No

If yes describe how you think it affects him/her
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………..

Is ………………..ever excluded from activities he would like to join in?
Yes        No

If yes how can you help …………………. to manage the situation?
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………




Liz Herd June 2005                                                 4
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Section 3
Carer to demonstrate ability to perform basic respiratory
assessment.

If you were looking at …………………. And he /she was well please
underline the most appropriate words
Colour      pale        pink      mottled   blue/cyanosis
Chest movement Intercostal recession nasal flaring tracheal tug
Cough       no cough persistent cough       productive cough
Generally happy         miserable irritable panic
Wheeze wheeze           no wheeze

If you were looking at ………………….. and he was unwell please
underline the most appropriate words to describe what you would
expect to see
Colour      pale        pink      mottled     blue/cyanosis
Chest movement Intercostal recession nasal flaring tracheal tug
Cough       no cough persistent cough         productive cough
Generally happy         miserable irritable   panic
Wheeze wheeze           no wheeze

Section 4
Carer to demonstrate cleaning of tracheostomy stoma.

List in order what you should do prior to cleaning the stoma
a) Ask…………….consent                                   ………
b) collect requirements                               ………
c) observe the site of stoma                          ………
d) ensure everything for an emergency tube change is available in
case tube is dislodged during cleaning                ..........

What would you observe the stoma site for?
a)…………………………………………………………………
b)…………………………………………………………………
c)…………………………………………………………………

Hand washing is an extremely important part of …………………care
How many steps are there in the hand-washing plan
4     6      8        10    (please circle)


Liz Herd June 2005                                                  5
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How often should each point of the plan be repeated?
2 4 5 8 10           (please circle)

How often should you wash your hands throughout the procedure?
………………………………………………………………………………
………………………………………………………………………………

When can you use alco-gel?
a) Any time you could wash your hands
b) On clinically clean hands only
c) You should not use it at all (please underline appropriate)

What equipment is essential when caring for …………….?
a)…………………………………………..
b)…………………………………………..

What pressures are appropriate for …………..?
………………………………………………………………………

What size of suction catheter does ………….. use normally?
…………………………………………………………………….

What must you do once the suction machine has been cleaned?
………………………………………………………………………….

Describe the care plan for cleaning ………... stoma site and neck?
…………………………………………………………………………….
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

If tape/fixings get wet why must they be changed immediately?
a)………………………………………………………………….
b)………………………………………………………………….

How many people are required to change tracheostomy tapes?
a) one     b)two     c)three     d)doesn’t need a specific number

What could happen as you clean the stoma?
………………………………………………………………………………

Liz Herd June 2005                                                  6
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When looking at the stoma site underline all of the following that
would give you cause for concern.
Blood at site                           areas of rubbing/chafing
Irregular stoma                         intact well looking skin
Discoloured discharge                   anything different from usual

Section 5
Carer to demonstrate safe changing of the tracheostomy tube

What do you need to change a tube?
a)……………………………………………………………………………..
b) ……………………………………………………………………………..
c)………………………………………………………………………………

When should you not change a tube?
………………………………………………………………………………
……………………………………………………………………………….

How many people are required to change a tracheostomy tube?
One             Two          Three     Four
(please underline appropriately)

What type of tube does…………..use?                                ………………………

What is his/her normal tube size?                               ………………………

What is his/her emergency size?                                 …………..........……

List what equipment you require to have prior to tracheostomy
change?
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

If the tube change had been done as an emergency what would you
expect to happen?..............................................................................
………………………………………………………………………………
………………………………………………………………………………


Liz Herd June 2005                                                                                7
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If ……….. did not improve what would you do? ………………………

What type of knot should you use to tie cotton tracheostomy tapes?
……………………....................................................…………………….

If using Velcro fixings what must you ensure to protect ……….. neck?
……………………………………………………………………………….

List 3 complications of tube change
a)…………………………………………………………………………….
b)…………………………………………………………………………….
c)…………………………………………………………………………….

Is ………….tube disposable?           Yes    No

How would you dispose of clinical waste?
………………………………………………………………………………..

Section 6
Carer to demonstrate safe changing of tapes.

List 2 places it is suitable to change tracheostomy tubes
a)…………………………………………………………………………
b)…………………………………………………………………………

Describe an environment that is unsuitable to change tracheostomy
tubes.
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

Describe the care plan for cleaning ………... stoma site and neck?
…………………………………………………………………………….
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

If fixings get wet why must they be changed immediately?
a)……………………………………………………………….
b)………………………………………………………………….

Liz Herd June 2005                                                  8
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How many people are required to change tracheostomy tapes?
a) one     b)two      c)three     d)doesn’t need a specific number

Please state reason for answer.
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

Describe how tight a tracheostomy tube should be.
Able to get one finger underneath
Able to get two fingers underneath
Doesn’t matter as long as its comfortable
(please underline)

Is there any reason ………….. cannot have his tracheostomy tube
fixed like that?   Yes   No
If so please give reason
………………………………………………………………………………
………………………………………………………………………………

What would you do if you discovered a problem with …………. neck?
………………………………………………………………………………
……………………………………………………………………………….

Section 7
Carer to demonstrate knowledge of complications and
emergency procedure

Please list all equipment you consider essential for emergencies
……………………..                    ………………………..
……………………..                     ……………………….
……………………..                     ……………………….
…………………….                      ……………………….
…………………….                     ………………………..

Why do we carry a size smaller tube?
………………………………………………………………………………

When would we use the smaller tube?...............................................
………………………………………………………………………………

Liz Herd June 2005                                                                   9
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Can you describe the difference between an emergency tube change
and a planned tube change?
………………………………………………………………………………
………………………………………………………………………………
……………………………………………………………………………….

Describe how you could use a suction catheter to help you place a
tracheostomy tube accurately.
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

Do you use tracheal dilators?                       Yes        No

Describe in a short paragraph …………………….. emergency contact
procedure.
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

Is there any CPR training that is specific to …………….?
Yes       No

If yes can you describe specific training?
……………………………………………...…………………………………
……………………………………………...…………………………………
……………………………………………...…………………………………
……………………………………………….………………………………..

Whose responsibility is it to ensure your training is current?
...............................................................................................................

Is this competency valid without up to date CPR?                                   Yes             No




Liz Herd June 2005                                                                                         10
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Section 8
Carer to demonstrate knowledge of safety routine
List 3 hazards for …………… at home
a)………………………………………………………………..
b)………………………………………………………………..
c)………………………………………………………………..

List 3 hazards for ……………in transit
a)…………………………………………………………………
b)…………………………………………………………………
c)…………………………………………………………………

List 3 hazards for …………...at school
a)………………………………………………………………….
b)………………………………………………………………….
c)………………………………………………………………….

List 3 hazards for ……………away from home
a)…………………………………………………………………..
b)…………………………………………………………………..
c)…………………………………………………………………..

How often should ………… equipment be checked?
At start of every shift   prior to going out daily
before you take over care weekly
(please underline)

Section 9
Carer to show awareness of importance of record keeping

Who do you report too?
named nurse    on-call    office   Doctor

What do you understand by accurate, appropriate documentation?
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………


Liz Herd June 2005                                               11
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Who do you need to write about?
Child    family      interventions

Does it matter when you write the document?           Yes    No

If so when should it be written?
As soon as possible within shift           within 24 hours
(please underline all appropriate)

Who should read this document?
………………………………………………………………………………

What colour should you write this in?
Red       blue      black         purple

List three things you must do to identify the child
a)…………………………………………….
b)…………………………………………….
c)…………………………………………….

Can you leave spaces for others to fill in later?     Yes     No

Who can you share information with about this child?
………………………………………………………………………………
………………………………………………………………………………

Do you always need parent’s permission to share information?
………………………………………………………………………………

Underline the words, which apply to good recordkeeping
Factual                     patient condition
Consistent                  legible
Accurate                    understandable
Fiction                     fit for purpose
Consecutive                 current
Abbreviations               concise
Jargon                      subjective comments
Contemporaneous



Liz Herd June 2005                                                 12
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List 3 things you must do to identify who wrote the record and when
the record was written
a)……………………………………………………………………………
b)……………………………………………………………………………
c)………………………………………………………………………………

List who you would report record keeping problems to?
………………………………………………………………………………

What information would it be suitable to discuss with …………teacher
in school?
………………………………………………………………………………
………………………………………………………………………………
Do you need parents/…………………… consent to share this
information?
………………………………………………………………………………
………………………………………………………………………………

Is there ever a time when breaching confidentiality is permissible?
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

Section 10
Carer to demonstrate awareness of issues of privacy and dignity

How does …………….express him/her self?
………………………………………………………………………………
……………………………………………………………………………….

Suction can be a distressing procedure for both the child/young
person and others around him how can we protect
dignity…………….. during this time?
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

How may we lessen the distress of others?
………………………………………………………………………………
………………………………………………………………………………

Liz Herd June 2005                                                    13
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Does other people’s curiosity distress ……………..?

Does asking ……………..consent support ……………dignity?
Yes       No

In a short sentence, explain what privacy means to you.
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

In a short sentence, explain what dignity means to you.
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

List how you would know if ………………………was
Happy................................................................................................
Sad....................................................................................................
In pain...............................................................................................
If possible, give examples
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

Explain what the expression child specific means to you.
………………………………………………………………………………..




Liz Herd June 2005                                                                                        14
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Questionnaire assessed by ______________________print assessor

I certify I am currently registered by the NMC_____________sign
Assessor

NB. Your responses to the questions in this document are used
to assist in the assessment of your competency to undertake the
particular procedures detailed in the accompanying competency
document and satisfactory completion of this document is only
part of the overall competency assessment. You may NOT
carry out child or young persons care independently until the
competency document has been signed by your assessor
evidencing your competence, yourself, and your employer if you
are a non NHS Trainee.




Liz Herd June 2005                                                15
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