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Tracheostomy naire

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

Patients name……Fred…………………………

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

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




Please list functions of structures labelled above
a)…nasal passages-warms and filters air……………………………...
b)…pharynx-back of throat where nasal and mouth meet………...
c)…larynx where vocal cords are situated……………………………
d)…oesophagus(not part of respiratory tract but situated behind
trachea this is why reflux may take place..
e)…Trachea large airway into lungs situated at front of neck.
 f)…Bronchus and bronchioles which allows passage of air to alveoli..
g)…right lung
h)…left lung alveoli in lungs where gaseous exchange takes place…
i)…Diaphragm-main muscle of respiration…………………………….

Liz Herd June 2005   Reviewed A Sims                                1
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What is a tracheostomy?......A tracheostomy is a surgical incision
between the 2nd and 4th rings of cartilage in the trachea that allows air
to pass directly into the trachea and by passes the upper respiratory
tract…

Where is Fred’s tracheostomy situated?
…At the base of the front of his neck……………..

Why does …Fred…………… have a tracheostomy?
…Specific reason Fred has his trachy……………………

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

Please label diagram below




List the functions of the areas you have labelled
a)nose- warms and filters air……………………………...
b)mouth –for food to stomach and can breath through to trachea….
c)vocal cords to create sound when air passes through……………
d)tracheostomy tube that supports airway and keeps stoma open…..
e)lower trachea to lungs……………………………..
f)oesophagus- situated behind trachea……………………

When caring for Fred……….. what is your priority?
Keeping the airway clear and in place…………………………..

Liz Herd June 2005   Reviewed A Sims                                    2
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What would happen if …Fred… accidentally lost his tracheostomy?
a)you have a little time when he/she can cope without it
b)he/she can manage up to an hour without it
c)he/she would die very quickly without it
(underline most appropriate to)
Section 2
Carer to understand the psychological implications of having a
tracheostomy.

How would you speak to …Fred…………….?
Age appropriately in a way he can understand without patronising
him…………

List 3 words that would describe how you would talk to …Fred.
parents/carers.
a)…Respectfully…
b)…Politely………
c)…pleasantly remembering professional boundries…………………

Does …Fred………have speech?               Yes    no

In a short paragraph describe how you feel a tracheostomy affects
a)…Fred…………..
…He often feels left out as communication is…can be difficult as his
speech is impaired by the trachy. He does not like it when people
stare and comment he dislikes suction but recognises it makes him
feel better when he has had it…………………………………….
b)Parents …His parents worry when he is not in their care. Mum
says she does not sleep well as she might need to suction him. She
feels this leads to a tiredness that affects the whole family. Dad
would like to go abroad on holiday but mum is too frightened to go
this also causes tensions Both parents feel that all his appointments
plus pressures from school about cover also affect the whole family.
c)Siblings Fred has 2 siblings 1older a girl one younger a boy the girl
resents all the attention Fred gets and she feels he is the centre of
attention all the time The little boy of 2 has tantrums and can get very
demanding according to Mum He has tried to pullout Fred’s tube but
he was only 7 months at the time but this also concerns Mum………



Liz Herd June 2005   Reviewed A Sims                                   3
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d)other people who meet Fred…………….
When Fred first started school his teachers were concerned about the
problems both for Fred and the other children they were also worried
about taking responsibility for Fred they are now much happier and
the care was supported by nurses till they were happy and confident
to take over they still have close links to Fred’s support services……

Does…Fred……………..
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 …Fred………….acceptance /lack of acceptance affect the
care you give?
…When Fred is “fed up” he can be uncooperative and occasionally
will cry and ask why he has the trachy. Return the questions to him
he knows why he has it look for the positives…………………..

 Does the tracheostomy affect …Fred’s………….body image?
          Yes            no
If yes describe how you think it affects him/her
…No not yet but it might as he gets older……………………..

Is ……Fred……ever excluded from activities he would like to join in?
Yes         no

If yes how can you help …Fred……. to manage the situation?
Fred cannot go swimming with his class he resents this even though
he does not like the water. He now has a special time in either the
soft play area or the white room so he has a treat in his place he likes
it when others in his class are unable to swim so he has company in
his special time Fred was quite distressed last year in school when he
got extra work to do and was taken to the poolside to do it…………




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

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

If you were looking at …Fred……………….. 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 persistant 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…Freds….consent                            …3….
b) collect requirements                           ...1…
c) observe the site of stoma                     …4…
d) ensure everything for an emergency tube
   change is available in case tube is dislodged
   during cleaning                                  …2…

What would you observe the stoma site for?
a)…Redness……………
b)…heat/swelling…………………
c)…discharge………




Liz Herd June 2005   Reviewed A Sims                               5
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Hand washing is an extremely important part of
……Fred’s………………….care

How many steps are there in the hand-washing plan
4    6       8       10     (please circle)

How often should each point of the plan be repeated? 2     4     5   8
10

How often should you wash your hands throughout the
procedure………
…At least at beginning and end but as often as required through the
proceedure

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 …Fred………….?
a)…working complete suction machine……………………..
b)…emergency kit as per care plan………..

What pressures are appropriate for …Fred………..?
……100-120mmhg 200 maximum……………………

What size of suction catheter does …Fred……….. use normally?
……size 8 ch………….

What must you do once the suction machine has been cleaned?
…restock it and ensure it is working on correct pressures.

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


Liz Herd June 2005   Reviewed A Sims                                     6
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If what gets wet why must they be changed immediately?
a)…ties /fixings……….
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?
…tube could dislodge…………………………

When looking at the stoma site underline all of the following that
would give you cause for concern.
Blood at site                         areas of rubbing/chaifing
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)…2 people …………………………………………………..
b) …suction machine……………………………………..
c)…emergency kit as described in careplan…

When should you not change a tube?
…You should only do it as a planned tube change with trained nurse
except in an emergency……………………………….

How many people are required to change a tracheostomy tube?
   One             two         three     four
(please underline appropriately)

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

What is his/her normal tube size?          …5.0…..

What is his/her emergency size?            …4.5………………

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

Liz Herd June 2005   Reviewed A Sims                                   7
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Tray,suction machine (working),alco wipes ,alco gel, hand washing
facilities, tubes x2 correct size + emergency size, fixings tape or
Velcro cleaning materials if required , gloves and apron……

Practice on doll/teddy changing tube
a)     /    /           b)    /     /      c)     /     /

Dates of at least 2 good tracheostomy changes on ……………..
   /   /        signed…………………….. (by assessor)
  /   /         signed…………………….. (by assessor)

If the tube change had been done as an emergency what would you
expect to happen?....Fred could breath easily again.become pink……

If Fred……….. did not improve what would you do? …
a) repeat suction x 2
b) get help to dial 999
c) consider repeating trachy change but only if suction catheter
cannot pass or obvious signs of blockage
What type of knot should you use to tie cotton tracheostomy tapes?
Reef knot………………………………………….

If using Velcro fixings what must you ensure to protect Fred’s.. neck?
That they are not too tight…and hard side of Velcro away from
neck…………….

List 3 complications of tube change
a)…difficulty in replacing tube ………………………….
b)…hypoxia……………………………………….
c)…shock collapse and death………………………………….

Is Freds………….tube disposable?            Yes    no

How would you dispose of clinical waste?
……according to waste disposal policy of trust…………………..




Liz Herd June 2005   Reviewed A Sims                                  8
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Section 6
Carer to demonstrate safe changing of tapes.

List 2 places it is suitable to change tracheostomy tubes
a)…In a clean place………………………………………
b)…Where Fred is comfortable………………………………

Describe an environment that is unsuitable to change tracheostomy
tubes.
An environment that is not clean and that could run the risk of
infection for Fred i.e toilets or farm yard………………………

Describe the care plan for cleaning …Fred……... stoma site and
neck?
Fred has his stoma cleaned with warm water and gauze the swab
must only be damp not very wet as tnis could cause aspiration of
fluid……………

If what gets wet why must they be changed immediately?
a)…fixings……………………………………………………………….
b)…wetness will cause rubbing and soreness………….

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.
…You need to help to remove tube whilst you insert the other tube
you may also need help to restrain child especially if Fred is
concerned also the careplan says 2 people………………………

Describe how tight a tracheostomy tapes 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 …Fred……….. cannot have his tracheostomy
tube fixed like that?   Yes no
If so please give reason


Liz Herd June 2005   Reviewed A Sims                                9
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…Fred has scoliosis so because of the shape of his neck it must be
loose………………………………………

What would you do if you discovered a problem with …Freds……….
neck?
…Tell parents and notify CCN and ducument what I found

Section 7
Carer to demonstrate knowledge of complications and
emergency procedure

Please list all equipment you consider essential for emergencies
…suction machine.             …adequate suction catherters………..
…charger………..                …tubing…………………….
…tray……………..                  …gloves…………………….
…normal size tube…               Velcro/tapes……………………….
…smallertube……….                scissors………………………..

Why do we carry a size smaller tube?
…incase the larger tube will not go in to the tracheostomy stoma……

When would we use the smaller tube?.....only in an emergency

Can you describe the difference between an emergency tube change
and a planned tube change?
…Planned will be done at a time to suit child it will usually be done by
parents or trained staf an emergency tube change needs to be done
at once with no time for other staff to get there As his carer it would
be my responsibility to change the tube with the help available …….

Describe how you could use a suction catheter to help you place a
tracheostomy tube accurately.
…Thread the catheter through the tube place the tube in the stoma
then use the suction catheter as a guide wire to facilitate the
placement of the tube …

Do you use tracheal dilators?          Yes   no

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

Liz Herd June 2005   Reviewed A Sims                                  10
Re-view June 2007
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………


Please show assessor current CPR training certificate
Date of training                 Renewal date
Signature of assessor……………………………………………………..

Is there any CPR training that is specific to …Fred………….?
    Yes      no
If yes can you describe specific training?
…to use the tracheostomy for respiratory support rather than mouth
to mouth…………………………………………..

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

Is this competency valid without up to date CPR? Yes        No
Section 8
Carer to demonstrate knowledge of safety routine

List 3 hazards for …Fred………… at home
a)Small items going into tracheostomy tube……………………..
b)Water going into tracheostomy……………………..
c)thick secretions blocking off tube……………………..

List 3 hazards for Fred in transit
a)Difficulties of changing tube in confind space…………………
b)Difficulties in communication over noise of engine…………………
c)Variations in temperarure……

List 3 hazards for …Fred…...at school
a)Other children!!!….
b)Sand play/glitter……….
c)water play /swimming…….

List 3 hazards for Fred……away from home

Liz Herd June 2005   Reviewed A Sims                                 11
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a)…Any or all of above………..
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

What do you understand by accurate, appropriate documentation?
Documentation that is precise and concise and about the child and
relevant facts in relation to his/her care…………………………………

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?
Only those who need to know…………….

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

List 3 things you must do to identify the child
a) name…………………………………………….
b) date of birth…………………………………………….
c) address……………

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

Who can you share information with about this child?
…Parents and named nurse……………

Liz Herd June 2005   Reviewed A Sims                            12
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Do you always need parent’s permission to share information?
As a rule but if child protection or public interest are involved you may
talk to named nurse or child protection specialist

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

List 3 things you must do to identify who wrote the record and when
the record was written
a)…Date and time…………………………………………..
b)…sign and print name……………………………………….
c)…Job title…………………….

List who you would report record keeping problems to………Named
nurse or manager……

What information would it be suitable to discuss with
……Fred’s……teacher in school?
Any thing parents asked you to discuss or information that you have
got consent to share…

Do you need parents/ Fred’s… consent to share this information?
…Almost always except in cases of child protection………
Who do you report too ? named nurse        on-call    office
Doctor

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

How does Fred…………….express him/her self?
Fred is very able to discuss his concerns and his care……………….




Liz Herd June 2005   Reviewed A Sims                                   13
Re-view June 2007
Suction can be a distressing procedure for both the child/young
person and others around him/her how can we protect his/her dignity
during this time?
Try to do the procedure in a place that gives privacy but remembering
that safety is the priority…………………………………

How may we lessen the distress of others?
By warning them if we have Freds consent and by trying to keep the
procedure short and not visable…………

Does other peoples curiosity distress …Fred…………..?
No it does not appear to at present but this might become a problem
as he gets older

Does asking …Fred’s…………..consent support
…Fred’s…………dignity?
Yes     no

In a short sentence, explain what privacy means to you.
Privacy means own space time to be private time to live as one
likes…

In a short sentence, explain what dignity means to you.
Dignity means being treated with respect having my views listened to
and acted up on being treated the way I treat others………………

List how you would know if ……Fred…………………was
Happy He would tel me
Sad He will cry and maybe have a tantrum
In pain He will show and tell me where it hurts

If possible, give examples
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………

Explain what the expression child specific means to you.
…Training for that child only so I may not use this training for another
child/young person…..


Liz Herd June 2005   Reviewed A Sims                                  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   Reviewed A Sims                              15
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