Produced when air passes through partially obstructed or narrowed airways on inspiration or expiration.
Wheezing may be audible, or it may be heard only with a stethoscope.
Ask the client to identify when the wheezing occurs and whether it resolves spontaneously or medication is required for relief.
Wheezing is not all caused by Asthma.
Stridor Given to high-pitched sounds produced when air passes through a partially obstructed or narrowed upper airway on inspiration. Inquire about changes in voice character, hoarseness, difficulty swallowing, sleep-related disorders, degree of snoring, hypersomnolence in the morning, early morning headaches, weight gain, fluid retention, apnea and restlessness.
Nasal and Sinus Complaints Nosebleeds (epistaxis) Sinus infection Hay fever Postnasal drips Rhinitis Nasal, facial, or referred ear pain
Review of Systems Past Medical History Surgical History Allergies Medications Dietary Habits Social History Family Health History
Traditionally, a single lumen tube is passed into the trachea The tube is supplied with an obturator in the lumen which aids insertion and is removed before use. A tracheal cuff allows separation of the lungs from pharyngeal secretions, although it is recognized that some leakage of secretions past the cuff may still occur. Uncuffed tubes are available for patients requiring long-term tracheostomy who have reasonable bulbar function but are unable to clear their secretions.
Double cannula tubes are supplied with an inner tube, which can be removed independently of the outer tube In the event of tube obstruction, this inner tube can be removed and cleaned, thus reducing the incidence of potentially life-threatening complications. This means that this is often the tube of choice especially for ward-based weaning. However, it should be noted that the work of breathing through a double cannula tracheostomy is increased due to the reduction in ID of the tube. In addition, some designs need the inner tube to be in situ to allow connection to the 15 mm ventilator tubing. Double cannula tubes may be fenestrated or unfenestrated
Fenestrated tubes have an opening in the posterior part of the outer tube. If the tube is cuffed, the fenestration lies above the cuff. Deflation of the cuff during spontaneous respiration (with the fenestrated inner tube in place) allows air to pass caudally through the tracheostomy lumen and fenestration, as well as around the tracheostomy tube, and up through the larynx. This encourages maximal airflow through the upper airways during speech and also allows assessment of the normal route of air passage during preparation for decannulation. If positive pressure ventilation is required, the unfenestrated inner tube should be inserted, to prevent air leak above the cuff. There are different designs of fenestrations; single and multiple fenestrated tubes are available.
Tracheostomy tube is usually plugged by inserting a tracheostomy plug (decannulation stopper) into the opening of the outer cannula if the tube has a “tight to shaft” cuff, fenestration, or no cuff. This closes off the tracheostomy , allowing air flow and respiration to occur normally through the nose and mouth.
A tracheostomy tube is removed after resumption of normal respiration as indicated by the clients ability to breathe comfortably with the tracheostomy plugged, to plugged, to cough and expectorate secretions and to maintain normally ABG values or oxygen saturation.
Release lock. Gently remove inner cannula and place in disposable bag. Discard gloves and don sterile ones to insert new cannula. Replace with appropriately sized new cannula. Engage lock on inner cannula.
Leave soiled tape in place until new one is applied.
Cut piece of tape that is twice the neck circumference plus 4 inches (10 cm). Trim ends on the diagonal.
Insert one end of tape through faceplate opening alongside old tape. Pull through until both ends are even.
Slide both tapes under patient’s neck and insert one end through remaining opening on other side of faceplate. Pull snugly and tie ends in double square knot. Check that patient can flex neck comfortably.
Carefully remove old tape. Reapply oxygen source if necessary.
Remove gloves and discard. Perform hand hygiene. Assess patient’s respirations. Document assessments and completion of procedure.
The Components of the Strategic Plan Strategic Plan Operational Plans Monitoring and Evaluation Action Plan Action Plan Action Plan Action Plan Action Plan Action Plan Vision and Values for Library Services Goals for Unit Service Strategic Directions The Mission
The Vision describes a preferred future that is realistic and attainable but also optimistic. The Vision retains all that is positive about the library today but also enhances and improves the library to create a better future.
Values describe core beliefs that are the foundation of the organization and affect day to day operations.
Action Plans are the tasks necessary to pursue each Strategic Direction. Action Plans are specific, measurable, tied to a schedule and often assigned to departments for implementation.
Vision Goals Position the College of Nursing as an institution that is continually relevant and vital to the success of Santiago’s future, providing essential services for vibrant, healthy, sustainable and diverse communities. The Northeastern College – Nursing Department, rooted in Santiago’s vibrant and healthy community, are meeting places and destinations that enliven their neighborhoods, enhance understanding of cultural diversities, and link people to one another, to a sense of Santiago’s past, and to their shared future. Strategic Directions Community & Civic Role Information Gateway: Develop Community Facilities Marketing & Communication
Discussion Questions #3 How current are your UNIT’s Vision, Mission and Goals? Do you have an effective plan for dealing with your UNIT’s future?