The nurse is caring for a client with a tracheostomy tube in place connected to a mechanical ventilator. When facilitating communication, which strategy is not appropriate?
1. Using a fenestrated tracheostomy tube
2. Using writing materials
3. Using a communication board
4. Using a Passy-Muir valve
Correct Answer: 1
Fenestrated tracheostomy tubes require placement of the inner cannula when the client requires mechanical ventilation, which defeats the speaking ability of the tube. Although a fenestrated tube allows a client to speak when weaning from the ventilator, it will not improve communication for the ventilated client. Use of writing materials is useful for improving communication if the client is alert and strong enough to be able to use them. A communication board is indicated if the client is not strong enough to use writing materials. A Passy-Muir valve can be used when the client is on or off of the ventilator, allowing the client to speak.
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