The nurse is caring for a client with a longstanding permanent tracheostomy that has been in place for several years in order to provide mechanical ventilation. Which type of tracheostomy should the nurse anticipate this client may have based on the health history?
1. Uncuffed tracheostomy
2. Cuffed tracheostomy
3. Fenestrated tracheostomy
4. Uncuffed or fenestrated tracheostomy
2
Rationale 1: The client with a long-term tracheostomy who does not require mechanical ventilation would be likely to have an uncuffed tube.
Rationale 2: Cuffed tracheostomy tubes are essential when the client requires mechanical ventilation because they provide a seal so that air does not leak when the ventilator provides a breath.
Rationale 3: It is unlikely that a fenestrated tracheostomy tube will be used.
Rationale 4: Both uncuffed and fenestrated tracheostomies would not be indicated for this client.
Global Rationale: Cuffed tracheostomy tubes are essential when the client requires mechanical ventilation because they provide a seal so that air does not leak when the ventilator provides a breath. The client with a long-term tracheostomy who does not require mechanical ventilation would be likely to have an uncuffed or fenestrated tube.
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A disadvantage to the utilization of the electronic medical record (EMR) includes which of the following?
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The clinic nurse speaks with the student nurse prior to the physical examination of a pregnant woman who is 32 weeks gestation
The clinic nurse explains that the heart sounds heard in pregnancy are usually S1 and S3 with a possible murmur related to increased cardiac output. A) True B) False
Which strategy is not always appropriate for a pediatric physical examination?
a. Take the history in a quiet, private place. b. Examine the child from head to toe. c. Exhibit sensitivity to cultural needs and dif-ferences. d. Perform frightening procedures last.