Identify the procedure performed on a patient as shown in photograph:

Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Medical Surgical Nursing

Easy

Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Explanation

The image shows a tube inserted through a surgical opening in the neck directly into the trachea, which is characteristic of a tracheostomy.
A tracheostomy is performed to establish a long-term, stable airway, bypassing the upper airway.
The device shown, with its flange and neck strap, is a standard tracheostomy tube.
This procedure is distinct from intubation (through the mouth/nose) and cricothyroidotomy (a higher, emergency incision).

Option A: A cricothyroidotomy is an emergency incision made through the cricothyroid membrane, which is located superior to the typical tracheostomy site. It is a more rapid but temporary procedure.
Option C: Intubation involves placing an endotracheal tube through the mouth or nose into the trachea. The image clearly shows the tube entering through an incision in the neck, not the mouth or nose.
Option D: Hoodectomy is not a recognized medical term for any type of airway procedure. It may be a misspelling or a distractor with no clinical relevance to this context.

Clinical Relevance

Nursing practice connection: Use the key finding related to Identification of surgical airway procedures to guide bedside assessment, documentation, and the next nursing action.
Nurses are responsible for routine and emergency care of patients with tracheostomies, including suctioning, stoma care, and ensuring the tube remains patent and secure.
It is critical to have emergency equipment at the bedside for a tracheostomy patient, including a spare tracheostomy tube (same size and one size smaller), an obturator, suction equipment, and a manual resuscitation bag (Ambu bag).
What if? If the tracheostomy tube becomes accidentally dislodged (decannulation), it is a medical emergency. The nurse's immediate action is to call for help, attempt to reinsert a new tube using the obturator, and if unsuccessful, cover the stoma and provide ventilation using a bag-valve-mask over the mouth and nose.

How to Approach the Question

First, carefully analyze the image provided. Note the key features: a tube is inserted into the front of the neck and secured with a strap.
Identify the anatomical location of the intervention. The tube is in the lower part of the neck, suggesting an opening into the trachea.
Read all the options provided.
Evaluate each option against the visual evidence. 'Intubation' involves a tube through the mouth/nose. 'Cricothyroidotomy' is an incision higher up on the neck. 'Hoodectomy' is not a relevant term.
Select the option that directly corresponds to a surgical opening in the trachea via the neck for airway management, which is a 'Tracheostomy'.

Concept Tested & Keywords

Concept Tested: Identification of surgical airway procedures.
Stem keywords: procedure, patient, photograph
Lead-in keywords: Identify
Clinical cues: Presence of a tube inserted into the neck with a flange and securing strap.

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E6 Nursing Fundamentals Taylor p. 736-738

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 pp. 115-117, 116-118