KPSC Staff Nurse - 20…: The complication associated with a tracheostomy tube is?

KPSC Staff Nurse - 2016

Medical & Surgical Nursing

Easy

Appeared in: KPSC Staff Nurse - 2016

Explanation

Damage to the laryngeal nerves, particularly the recurrent laryngeal nerve, is a known potential complication during the surgical creation of a tracheostomy due to its anatomical proximity.
Injury can also occur post-procedure from pressure necrosis caused by an overinflated tube cuff.
This damage can lead to vocal cord paralysis, manifesting as hoarseness (dysphonia), a weak cough, stridor, and an increased risk of aspiration.

Option A: This is incorrect. Procedures like tracheal suctioning can cause vagal stimulation, which leads to bradycardia (a slower heart rate) and a subsequent decrease, not increase, in cardiac output.
Option B: This is incorrect. Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure that is a common reason for performing a tracheostomy to facilitate long-term mechanical ventilation. It is an indication for the procedure, not a complication.
Option C: This is incorrect. While blood pressure can fluctuate due to pain or anxiety, a more specific risk related to tracheostomy care (suctioning) is hypotension due to vagal-induced bradycardia.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Tracheostomy as background academic context rather than a clinical decision trigger.
Nurses must monitor for signs of laryngeal nerve injury post-tracheostomy, such as a new onset of hoarseness, weak cough, or stridor, and report these findings to the provider immediately.
A key nursing responsibility is proper cuff pressure management. The cuff pressure should be monitored regularly (e.g., every 8 hours) and maintained within the therapeutic range of 20-30 cm H₂O to prevent tracheal and nerve damage.
What if? If a patient with a new tracheostomy suddenly develops a harsh, high-pitched sound on inspiration (stridor), the nurse should suspect airway obstruction or a complication like vocal cord paralysis. The immediate priority is to assess airway patency, notify the rapid response team or provider, and prepare for potential emergency re-intubation.

How to Approach the Question

First, identify the core concept of the question, which is to identify a direct complication of a tracheostomy tube.
Systematically evaluate each option based on your knowledge of the tracheostomy procedure and its potential adverse effects.
Analyze Option A (Increased cardiac output): Recall that vagal stimulation from suctioning can cause bradycardia, which decreases cardiac output. This makes it an unlikely complication.
Analyze Option B (ARDS): Recognize that ARDS is a reason for a tracheostomy, not a result of it.
Analyze Option C (Increased blood pressure): Similar to cardiac output, hypotension is a more noted risk during suctioning. Hypertension is not a direct, expected complication.
Analyze Option D (Damage to laryngeal nerves): Consider the anatomy of the neck. The recurrent laryngeal nerve is very close to the trachea, putting it at risk during the surgical incision. This is a plausible complication.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 1

E6 Medicine Harrison 22e Part 2 p. 211-213