# A client with a 3-day-old tracheostomy coughs vigorously and the entire tracheostomy tube is expelled. The client is in respiratory distress. Which actions are appropriate? Select all that apply.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374980&lang=en  
> language: en  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## Question

A client with a 3-day-old tracheostomy coughs vigorously and the entire tracheostomy tube is expelled. The client is in respiratory distress. Which actions are appropriate? Select all that apply.

1

Position the client supine with the neck hyperflexed to bring the stoma into view for tube reinsertion

2

Wait for the rapid response team to arrive before attempting to ventilate or reinsert the tube

3

Cover the stoma with sterile gauze and ventilate by face mask over the mouth and nose

4

Call the rapid response or airway team while continuing oxygenation and preparing for oral intubation by a skilled clinician

5

Prepare the same-size and smaller spare tubes with an obturator for the skilled airway clinician, without attempting blind reinsertion

## Explanation

A 3-day-old tracheostomy has an immature tract, so accidental decannulation can create a false passage and is an airway emergency. Option 1 is incorrect because hyperflexion obstructs access and can worsen airway alignment. Option 2 is incorrect because oxygenation must begin immediately while help is summoned. Option 3 is correct when the upper airway is patent: occlude the stoma and ventilate through the mouth and nose with a bag-mask device. Option 4 is correct because expert airway help should be activated immediately while oxygenation continues; a fresh tracheostomy favors oral intubation by a skilled clinician when mask ventilation is inadequate. Option 5 is correct because replacement equipment should be ready for the airway clinician, but a bedside nurse should not blindly force a tube through an immature tract.

## In-depth explanation

Bedside emergency kit: obturator, same and smaller size spare, suction, sterile gauze, scissors, syringe for cuff. Memorize the sequence.

## Clinical scenario

Bedside kit at hand: obturator, same-size and one-size-smaller spare tubes, suction. SpO2 87 percent and falling.

## Key concepts

- **decannulation** — Removal or expulsion of the tracheostomy tube; emergency in fresh stomas.
- **obturator** — Smooth-tipped guide that fits inside the trach tube to ease reinsertion.
- **stomal tract** — Channel from skin to trachea; matures around day 7-10 post-procedure.

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