Mr. Kent, 42 years old, had a cuffed tracheostomy tube placed 4 weeks ago. This morning, his doctor made an order for him to begin eating by mouth, with the tracheostomy in place. To prevent aspiration, the nurse will: Select all that apply:

  1. Raise the head of the bed to high Fowler's
  2. Increase Mr. Kent's FiO2
  3. Deflate the cuff on the tracheostomy tube
  4. Suction the client before eating
  5. Assess gag and swallow ability
Explanation

Answers: A, C, D, E - (A) By raising the head of the bed, gravity helps the client swallow and helps prevent aspiration; (C) the cuff should initially be deflated to assess gag and swallowing ability; (D) the client's airway should be patent and secretions removed before deflating the cuff; and (E) assessing the client's gag and swallowing ability is crucial before starting the client on PO food and fluids. Choice B is incorrect because there is no reason to increase FiO2. Choice F is incorrect because it is not necessary to replace the tracheostomy ties before the client eats, unless they are noted to soiled or loose.

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