Which nursing diagnosis is the priority in the care of a patient with a traumatic brain injury in whom a tracheostomy is placed?
A)Risk for skin breakdown.
B)Impaired gas exchange.
C)Ineffective airway clearance.
D)Risk for infection.

Question

Quizplus · Accepted Answer

Patients with tracheostomies rely on the tracheostomy tube to provide a stable open airway.The nurse is also concerned that the patient would not be able to cough up his or her own secretions,which could occlude the tracheostomy,putting the patient at risk for Ineffective airway clearance.Nursing priorities are airway,breathing,and circulation.Nursing diagnoses that occur frequently should be addressed before "Risk" diagnoses.Skin breakdown and infection are not immediately life-threatening.

Which Nursing Diagnosis Is the Priority in the Care of a Patient