The nurse auscultates rhonchi in a client with a tracheostomy tube and performs endotracheal suctioning to clear the secretions. Which nursing interventions are most appropriate to limit the risks associated with suctioning? Select all that apply.

A. Use sterile technique during suctioning.
B. Limit the suctioning time to 10 seconds or less.
C. Apply suction while inserting the catheter.
D. Administer antibiotics before suctioning.
E. Maintain proper hydration for the client.

To limit risks associated with suctioning a tracheostomy tube, nurses should use sterile technique, limit suctioning time to under 10 seconds, apply suction while withdrawing, not inserting the catheter, and ensure patient hydration to thin the secretions. Administering antibiotics isn't generally necessary unless an infection is present.

Explanation:

For a client with a tracheostomy tube who exhibits rhonchi (rumbling sounds from the bronchial tubes), the most appropriate nursing interventions to limit the risks associated with suctioning are: a) Using sterile technique during the procedure, this minimizes the risk of introducing microorganisms which can cause an infection. b) Limiting the suctioning time to no more than 10 seconds. Prolonged suctioning can cause a drop in oxygen levels in the blood, known as hypoxemia. c) Applying suction while withdrawing the catheter, not while inserting it, to prevent trauma to the tracheal mucosa. Lastly, e) Maintaining proper hydration for the client. This helps to thin the secretions, making them easier to suction.

Administering antibiotics before suctioning (d) is not generally required unless the client has a tracheal infection. The primary concern during suctioning is to maintain patent airway and prevent infections, not just by antibiotics but through a sterile technique.

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