A nurse is planning care for a client who has a tracheostomy. Which of the following interventions should the nurse include in the plan of care?

Nursing care for a client with a tracheostomy focuses on maintaining airway patency, preventing infection, and ensuring the secure positioning of the tracheostomy tube. A tracheostomy creates a direct airway opening through the neck into the trachea, requiring meticulous care to avoid obstruction, displacement, or skin breakdown. Proper tie tension, stoma care, and sterile technique are essential components of safe management. Ensuring the tube is neither too tight nor too loose is critical for airway safety and skin integrity. Rationale: A. Removing the soiled ties before replacing them with new ties is unsafe because it may lead to accidental decannulation (dislodgement of the tracheostomy tube). The correct approach is to secure the new ties before removing the old ones to maintain airway stability at all times. Airway security is the highest priority in tracheostomy care. B. Allowing one fingerbreadth between the tie and the client’s neck is appropriate because it ensures the ties are secure enough to prevent tube displacement while avoiding excessive pressure on the skin. This prevents skin breakdown, impaired circulation, and discomfort while maintaining airway stability. Proper fit is essential for both safety and comfort. C. Using a cotton swab to clean inside the stoma is incorrect because it may introduce microorganisms and cause trauma to delicate tissue. The stoma should be cleaned using sterile technique with appropriate gauze or sterile applicators. Inserting materials into the stoma can also risk airway irritation or obstruction. D. Cleaning the tracheostomy plate before the stoma site is incorrect because the correct sequence is to clean the stoma first and then the outer surfaces. Cleaning from the inside outward prevents contamination of the stoma with external debris. Proper order helps reduce infection risk and maintains sterile technique around the airway opening.