A nurse is caring for a client with a new tracheostomy. The client becomes anxious and signals that they cannot breathe. What is the FIRST nursing action?

A CLIENT WITH TRACHEOSTOMY reporting inability to breathe is a RESPIRATORY EMERGENCY. Never leave the client alone during a tracheostomy emergency. IMMEDIATE ASSESSMENT AND ACTIONS: STAY WITH CLIENT and CALL FOR HELP (call code/emergency team, call RN and provider); ASSESS AIRWAY: look-listen-feel at the tracheostomy opening; ASSESS TUBE POSITION: is the tube in the correct position or has it been displaced (dislodged, obstruction)? OBSTRUCTION WITH MUCUS PLUG (most common cause): suction the tracheostomy immediately using sterile technique (inner cannula, suction through tube); can also attempt to IRRIGATE with 1-2 mL normal saline (now less recommended but still used acutely); INNER CANNULA: remove and clean or replace disposable inner cannula — this can rapidly relieve blockage; TUBE DISLODGEMENT: if tube has come out or is clearly out of the trachea: keep stoma open; position: hyperextend the neck to open the stoma; use an obturator to re-insert same tube if available; OR use 10% smaller tube if same size won't go in easily; EMERGENCY SUPPLIES that must be AT BEDSIDE for every tracheostomy patient: tracheostomy tube of SAME SIZE AND ONE SIZE SMALLER, obturator (used for reinsertion), bag-valve mask (Ambu bag) that fits tracheostomy, suction supplies, extra inner cannula, emergency tracheostomy tray; BAG-VALVE MASK VENTILATION through tracheostomy if client is not breathing; OXYGEN: ensure 100% O2 during emergency. PN ROLE: recognize the emergency; call for help; initiate airway management within scope; have emergency supplies organized at bedside; document. ONGOING CARE: tracheostomy care every 8 hours or per protocol (clean stoma, change inner cannula, change ties when loose/soiled, assess for complications).