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130 Cards in this Set
- Front
- Back
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1. define post-acute care |
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2. what are considered the different settings of post-acute care? |
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3. What type of patients would be suited for subacute care rather than acute care (3)? |
stable patients who: 1. have experienced an acute event resulting from injury, illness, or disease process 2. have a determined course of treatment 3. require diagnostic or invasive procedures but not those requiring acute care |
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4. where is most post-acute respiratory care provided? |
in the home |
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5. when would the home setting not be the best setting to provide subacute care (3)? |
1. patients unable to care for themselves 2. adequate patient support unavailable 3. home environment unsuitable |
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6. what are the goals of respiratory home care (5)? |
1. supporting and maintaining life 2. improving physical, emotional, social well-being 3. promoting self-sufficiency 4. ensure cost care 5. maximizing comfort near end of life |
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7. What disorders would respiratory home care be considered? (5) |
COPD cystic fibrosis chronic neuromuscular disorders chronic restrictive conditions carcinoomas of the lung |
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8. what benefits do carefully selected home treatment regimes have? (4) |
- increased longevity - improved quality of life - increased functional performance - reduction in individual and societal costs associated with hospitalization |
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9. from where do the standards for the delivery of subacute and home health care derive (3)? |
1. clinical practice guidelines produced by AARC 2. federal (CMS) and state laws 3. private sector accreditation |
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10. what statutory regulation ensures skilled nursing facilities and home health agencies meet minimum health and safety requirements? |
Medicare provider certification program |
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11. What is the primary organization responsible for standard setting and voluntary accreditation of care providers in alternative settings |
The Joint Commission |
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12. what are the key features that distinguish the delivery of respiratory care services in alternative settings from traditional acute care delivery? |
resource availability supervision and work schedules documentation and assessment provider-patient interaction |
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13. what should be included as part of a good discharge plan (4)? |
1. patient evaluation 2. site evaluation 3. multidisciplinary plan of care 4. education and training |
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14. what is the desired outcome of a good discharge plan (7)? |
1. no readmission because of discharge plan failure 2. the equipment meets needs 3. all treatment and modalities are performed satisfactorily 4. caregivers assess, troubleshoot, and solve problems as they arise 5. treatment meets needs and goals 6. patient and family are satisfied 7. site provides necessary services |
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15. members of the home care team (9) |
Utilization review Discharge planning (social service, community, or public health) Physician Respiratory care Nursing Dietary and nutrition Physical and occupation therapy Psychiatry or psychology DME supplier or home care company |
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16. Who establishes the therapeutic objectives as part of the home are team? |
Physician |
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17. Who makes contacts with outside agencies as part of the home care team? |
Discharge planning |
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18. Providing regular in-home follow-up visits and assessing the patients overall progress is the responsibility of who? |
Nursing |
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respiratory care |
evaluates patient and recommends appropriate respiratory care, provides care and follow up |
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19. DME supplier or home care company |
provides needed equipment and supplies and handles any emergency situation involving delivery or equipment operation |
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20. DME's provide which respiratory home care services? |
24/7 service Third party insurance processing Home instruction and follow-up by an RT Most forms of respiratory care |
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21. What factors do you consider for choosing a DME? |
Companies accredidation process Cost and scope of services Dependability Location Personnel Past track record Availability |
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22. To determine if a home setting can support the equipment needs of a mechanically ventilated patient, what should be assessed? |
Accessibility Equipment Environment |
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23. key environmental factors that should be assessed in considering discharge of a patient to the home care setting include? |
Heating and ventilation Humidity Lighting Living space |
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24. What is the most common respiratory home care modality? |
O2 therapy |
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25. What are indicators of hypoxemia for purposes of justifying home O2 therapy? |
ABG's Oximetry |
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26. Home O2 therapy can be justified in patients with PaO2 values greater than 55mmHg in these diseases? |
Cor pulmonale Congestive heart failure Erythrocythemia Hematocrit >56% |
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27. Physical hazards associated with home O2 therapy equipment include? |
Unsecured cylinders Ungrounded equipment Liquid O2 burns Fire |
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28. To determine the need for long-term home O2 therapy after initial justification, when should ABG's be repeated? |
1-3 months |
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29. Once the need for long-term home O2 therapy has been documented, why should repeated ABG's be conducted? |
Follow the course of the disease Assess changes in clinical status Facilitate changes in O2 prescription as needed |
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30. CMS regulations require that prescriptions for home O2 therapy be based on? |
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31. What are acceptable methods of documenting the presence of hypoxemia in patients being considered for home O2 therapy |
... |
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32. What must a physician include in a home O2 prescription? |
Flow rate in LPM or FIO2 Frequency - hours per day and minutes per hour Duration of need Diagnosis Laboratory evidence - ABG/oximetry Additional medical documentation (No acceptable alternatives to home O2 therapy) |
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33. Home O2 can be supplied by which of the following systems? |
Compressed O2 cylinders Liquid O2 systems O2 concentrators |
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34. Advantages of compressed O2 cylinders? |
Good for small volume user No waste or loss Stores O2 indefinitely Widespread availability Portability (small cylinders) |
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35. Disadvantages of compressed O2 cylinders? |
Large cylinders heavy and bulky High-pressure safety hazard Provides limited volume Requires frequent deliveries Tight valves can be a problem |
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36. Primary use of compressed O2 cylinders in alternative settings? |
Ambulation (small cylinders) Back up to liquid or concentrator supply systems (large cylinders) |
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37. In addition to compressed gas cylinders, what additional equipment is needed? |
Pressure reducing valve Calibrated low flow meter |
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38. What solution should a bubble humidifier be filled with? |
Distilled water |
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39. You notice white deposits hindering the flow of a bubble humidifier, what would you recommend? |
Too much minerals in water, switch to distilled water |
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40. 1 cubic foot of liquid O2 equals how many cubic feet of gaseous O2? |
860 cubic ft gas |
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41. The O2 inner reservoir of a home liquid O2 system is maintained at what temp? |
-300F |
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42. When not in use vaporization in liquid O2 system is maintained in what pressure range? |
20-25psi |
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43. Liquid O2 leaving the vaporizing coil is heated by what? |
exposure to room temp |
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44. 1lb of stored liquid O2 equals how many gaseous liters? |
344L of gaseous O2 |
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45. The gauge reading of a 50lb home liquid O2 system indicated the cylinder is 1/3 full. What is the duration of flow at 2lpm? |
1. Compute available liquid O2 .50 x 1/3 = 16.65lb 2. Compute available gaseous O2 16.65 x 344L/lb = 5727.6 3. Divide gaseous O2 by liter flow 5727.6 / 2lpm = 2863.8 min or 47.73 hours or 1.98 days |
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46. What is the purpose of the small refillable O2 tank included with stationary home liquid O2 reservoirs? |
This system is ideal for an ambulatory patient who is capable of physical activity |
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47. Most portable liquid O2 systems can provide low flow O2 for how long? |
5-8 hours of O2 at 2lpm |
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48. If a portable liquid O2 does not last long enough, what would you recommend? |
Add an O2 conserving device |
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49. Advantages of home liquid O2 systems? |
Provides large volumes Low pressure system (20-25psi) Portable units can be refilled from reservoir (up to 8 hour supply at 2lpm) Valuable for rehabilitation |
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50. Disadvantages of home liquid O2 systems? |
Loss of O2 through venting system Low temp safety hazard Cannot operate ventilators or other high-pressure devices Some difficulty in filling portable unit |
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51. What electronic device separates O2 from N2 in room air? |
O2 concentrator, most common type is molecular sieve |
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52. Advantages of O2 concentrators? |
No waste or loss Low-pressure system (15psi) Cost effective when a continual supply of O2 is needed Eliminates need for deliveries |
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53. Between 1-2lpm, molecular sieve concentrators provide what O2 concentration? |
92-95% O2 |
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54. Between 3-5lpm, molecular sieve concentrators provide what O2 concentration? |
85-93% O2 |
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55. To prevent problems with home O2 therapy, how often should delivery equipment be checked? |
Once a day |
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56. In setting up home care for a COPD patient for continuous low flow O2 therapy through an O2 concentrator, what additional equipment must be provided? |
Emergency back up O2 cylinder |
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57. Besides providing an H-tank for a home O2 therapy patient using a concentrator, what other safety measures would you take to ensure uninterrupted supply? |
Notify the electric power company in writing that life supporting equipment is in use at the location |
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58. Routine in home monthly maintenance of O2 concentrator should include which of the following? |
Cleaning and replacing filters Check alarm system Confirm FIO2 levels using units O2 sensor or separate calibrated O2 analyzer (If the concentration is less than the manufacturers recommendations the pellet canisters are exhausted and need replacing) |
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59. A home care patient requiring IPPB treatments has a pneumatically powered IPPB device, what gas source should be used to drive this device? |
50psi gas source such as a large O2 cylinder |
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60. What is the most common O2 delivery system for long-term care? |
Nasal cannula |
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61. Please list the different forms of O2 conserving delivery systems? |
Trans-tracheal catheter Reservoir cannula Demand or pulse dose O2 delivery systems |
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62. A patient does not like the cosmetic appearance of a reservoir cannula, what device is capable of addressing these concerns? |
Trans-tracheal O2 therapy |
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63. TTOT should be considered for what patients requiring long term therapy? |
-Cannot adequately oxygenate with standard approaches -Do not comply well when using other devices -Exhibit complications from nasal cannula use -Prefer TTOT for cosmetic reasons -Have need for increased mobility -Sleep apnea when CPAP not tolerated or when combined O2 and nasal CPAP are required |
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64. Who should perform routine cleaning of a trans-tracheal catheter? |
Patient or caregiver |
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65. If a patient is unable to reinsert a trans-tracheal catheter after cleaning, what do you recommend? |
Use a nasal cannula |
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66. To avoid failure how often should trans-tracheal catheters and tubing be replaced? |
Routinely replaced every 3 months |
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67. Which O2 delivery system would be recommended for an active patient with low FIO2 who desires increased mobility? |
Ambulatory patients using compressed or liquid O2 in alternative sites |
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68. Complications associated with insertion of a transtracheal O2 catheter? |
Bleeding Pneumothorax Bronchospasm |
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69. What problems should be monitored for a new patient with transtracheal catheter? |
Tract tenderness Fever Excessive cough Increased dyspnea Subcutaneous emphysema |
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70. You note marked erythemia and swelling at the stoma site of a 6-month transtracheal catheter patient, what action do you take? |
Contact the physician immediately and report your findings |
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71. Major problems with demand O2 delivery systems? |
- Cumbersome, unattractive - High cost; not always fully reimbursed - Possibility of poor response times and delays in valve opening and closing - Fragile, easily damaged - Battery operated; batteries must be recharged/replaced - Catheters/sensor malfunction due to sensor dislodgement, plugging, or breathing problems |
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72. Who are good candidates for home mechanical ventilation? |
1. Patients unable to maintain adequate ventilation over prolonged periods 2. Patients requiring continuous mechanical ventilation for long-term survival 3. Patients who are terminally ill with short life expectancies |
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73. Home care patients requiring continuous ventilatory support for long-term survival include? |
High spinal cord injuries Apneic encephalopathies Severe COPD Late stage muscular dystrophy |
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74. What indications show that a patient is sufficiently stable for home mechanical ventilation? (9) |
- Ability to tolerate mechanical ventilation - Acceptable ABG's and blood work - Relatively low FIO2 needs <40% - Psychologic stability - Absence of life-limiting comorbidities, cardiac dysfunction and arrhythmias - Peep <10cmH2O - Ability to clear airway secretions by cough, suction, or cough assisted device - Tracheostomy tube, as opposed to endotracheal tube, for invasive ventilation - No readmissions expected for >1 month |
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75. Mechanical ventilation in the home setting can be provided by what methods? |
Invasive or noninvasive support |
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76. According to the AARC, which standards should be met when considering ventilatory support outside the acute care hospital? |
See page 1325 |
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77. What equipment function should lay caregivers of home mechanical ventilation assess regularly? |
Appropriate configuration of circuitInternal and external battery levels Alarm function Overall equipment condition Cleanliness of filters Self inflating BVM cleanliness and function |
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78. Patient parameters that lay caregivers of home mechanical ventilation should assess regularly include? |
See page 1326 51-3 |
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79. What are the prerequisites to successful home based mechanical ventilation? |
Willingness of family to accept responsibility Adequacy of family and professional support Overall viability of the home care plan Stability of patient Adequacy of home setting |
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80. What is the first step in discharging a patient from an acute care facility who will require home based mechanical ventilation? |
Family is consulted regarding feasability |
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81. Which areas would you be sure to cover in a discharge plan for a patient requiring mechanical ventilation? |
... |
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82. What are the emergency situations that home caregivers of mechanically ventilated patients be trained to recognize and manage? |
Ventilator or power failure Ventilator circuit problems Airway emergencies Cardiac arrest |
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83. In organizing a patient and family education program for a discharge plan for a mechanically ventilated patient, what method would be best for training the family in the operation of the chosen ventilator? |
See page 1327 |
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84. In the early stages after your patient requiring mechanical ventilation is discharged to home, how often should patient follow-up by a respiratory care practitioner occur? |
Daily |
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85. What conditions are an indicator for the application of noninvasive ventilation? |
Patient is mentally competent, cooperative, and not using heavy sedation or narcotics Supplemental O2 therapy is minimal FIO2<40% SaO2 greater than 90% maintained by aggressive airway clearance techniques Bulbar muscle function is adequate for swallowing without potentially dangerous aspiration No history exists of substance abuse or uncontrollable seizures Unassisted or manually assisted peak expiratory flows No conditions present that interfere with NIV interfaces (facial trauma) |
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86. Relative contraindications for using noninvasive ventilation include? |
Severe upper airway dysfunction Copious secretions that cannot be cleared by spontaneous or assisted cough O2 concentration requirements exceeding 40% |
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87. For what patient groups would you recommend long term negative pressure ventilation in an alternative setting? |
Patients who have failed NIV trials Patients with intact upper airway where NIV is contraindicated Patients who require frequent airway access for suctioning Patients with severe nasal congestion |
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88. What equipment is needed for a patient receiving positive pressure ventilation? |
Ventilator Manual resuscitator Heated ventilator humidifier with thermostat or HME Monitoring or alarm devices12V battery and chargerair compressor O2 source Power strip/surge protector Suction machine Stethoscope O2 analyzer Pulse oximeter Hospital bed with table Patient lift Bedside commode Wheelchair |
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88. What supplies are needed for a patient receiving positive pressure ventilation? |
O2 and delivery devices Airway interface Trach tube inner cannulas Extra trach tubes of different sizes Trach care kits Ventilator circuits Bacterial filter Connecting tubing Suction catheters Disposable gloves Sterile water Small volume nebulizer Cleaning and disinfecting supplies |
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89. In what situations would you recommend that more than one ventilator be provided for a home care patient? |
-Patient cant maintain spontaneous ventilation for more than 4 consecutive hours -Lives where replacement ventilators are more than 2 hours away -Requires mechanical ventilation during mobility |
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90. What strategies would you recommend for a patient with a tracheotomy who requires home ventilator support? |
Positive pressure ventilator Humidification system Servo controlled heated humidifier with alarms |
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91. What strategies would you recommend for a cooperative patient with an intact upper airway who requires home ventilator support? |
Device capable of NIV unless contraindicated |
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92. What are the absolute contraindications for using noninvasive positive pressure ventilation? |
Need for immediate intubation Hemodynamic instability Uncooperative patient Facial burns or traumaInadequate airway protection Patient tracheoesophageal fistula |
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93. What strategies would you recommend for a thermodynamically unstable patient with an intact upper airway who requires ventilatory support? |
Negative pressure ventilation. |
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94. Characteristics common to most positive pressure ventilation designed for use in the home setting are? |
Electronically powered Dependable Easy to operate Portable |
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95. What are the essential features of positive pressure ventilators that are used in the alternative care settings on patients with intact ventilatory drive and respiratory muscles? |
An essential feature is basic to safe and effective operation in most patient care settings and includes: Positive pressure tidal breaths Mandatory Rate |
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96. What are the advantages of pressure limited ventilators used in alternative settings? |
... |
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97. What types of home care patients requiring mechanical ventilation would you recommend a portable volume cycled ventilator rather than a pressure limited device? |
Patients with neuromuscular or neurological disorders |
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98. A home care patient receiving continuous noninvasive positive pressure ventilation through a nasal mask complains of pressure sores over the nasal bridge. What actions could help alleviate this problem? |
Reduce strap tension, use forehead spacer, try nasal pillow, use artificial skin |
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99. What alarm systems are needed for post-acute care patients who require only intermittent pressure limited noninvasive positive pressure ventilation? |
A loss of power alarm is generally sufficient |
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100. What are the different types of negative pressure ventilators used in post acute care? |
Iron lung Chest cuirass and wrap Pneumosuit |
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101. What negative pressure ventilator systems require a separate negative pressure generator? |
Chest cuirass (a rigid shell) and wrap types systemsEx. Philips-Resperonics NEV-100 |
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102. You are conducting a routine visit to a ventilator dependent patient in a home care setting. What should you perform while on this visit? |
ABG Check and clean equipment Prescribed respiratory therapy Leave supply items with care givers Document the status of patient and equipment |
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103. What is the major potential problem in the application of bland aerosol therapy in the home setting? |
Infection from contaminated equipment |
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104. What are the first line aerosol drug delivery systems for home care patients? |
Beta andrengenic bronchodilators, anticholinergic agents, and anti-inflammatory drugs are delivered in metered dose inhalers, dry powder inhalers, and small volume nebulizers - Jet Nebulizer |
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105. Routine tracheostomy care for a home care patient can be provided by who? |
Any trained care giver |
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106. What personnel are allowed to change a tracheostomy on a home care patient? |
Nurse, physician, or RT |
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107. What are the components of a portable home suction unit? |
Electrically powered suction pump, collection bottle, connecting tubing, suction catheter |
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108. In order to control the cost of suction supplies for a home care patient, what are acceptable strategies? |
Single suction catheter used for 24 hours and cleaned in hydrogen peroxide or 2.5% acetic acid between suction attempts and then discarded |
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109. What are the secretion clearance methods for home care patients? |
Independently: -coughing- Forced exhalation- Active cycle of breathing- autogenic drainage methods Caregiver assisted:- traditional postural drainage-percussion and vibration-directed or assisted cough Additional assistance :-expiratory pressure mask-flutter valve- High-frequency chest compression vest-Emerson mechanical inexsufflator or coughlator |
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110. What evidence is needed to support Medicare reimbursement for adult nasal CPAP equipment to treat sleep apnea? |
The diagnosis of sleep apnea must be confirmed by polysomnography AKA sleep study |
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111. What are the components of a nasal CPAP apparatus? |
Consists of a flow generator capable of establishing various levels of PEEP or CPAP (2.5-20cmH2O), a circuit, and a patient interface (nasal mask, nasal pillows) |
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112. What is the most common way to determine the proper CPAP level for an individual? |
Sleep study, titrating different levels of CPAP. Observed changes in the apnea-hypopnea index are correlated with various CPAP levels. The prescribed level of CPAP is the lowest pressure at which apneic episodes are reduced to an acceptable frequency and duration |
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113. What are common problems encountered when using adult nasal CPAP? |
Skin irritation Conjunctivitis Epistaxis Nasal discomfort (drying, burning, and congestion) |
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114. What procedures can help to minimize skin irritation while using nasal CPAP? |
Adjust the straps Clean daily to remove dirt and facial oils Replace mask and nasal pillow every 3-6months if leakage or discomfort occurs |
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115. What should you consider recommending for a home care patient receiving nasal CPAP who complains of severe nasal dryness? |
In line humidifiers Room vaporizers Chin straps (decrease upper airway moisture loss) Saline nasal sprays |
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116. You turn on the CPAP machine, it reads 0cmH2O, what is the most likely cause for this problem? |
Inadequate flow or system leaks due to inappropriate patient interface (mask vs. nasal pillows) or pressure loss through open mouth |
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117. What group of hospitalized infants are frequently set up on apnea monitors? |
Recurrent apnea, bradycardia, and hypoxemia in at-risk infants |
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118. During what phase of subacute care management does the RT establish short and long term rehabilitation goals? |
Treatment planning and ongoing assesment |
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119. What should be included in a RT weekly summary? |
Synopsis of progress toward goal attainment Changes in respiratory status Results of additional tests Explanation of any patient education Recommendations for additional therapy |
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120. For patients receiving home respiratory care, how often should follow up evaluation occur? |
Regularly |
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121. What factors would you consider in determining the frequency of follow-up visits needed by a home care patient? |
Patients condition and therapeutic needs Level of family or caregiver support available Type and complexity of home care equipment Overall home environment Ability of the patient to provide self-care Third party reimbursement for such visits |
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122. What functions should a respiratory home care practitioner provide when making a home care visit? |
Patient assessment including pretreatment and posttreatment clinical assessment Compliance with prescribed respiratory home care Equipment assessment ID of problem areas or patient concern Statement related to patient goals and therapeutic plan |
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123. After making a home care visit, who should copies of the report be sent to? |
Physician, home care referral source, and any other member of the medical team requiring this information |
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124. Basic principles of infection control in the home are? |
Sources of infection Basic principles of infection control Patients at high risk Disinfection methods Equipment processing Care of solutions and medication Surveillance, prevention, and control of infection |
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125. Correct order of steps for cleaning nondisposable respiratory care equipment? |
Completely disassembled and washed in water Soak in warm soapy water for several minutes Scrubbed to remove organic material Thoroughly rinsed Air dry on clean surface or rack |
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126. What agent recommended by the American respiratory care foundation for the disinfection of respiratory home care equipment? |
Quaternary ammonium compounds (quats) Acetic acid |
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127. You notice that the expiration date on an expensive multidose bronchodilator has passed, what do you recommend? |
Guidelines for the specific handling of medications should be strictly followed |
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128. What are the goals of home care of terminally ill patient near the end of life? |
Minimize the patients dependence on institutional care maximize comfort and well-being Control of pain and other symptoms Maximize psychological, social, and spiritual well-being |
