Exam 51: Respiratory Care in Alternative Settings

What is the first step in discharging a patient from an acute care facility who will require home-based mechanical ventilation? 1.Family is consulted regarding feasibility.2.Physician writes appropriate orders.3.Discharge planner coordinates efforts of team members and discharge plan is formulated.4.Physician and other team members discuss plan with family and/or caregivers.5.Education and training are initiated and completed.6.Patient and family are prepared for discharge.7.Home layout is assessed with necessary changes made.8.Equipment and supplies are readied.9.Discharge planner meets with team and makes final preparations.10.Patient is discharged (with trial period, if necessary).11.Local power company is notified regarding the presence of life support equipment; appropriate backup power (battery or compressed gas source) is made available.12.Ongoing and follow-up care provided by visiting nurse, respiratory therapist, and other health care professionals (as necessary).

In addition to specifying the liter flow or concentration, which of the following must a physician include in a home O₂ prescription? I.evidence of central cyanosis II.appropriate medical diagnosis III.laboratory evidence of hypoxemia IV.frequency of use of O₂ V.duration of need for O₂

To determine the need for long-term home O₂ therapy after initial justification, when should blood gas analysis be repeated?

Which of the following would you consider recommending for a home care patient receiving nasal CPAP who complains of severe nasal dryness? I.room vaporizer II.heat-moisture exchanger (HME)III.in-line humidifier IV.saline nasal spray

Establishing therapeutic objectives for home care is normally the responsibility of which member of the respiratory home care team?

In addition to a ventilator, which of the following equipment or supplies would you recommend for a home care patient receiving long-term invasive positive-pressure ventilation? I.self-inflating bag-valve-mask II.portable suction system III.portable DC defibrillator IV.tracheal tubes and care kits V.disposable circuits and catheters

When visiting a home care patient receiving nasal O₂ at 2 L/min through an O₂ concentrator, you measure the FIO₂ of the outlet gas as 0.63. Which of the following best explains this finding?

Which of the following conditions is an indication for application of noninvasive positive-pressure ventilation (NPPV)? 1.The patient is mentally competent, cooperative, and not using heavy sedation or narcotics.2.Supplemental O₂ therapy is unnecessary or minimal.3.SaO₂ can be maintained above 90% by aggressive airway clearance techniques.4.Bulbar muscle function is adequate for swallowing without potentially dangerous aspiration.5.No history exists of substance abuse or uncontrollable seizures.6.Unassisted or manually assisted peak expiratory flows during coughing exceed 3 L/sec.7.No conditions are present that interfere with NPPV interfaces (e.g., facial trauma, inadequate bite for mouthpiece, presence of nasogastric tube, or facial hair that can hamper airtight seal).

Under which conditions is the home NOT the best setting for providing subacute care? I.when the patient is unable to do self-care II.when adequate caregiver support is unavailable III.when the patient's physician cannot make home visits

To help prevent problems with home O₂ therapy, you should have the patient or caregiver check all delivery equipment at least how often?

A home care patient with kyphoscoliosis requires intermittent positive-pressure breathing (IPPB) treatments twice per day with O₂. A local charitable organization has given the family a pneumatically powered IPPB device for this purpose. Which of the following gas sources would you recommend to drive this device? I.liquid O₂ reservoir II.O₂ concentrator III.compressed gas cylinder

Which of the following personnel should be allowed to change a tracheostomy tube on a home care patient? I.trained family member II.respiratory care practitioner III.visiting nurse

After making a home care visit, to whom should you forward copies of your written report? I.patient's physician II.patient's family III.home care agency

You are caring for a patient who has just received a transtracheal catheter for long-term continuous home O₂ therapy. Which of the following problems should you be on guard for with this patient? I.airway obstruction II.catheter clogging III.stoma infection

Which of the following is NOT normally part of the respiratory home care team?

Home O₂ therapy can be justified in patients with PaO₂ values greater than 55 mm Hg in all of the following conditions except:

At normal liquid cylinder operating pressures, 1 lb of stored liquid O₂ equals about how many liters of gaseous O₂?

Which of the following procedures can help to minimize skin irritation in home care patients using nasal CPAP? I.Replace the mask every 3 months. II.Adjust the mask straps. III.Clean the mask daily.

You have been asked to organize a patient and family education program as part of a discharge plan for a patient requiring home ventilatory support. Which of the following areas would you be sure to cover? I.equipment operation and disinfection II.patient assessment and monitoring III.airway management and clearance IV.emergency procedures

Transtracheal O₂ therapy (TTOT) should be considered as an option for what patients requiring long-term O₂ therapy? I.those who remain hypoxemic with standard approaches II.those who do not comply well when using other devices III.those who exhibit complications with nasal delivery IV.those who prefer TTOT for cosmetic reasons V.those who require increased mobility