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RTT 227 - Ch. 51
Ch. 51 - Egan's - Respiratory Care in Alternative Settings
| Question | Answer |
|---|---|
| what remains the most common alternative site for providing health care? what are other post-acute care settings? | home care; subacute, rehabilitation, skilled nursing facilities |
| what advantage do alternative health care settings offer? | lower costs and enhanced pt comfort |
| what is one of the most notable changes of resp. care in alternative sites? | introduction of Medicare's prospective pt system |
| what is reimbursement in PPS now based on? | predetermined monthly payment, health conditions, geography |
| certain types of resp equipment were categorized as ____________ items. | "capped-rental" |
| what are capped-rental items? | those eligible for reimbursement under the PPS |
| what are 2 other legislation that has substantially affected Medicare reimbursement? | BBA of 1997; Deficit Reduction Act of 2005 |
| what does the daily rate in SNFs cover? | routine nursing services, room, board, medical supplies, therapies, drugs, lab services |
| besides SNFs, what other area is under review? | reimbursement for reasonable time spent by RTs in administering care and pt education |
| what does reimbursement under federal Medicare and state Medicaid programs only apply too? | respiratory equipment (home 02, MV) |
| what is a further development stemming mainly from our aging population that is a significant increase in popularity? | assisted living facilities |
| because these services typically are provided after an acute episode of hospitalization, good ________ _________ is critical. | discharge planning |
| what is the most common respiratory care service provided in these alternative settings? | continuous O2 therapy, long-term MV, aerosol drug administration, airway care, sleep apnea treatment, sleep/apnea home monitoring, pulmonary rehabilitation |
| what is one of the main goals of the RT in alternative settings? | educating the pt, family, and caregivers on the safe and effective use of such equipment |
| _______ _____ is a comprehensive level of inpatient care for stable pts who (1) experienced event from injury, illness, or exacerbation, (2) determined course of tx, (3) require diagnosis or invasive procedures but not those requiring acute care. | subacute care |
| what is the goal of acute care? | apply resources to stabilize pts after severe episodic illness |
| what does subacute care aim to restore? | the whole pt back to the highest practical level of function (self-care) |
| what are some conditions included in subacute care? | neurologic disorders, musculoskeletal deformities, genetic defects, chronic pulm disease |
| what does the AARC define respiratory home care as? | specific forms of resp care provided in pt's home by personnel trained in resp care working in medical supervision |
| what is the primary goal of home care? | provide quality health care services to clients in their home, thus minimizing their dependence on institutional care |
| what can respiratory home care contribute too? | 1. supporting/maintaining life 2. improve pt's well-being 3. promoting self-sufficiency 4. cost-effective delivery 5. pt comfort at end |
| most pts for whom resp home care is considered are those with _______ _________ ________. these disorders include: | chronic respiratory diseases; COPD, CF, chronic neuromuscular disorders, chronic restrictive conditions, lung carcinomas |
| what is the majority of reimbursement for postacute care through? | federal medicare or federal/state medicaid |
| what is the federal agency responsible for overall administration of medicare and medicaid? | centers for medicare and medicaid services |
| what are the minimum health and safety requirements called? | "conditions of participation" |
| what is the primary organization responsible for standard setting and voluntary accreditation of postacute care providers? | TJC |
| what are the key differences in postacute care settings and acute care hospital? | resource availability, supervision/schedules, documents/assessment, interaction |
| effective ________ _________ provides the foundation of quality postacute care. | discharge planning |
| what are 2 key elements in making subacute care work? | communication and mutual respect for each member's talents/abilities |
| what are the primary factors determining the appropriate site for discharge? | goals and needs of the pt |
| what is essential for discharge to the home? | evaluation |
| what is imperitive for the discharge team to ensure? | adequate number of caregivers are part of the care plan |
| what is an all too common discharge planning mistake? | reliance on too few individuals/overestimation of caregiver capabilities |
| what are equipment support and selected clinical services for resp home care pts often provided by? | durable medical equipment supplier |
| what services do DME suppliers provide? | 24/7 service, 3rd party insurance, home instruction/follow-up, most forms of resp care |
| to help ensure a basic level of quality, one should select a DME supplier that is ______ accredited. | JCAHO |
| _______ ________ is by far the most common mode of resp care in postacute care settings. | oxygen therapy |
| what are the benefits of O2 therapy? | survival, improves quality of life; nocturnal O2 sat, reduced PAP, lower vascular resistance |
| what must O2 prescriptions be based on? | documented hypoxemia |
| what all must a prescription for O2 therapy in postacute care setting include? | flow rate; freq; duration; diagnosis; laboratory evidence; additional documentation |
| how is O2 normally supplied in alternative care sites? | 1. compressed O2 cylinders 2. liquid O2 systems 3. O2 concentrators |
| what is the primary use of compressed O2 cylinders? | ambulation or as backup to liquid or concentrator supply systems |
| in addition to the cylinder gas, what else is needed to deliver O2? | pressure-reducing valve w/ flowmeter |
| how much flow do standard clinical flowmeters deliver? flow in alternative sites? | 15 L/min; 0.25-5.0 L/min |
| because of this, what should the RT select whenever possible? | calibrated low-flow flowmeter |
| if humidification is needed, what is to be used? | simple unheated bubble humidifier |
| what temp is the liquid O2 kept at? | -300 degrees F |
| when the cylinder is not in use, vaporization maintains pressures of? | 20-25 psi |
| how much do small liquid O2 cylinders hold? | 45-100 lbs of liquid O2 |
| how much do typical portable units weigh? | 5-14 lbs |
| what is an O2 concentrator? | electrically powered device that physically seperates the O2 in room air from nitrogen |
| the most common type of concentrator uses a __________ ______ to extract O2. | molecular sieve |
| how much O2 does the typical molecular sieve concentrator provide? | 92%-95% |
| what is an example of a device that enhances O2 production and delivery devices? | Inogen One System (battary-powered concentrator) |
| what are the most cost-efficient supply method for pts in alternative settings who need continuous low-flow O2? | O2 concentrators |
| what are 2 ways to prevent problems? | provide instructions; document caregivers' abilities |
| what must always be checked? | O2 delivery equipment |
| what must the clinicians ALWAYS ensure? | all systems have emergency backup supply |
| what are possible physical hazards to pts and caregivers? | unsecured cylinders, ungrounded equipment, mishandling liquid, fire |
| ________ _________ of the neb or humidification systems is another potential problem. | bacterial contamination |
| in the home, what should be checked and confirmed as part of a routine monthly maintenance visit? | FiO2 |
| when 50 psi O2 is needed, what is the storage system of choice? | large gas cylinders |
| what is the most common O2 delivery system for long-term care? what is also used but a lot less common? | nasal cannula; simple O2 masks/air entrainment masks |
| ___________ _______ _______ is O2 delivered via a catheter with a small orifice that is inserted through the skin and neck tissue into the trachea. | transtracheal oxygen therapy |
| what are the indications that pts must meet one or more of for TTOT? | 1. not oxygenated by standard approaches 2. don't comply well w/ other devices 3. complications w/ NC 4. TTOT for cosmetic reasons 5. need for increased mobility |
| what are key pt responsibilities for TTOT? | routine catheter cleaning and recognizing and troubleshooting common problems |
| what demand-flow O2 delivery device uses a flow sensor and valve to synchronize gas delivery w/ the beginning of inspiration? | pulsed-dose O2-conserving device |
| what does most of the effective O2 delivery occur? | first half of inspiration |
| what provides the greatest savings in O2 use for a given level of arterial saturation? | demand-flow O2 systems |
| what are the "three P's" when selecting a long-term O2 system? | 1. purpose 2. patient 3. performance |
| what is the goal of this? | match performance of the equipment to both the objectives of therapy and pts special needs |
| __________ problems are most common with TTOT and demand-flow systems. | technical |
| what are most problems with TTOT related to? | initial catheter insertion or ongoing maintence |
| what are most problems with demand-flow systems based on? | current limits to this technology |
| what are the 3 categories pts needing ventilatory support outside the acute care hospital fall into? | 1. unable to maintain adequate ventilation for a while 2. continuous MV for survival 3. terminally ill |
| what must pts be regardless of diagnosis to be considered for ventilatory support in alternative setting? | medically/psychologically stable |
| the most common setting for ventilatory support outside the acute care is the ______. | home |
| what are the 2 major support approaches? | invasive/noninvasive |
| what does invasive ventilatory support involve? | positive-pressure ventilation by tracheotomy |
| what does noninvasive ventilatory support involve? | pos/neg pressure ventilation (intact upper airway or abdominal displacement methods) |
| how do postacute care institutions that provide ventilatory support differ from acute care facilities? | level of technology support |
| what are the prerequisites for home ventilatory support to be successful? | willingness to accept responsibility; support; viability of plan; pt stability; adequacy of home |
| what are 5 caregiver education skills? | 1. pt assessment 2. airway management 3. CPT techniques 4. cleaning/disinfecting 5. emergency procedures |
| what are the emergency situations that caregivers must be trained to recognize and properly deal with? | 1. vent/power failure 2. vent circuit problems 3. airway emergencies 4. cardiac arrest |
| how long is training sessions? | 1-2 weeks |
| what was until recently the de facto standard for long-term MV? what is now becoming popular? | invasive pos-pressure ventilation; noninvasive support |
| what is the first choice of noninvasive support? | noninvasive positive pressure ventilation |
| what are the 2 categories of pts that can benefit from NPPV? | 1. cessation of ventilation could lead to death 2. clinical benefit (cessation not life-threatening) |
| what are contraindications to NPPV? | severe upper airway dysfunction, copious secretions, O2 concentrations >40% |
| what is considered a second-line strategy for noninvasive ventilatory support? | neg-pressure ventilation (freq suction; severe nasal congestion) |
| what mode should be avoided on pts with poor inspiratory muscle strength? | IMV/SIMV |
| what type of ventilation do COPD pts prefer? | pressure-limited |
| what is the biggest challenge with NPPV? | getting a good, comfortable, leak-free interface |
| what kind of alarm must all pos-pressure ventilators use? | loss of power |
| what is bland-aerosol therapy? | delivery of sterile water or various concentrations of saline solution in aerosol form |
| what is the potential problem of bland-aerosol therapy? | infection from contaminated equipment |
| the _______ _____ is popular for drug administration to respiratory pts undergoing postacute care. | aerosol route |
| what do postacute care pts with tracheostomies require? | daily stoma care and tracheobronchial suction |
| ______ _____ has become an accepted form of home care used to treat the sleep apnea-hypopnea syndrome. diagnosis must be confirmed by __________. | nasal CPAP; polysomnography |
| what does a nasal CPAP include? | flow-generator, one-way valve, pt interface, PEEP/CPAP valve |
| what are the adjustable pressures? | 2.5-30 cmH2O |
| what does BiPAP use? | 1. IPAP 2. EPAP |
| what is the most common method in determining proper CPAP level? | sleep study, titrate different levels of CPAP |
| what is the prescribed level of CPAP? | lowest pressure at which apneic episodes are reduced to an acceptable freq and duration |
| what is another way CPAP may be titrated? | w/ pulse oximetry (use lowest CPAP pressure that'll prevent desat) |
| what contraindicates nasal CPAP? | reversible upper airway obstruction |
| what is the most common problem with the actual CPAP apparatus? | inability to reach or maintain set pressure |
| what condition requires an apnea monitor and for how long? | sudden infant death syndrome; 2-4 months |
| what are the 4 key components of assessment and documentation that institutions providing subacute or long-term care require? | 1. screening 2. treatment plan 3. ongoing assessment 4. discharge |
| what are 5 factors to consider when deciding on the freq of home visits? | 1. pt's condition/needs 2. environment 3. level of support 4. type/complexity of equipment 5. ability to provide self-care |
| what are the 5 functions an RT must provide when visiting? | 1. pt assessment 2. pt compliance w/ care 3. equipment assessment 4. identification of problems/concerns 5. statement of goals/plans |
| what is discouraged to disinfect home care equipment? what should be used instead? | quaternary ammonium compounds or acetic acid; glutaraldehyde |
| what is recommended to be used for humidification or nebulization? | distilled water |
Created by:
christa_2008
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