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Diag Pro Unit 10

SPC Diagnostic Procedures Exam 5 Unit 10

CSA means? Central Sleep Apnea
HME means? Home Medical Equipment
Exacerbation means? Acute worsening, flare up pf a chronic disease
LTOT means? Long Term O2 Therapy
OSA means? Obstructive Sleep Apnea
SNF means? Skilled Nursing Facility
Primary forms of Home Respiratory Care? 1. O2 Therapy 2. Aerosol Therapy 3. Bronchial Hygiene Therapy 4. CPAP/BiPAP 5. Mechanical Vent
Who pays for Home RT Care? Federal: Medicare Part B DME & VA State: Medicaid Local: Community Organizations, Easter Seals, American Cancer Society, Muscular Dystrophy Foundation Private: Insurance, HMO, Workers Comp., self pay
Home O2 Indications? 1. SPO2 <80% during ambulation, sleep, & exercise 2. PaO2 >55mmHg or SPO2 >88% if there is documentation of Pulmonary HTN, cor pulmonale, or erythrocytosis 3. May be prescribed during exercise is PaO2 falls <55mmHg or SPO2 falls to <88% and sleep <88%
Benefits of LTOT? 1. Proven to increase survival 2. Improves QoL of pt w/ COPD 3. Improves exercise capacity 4. Decreases cardiovascular work 5. Decreases WOB 6. Decreases pulmonary HTN 7. normalizes hemoglobin levels
If LTOT is indicated there are no what? No Contraindications, but certain things need to be monitored: ^CO2 retention, non compliance, fire hazards, bacteria hazards with neb & humidifiers, physical hazards such as non-secured tanks and burns from liquid O2
For assessing the need for LTOT there must be a documented indication done by what? ABG on room air, Pulse ox on room air, or Sleep study that documents hypoxemia
Where this is a major change in patient status from a cardiopulmonary case what needs to be done? Additional ABG's needed
How often is patient reassessed for home O2? By ABG every 1-3 months
Most O2 devices in patients homes are what kind of device? Low flow systems that can give both high or low FIO2
Nasal Cannulas for Home O2? FIO2 24-40% Flow for adults 6 lpm should be humidified for >4 lpm Flow for infants 2 lpm should be humidified all the time
Transtracheal O2 Catheter/Scoop Catheter for Home O2? Not very common but can provide the same FIO2 at half the flow at rest and 2/3 the flow at exercise (Greater patient supervision and greater risk of complications)
What is a pulse dose or demand regulator do? Delivers a predetermined dose of O@ at the beginning of inspiration saving the O2 which is expensive
3 types of systems used to deliver LTOT for home use? 1. O2 Concentrator 2. Liquid O2 Cylinder 3. O2 Tanks
With O2 concentrators it is important to realize that government standards require that O2 concentrator delivers a consentation of? 92% O2 @ 6 lpm This is NOT the FIO2
O2 Concentrators do what? Compressors use a special filter that "scrubs" oxygen out of the air in the room by forcing it through a molecular sieve.  This results in a higher concentration of oxygen that can be delivered to the patient at the desired liter flow.
Advantages of O2 Concentrators? 1. Infinite source of O2 2. Simple and easy 3. Least follow up of all LTOT delivery devices 4. Newer concentrators can deliver flows up to 10 lpm
Disadvantages of O2 Concentrators? 1. Consume Electricity 2. Noisy 3. Possible mechanical failure 4. Limited flows 5. Not protable
Liquid O2 systems do what? O2 is cooled until liquid and kept refrigerated under pressure.  The Liquid O2 return to gaseous form as it is released.  Most liquid O2 is stored in large unit in the patient's home called a "cow“ Small, portable canisters are refilled from this cow.
Advantages of Liquid O2 Systems? 1. Portable 2. Easily refilled 3. Flows from .5 to 15 lpm 4. 100% O2 5. Quiet 6. Require no electricity or power source
Disadvantages of Liquid O2 Systems? 1. Some O2 lost to evaporation 2. Leak if tipped 3. Frequent deliveries to restock 4. May freeze up 5. Parts become very cold, burns if touched 6. Requires backup O2 cylinders in case unit evaporates dry
O2 Cylinder/Tank do what? May be used as the primary O2 system or as a backup?
Advantages of O2 cylinder? 1. Fixed stable source 2. Store O2 almost indefinitely 3. Large liter flows delivers 50 psi with adaptor 4. 100% at any liter flow 5. Cylinders are quiet 6. E cylinders are portable 7. No electricity
Disadvantages of O2 cylinders? 1. Heavy and bulky 2. Smallest content of O2 for the space 3. Require frequent deliveries 4. High pressures of tank can be dangerous
Patients with what benefit from bland aerosol therapy? Cystic fibrosis & bronchiectasis
Bland Aerosol Therapy means what? An aerosol that does not contain a medication or hypertonic saline just sterile water.
The best mucolytic is a what? Well hydrated patient
If patient is not receiving adequate systemic hydration then bland aerosol therapy does what? Will be of little help
A home nebulizer should be used when? 1. Drug isn't available in MDI or DPI 2. Patient cannot use MDI or DPI properly 3. Limited inspiratory capacity 4. Can not afford MDI or DPI
Disadvantages of Home Nebs? 1. Contamination of Neb, solution, proper hand washing and cleaning of equipment
Home bronchial hygiene therapies include? CPT, including postural drainage, chest percussion, chest vibration, incentive spirometry, flutter valve, acapella, PEP, IPPB
Most common in/ex sufflator is? Emerson Coffilator
Disadvantage of exsufflation? Can cause premature airway collapse from the negative pressure exsufflations.
Medicare will pay for home CPAP unit if the patient? 1. Shows apneic/hypopneic (AHI) index of 15 events per hr or more 2. Has (AHI) index of 4-14 events per hr AND has daytime sleepiness, impaired cognition, mood dosorders, insomnia, hypertension, ischemic heart disease or prior CVA
Home vent patients are always what? Trached and put on simpler modes like AC/SIMV/PS
Ideal candidate for Long term vent support? 1. Neuromuscular/Neurological disorder 2. Clinically stable 3. well educated 4. Motivated in caring for themselves 5. Good support system 6. Some degree of vent independence
Home caregivers for vent patients must be made aware that? 1. Adult patients require 8hrs a day of care 2. Neonates & children require more 3. Patients with not vent independence require even more
Type of apnea monitor is called? Impedance Plethymography similar to EKG
Other types of known as Inductive Plethysmography use what? Belt or strap across the patients chest to detect movement
Home apnea monitors are indicated for? 1. Premature infants 2. Risk for SIDS 3. Previous life threatening event 4. Post epidural patients
Home vents tend to be? 1. Small and portable 2. Simple 3. Volume vents 4. Limited to simpler modes 5. Expensive 6. Well alarmed 7. Has internal battery 8. Humidification required usually HME's
Pneumobelts generate? 50-70 cm H2O that hold up to 2 liters and tidal volumes 300-500
Rocking beds are most effective in patients with what? Neuromuscular disorders
Created by: Langhout1418
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