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RTT 227 - Ch. 51

Ch. 51 - Egan's - Respiratory Care in Alternative Settings

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