EXAM I Flashcards
What settings would a non-rebreather mask be appropriate for? (Hospital or Home)
Hospital
How does a pulse dosed system deliver oxygen differently from a traditional system? (Be specific about the breath.)
This type of OCD is an electromechanical device that administers a pulse of oxygen or rather a small bolus at the beginning of a patient’s INSPIRATION.
Having a small bolus of oxygen, approximately 35mL, of oxygen delivered at the beginning of inspiration as opposed to a continuous flow results in a significant reduction in the amount of oxygen used.
*Most pulsed dose devices allow patient to switch to continuous flow if needed.
Are suction catheters for mechanically ventilated patients reimbursed by Medicare? What kind of catheters? What is a common practice that home care patients do regarding suction catheter use that is not done in hospital setting?
Yes.
Standard and In-line suction catheters are reimbursed.
Bonus
How frequently will Medicare reimburse for suction catheters?
?
What are common problems to be addressed in a COPD patient’s care plan?
- Assess and monitor
- Reduce risk factors
- Manage stable COPD
- Managing exacerbations
What is an ALTE? An ALTE is an indication for what home care device?
ALTE= Apparent Life-Threatening Event
Apnea Monitor
Is it permissible for “hospital-based” RCPS to instruct patients in home respiratory care procedures?
YES
Identify 5 members of the discharge planning team who should be involved with the discharge planning process for the home bound respiratory patient
- Case manager
- RT
- RN
- Physician
- Patient
- Family/Caregivers
If a patient is 65 years or older, home oxygen therapy is covered by what type of insurance?
Medicare
Is it acceptable for the home care RCP to monitor patients by telephone?
NO
Are Durable Medical Equipment (DME) items covered by Medicaid?
YES
What part of Medicare (Part A or B) coverage reimburses for durable medical equipment ?
Part B
When do most people get Medicare Part A coverage?
Part B?
Part A: People 65 or older–OR–younger than 65 and medically disabled or have end-stage renal disease.
Part B: Low income mothers and children, non elderly disabled, and low income disabled. (You must apply)
How is supplemental oxygen at home prescribed for most people? Are there any measurements needed?
Liter flow, device, interface, duration
Documented hypoxemia:
- -In adults, children and infants older than 28 days
- -PaO2 < or = 55torr OR SaO2 < or = 88% in subjects breathing room air
- -PaO2 of 56-59 torr or SaO2 or SpO2 < or = 89% in association with specific clinical conditions (e.g., cor pulmonale, congestive heart failure, or with hematocrit >56)
Do pulse dosed oxygen systems allow patient o switch to continuous flow?
No, unless it is a hybrid system which switches to continuous flow when inspiration is not detected
Name 3 types of oxygen conserving devices or systems presently available.
- Reservoir cannula
- Pulse dose or demand flow systems
- Transtracheal oxygen systems
Nasal CPAP units are mainly used in the treatment for home care patients diagnosed with what?
Moderate to Severe Obstructive Sleep Apnea (OSA)
At minimum, oxygen concentrators should be able to provide an oxygen concentration of __________ percent at a flow rate of ____ L/min? In general, the O2% will be greater than ________ at 2 L/min.
> 85%
5 L/min
95%
Should patients wash equipment with Antimicrobial dishwashing detergent prior to disinfection?
YES
Would it be appropriate to suggest to a patient that his/her upstairs bedroom should be relocated to a room on the main floor if possible?
YES
The best product to use for home disinfection of equipment is ___________.
White vinegar/water mix (1:1)
The least expensive way to give a respiratory home care patient receiving oxygen mobility around the home is a ______________.
Piece together enough oxygen tubing so that the patient will be able to walk freely around their home
The non-physician member of the rehabilitation team best able to evaluate respiratory status by inspection, palpation, percussion, and auscultation is the _____________.
Occupational Therapist
How do “pulse dosed” systems conserve oxygen?
Pulse dosed systems provide a bolus of oxygen at a relatively high flow rate, only during the first part of inspiration
How does the transtracheal catheter benefit the patient?
- Improved compliance
- Increased mobility
- Less accidental disruption during sleep: improved sleep
- Less facial, nasal, and ear irritation (vs NC)
- May combine with a pulse dosed oxygen device
- More cosmetically appealing
- Reduces the amount of oxygen in use
- Sense of taste and smell not affected
The mustache cannula may allow what benefit to the user?
Designed as a reservoir cannula, this oxygen-conserving device may allow the user to decrease the necessary flow rate to achieve a desired level of oxygen
- Less expensive to operate
- Reduces the amount of oxygen in use
What is the “SCOOP” catheter?
Transtracheal Catheter
What are the 3 major oxygen delivery systems used in the home setting?
- Compressed oxygen tanked
- Liquid oxygen (LOX)
- Oxygen concentrator
With signs of right sided heart failure (cor pulmonale), long term continuous low-flow oxygen therapy is indicated with a PaO2 as high as __________ mmHg
56-59 mmHg.
OR
SpO2 = 89%
(requires secondary diagnosis of CHF; cor pulmonale)
Without signs of cor pulmonale, the Medicare criteria for long-term continuous low-flow oxygen therapy is a saturation of _______% and a PaO2 of _______ mmHg
88%
55 mmHg
In what cases would a venturi-mask be appropriate for home therapy?
Venturi-Masks are NOT appropriate for home care
An oxygen concentrator can deliver oxygen through tubing up to _____ ft
50 feet
Do people with end-stage renal disease qualify for Medicare home O2 coverage?
List the aspects of the patient’s home environment that should be evaluated prior to the initiation of home respiratory care.
- Fire
- Electrical
- Safety
- Health
What non-ventilator support (non invasive?) is appropriate for home care patients who develop nocturnal hypoventilation?
BiPAP
Ideally, how long should patient teaching sessions be?
Limit training sessions to 30 minutes, if possible.
- Present only necessary information
- Use only one instructor
- Keep outside stimuli to a minimum
- Present information in simple terms
What is typically performed in the physical assessment of a patient during the home visit?
Respiratory: Inspection, palpation, percussion, auscultation, related symptoms, sputum change, chest pain, pleuritic.
Cardiovascular: BP, HR, Rhythm, capillary refill, chest pain (angina), JVD, urine output
Fluid and electrolyte assessment
Neurological
Pyschosocial
What criteria are there for discharging a patient from the care of a home care service?
Patient has chronic respiratory condition
- Plus:
1. Stable condition
2. No longer requires acute/sub-acute care
3. Home permits effective care
4. Caregivers can safely and correctly administer prescribed care at home
What are the goals of respiratory home care?
Life Support (maintain longevity) Quality of Life Functional Performance Reduce costs (to individual and society) Minimize future hospitalizations
What respiratory conditions are commonly treated through home care?
Patient who have:
- Chronic pulmonary disease
- Have repeated hospitalizations
- Require ongoing medical care after discharge
- Are technology dependent
- Have difficulty performing essential activities of daily life
Describe how you would teach a patient to disinfect a small volume nebulizer at home and then verify their understanding.
- Explain procedure
- Demonstrate to them
- Have patient explain and demonstrate until they got it
How would you determine if a patient is a candidate for stationary versus portable home oxygen? How would you determine if a patient is a candidate for an oxygen concentrator versus a liquid oxygen?
- If patient ambulates beyond 50 feet
2.
According to the American Subacute Care Association, subacute care is a comprehensive, cost effective inpatient level of care for patients who:
- Had acute event resulting from injury, illness, or exacerbation of a disease process
- Have a determined course of treatment and though stable, require diagnostic/invasive procedures, but not acute level care
- Utillize case management/coordination of service
List the key members of a typical sub-acute care facility.
- Patient
- Physician
- Nurse
- RT
- Physical therapist
- Speech therapist
- Dietician
- Social worker
The USE Report described which key findings?
It cost 11% more to serve a non-RT treated patient
3-6 day shorter length of stay from RT treatment
Lower death rates
*Medicare beneficiaries treated by RTs had better outcomes than those not treated by RTs
What is needed to qualify for hospice? What is the goal of hospice?
Life expectancy <6 months and two physicians agree
Reduce pain and make patient comfortable
