Pilbeams chapter 21 Flashcards
Chronic progressive disorders that require MV
Ventilatory muscle disorders
Acute severe illness
Alveolar hypoventilation
Ob. Lung disorders
Restrictive lung diseases
Cardiac disorders
-Mortality rates for patients receiving LTMV are high
-2 years (57%)
-5 years (66%-97%)
Patients who are successfully liberated from the ventilator and decannulated, have greater chance for survival
Goals of LTMV
Improve the patient’s quality of life by:
1. Enhancing the patient’s living potential
2.Improve physical and psychological level of function.
3. Reduce morbidity
4.Lessen hospitalization
5. Extending life
6. Providing cost effective care
Acute care sites
ICU, Specialized respiratory care units, General med-surge units, long term acute care hospitals
Intermediate care sites
Sub-acute care units, long-term care hospitals, rehab hospitals
-Intermediate care sites are not as expensive as acute care sites and provide more patient independence and QOL.
Long-term care sites
Skilled nursing facilities, congregate living centers and single-family homes
-LTC facilities do not have the resources for weaning, or to treat acutely ill patients.
-Are the least expensive and provide a better QOL
Patient selection
- Disease process
2.Psychological evaluation of the patient - Financial considerations
Disease process and clinical instability
3 categories of ventilator dependent patients
1. Patients recovering from acute illness es that are not responding to repeated attempts of liberation from the ventilator. May sustain several hours of unsupported breathing but will eventually fatigue.
2. Patients with chronic disorders who only require MV for a part of the day.
3. Patients requiring continuous ventilatory support to survive, their disorder is inexorably progressive
Disease processes that involves organs other than the respiratory system are associated with a higher risk of complications and require long term acute care.
Candidates who require LTMV in the home must be clinically and physiologically stable for 2 weeks before discharge..
This includes stable cardiac and renal function, no uncontrolled hemorrhage or coma, ability to clear secretions, tolerate NIV,
Psychosocial factors
Patient and family must be psychologically stable to handle stress
Financial considerations
ICU and acute care is most expensive and home care is least expensive.
Factors associated with LTMV
-Age, diagnosis, level of acuity, the need for rehab services, type of vent selected, need for monitoring, supplemental O2, medications
What is the major factor affecting the cost of homecare?
The need for professional or skilled workers.
Preparation for discharge to the home
-Equipment selection
-Comprehensive discharge prescription, educational program for the patient and the family.
-Usually takes 7-14 days
Geographical and home assessment
Patient’s home be in close proximity to a hospital ED, DME and home health agency.
Home must be assessed for size of patient care area, storage areas available, accessibility and safety (Fire extinguishers, smoke detectors), must have telephone service, electrical system must have adequate amperage for ventilation, suction and o2 concentrator.
Family Education
Ventilator operation
Resuscitation
Aseptic suctioning
Tracheostomy care
Bronchial hygiene
-The RT is charged with the responsibility of teaching the care givers the skills necessary for airway management
