Ch. 15: Respiratory Home Care

Question 1

List the goals of rehabilitation (4)

Answer 1

1. Patient independence
2. Help the patient improve the ability to cope with the disease.
3. Help the patient gain an understanding of the disease and the limitations that result from it.
4. Help the patient to set realistic goals for life and then help him or her attain those goals

Question 2

Indications for pulmonary rehabilitation (5)

Answer 2

1. Symptomatic COPD patients
   a. Gold stage II, III and IV may be considered
2. Patients with bronchial asthma and associated bronchitis
3. Patients with combined obstructive and restrictive lung disease
4. Patients with chronic secretion clearance problems
5. Patients with severe dyspnea and exercise limitations

Question 3

Contraindications for Pulmonary
Rehabilitation

Answer 3

1. Cardiovascular instability that requires cardiac monitoring
2. Malignancies involving the pulmonary system
3. Severe arthritis or neuromuscular abnormalities
   (not in all cases, but should be considered)

Question 4

Smoking cessation compliance (breath test todetermine CO levels in the blood; a level above normal indicates the patient is still smoking). What is the normal?

Answer 4

(0.5% to 1%)

Question 5

How do you instruct patients to purse lip breath?

Answer 5

Instruct the patient to inhale through the nose and exhale through pursed lips.

Question 6

What type of patients would benefit from pursed lip breathing?

Answer 6

Patients who experience premature airway closure by generating a back pressure in the airways.

Question 7

Diaphragmatic breathing teaches the COPD patient to use the diaphragm during breathing rather than accessory muscles.

Answer 7

Okay

Question 8

Increasing the use of the diaphragm results in a:

Answer 8

• decreased respiratory rate
• increased VT
• decreased FRC
• increased alveolar ventilation.

Question 9

Segmental breathing is similar to diaphragmatic breathing. What is the difference?

Answer 9

This is similar to diaphragmatic breathing exercises, except that a hand is placed over a specific lung area in which there is atelectasis, secretions or decreased airflow.

Question 10

A vital capacity of less than ________ of ideal body weight indicates inadequate volume for an effective cough.

Answer 10

10 to 15 mL/kg

Question 11

HOME OXYGEN ADMINISTRATION

________ is probably the least expensive O2 setup in the home at the present time depending on usage

Answer 11

Oxygen cylinders

Question 12

HOME OXYGEN ADMINISTRATION

List the disadvantages of oxygen cylinders. (6)

Answer 12

(1) Heavy and difficult to move
(2) High-pressure hazard
(3) Difficult for older or debilitated patients to
change cylinder or attach a regulator
(4) Small cylinders are difficult to walk with
(5) The RT should discuss the safety measures and handling of the cylinders with the patient and family members and document the caregivers’ ability to operate and handle the equipment safely
(6) Good supply system for patients using a small volume of O2

Question 13

True or false.
Liquid is safer than gas stored in high-pressure cylinders.

Answer 13

True

Question 14

____ times more oxygen can be stored in liquid form than in gaseous form.

Answer 14

860

Question 15

What is a good supply system for patients who use high volumes of O2?

Answer 15

Liquid O2 system

Question 16

What is the proper way to instruct a patient cough?

Answer 16

Tell the patient to:
a. Inhale slowly and deeply through the nose and
hold the breath for 3 to 5 seconds (in a sitting position)
b. Clasp arms across his or her abdomen and
give three sharp coughs without taking a
breath while pressing arms into the abdomen.
c. Use a pillow to splint incision sites (e.g., thorax,
abdomen).

Question 17

What are the two types of O2 cylinders?

Answer 17

Membrane: produces only about 40% O2
from the unit; rarely used.
(2) Molecular sieve: much more commonly used and produces 90% to 95% O2 from the unit.

Question 18

How often should the air inlet filters on concentrators be cleaned?

Answer 18

Weekly

Question 19

Since concentrators are powered by
electricity, a backup O2 system with a __________ should be available in case of a power outage.

Answer 19

1- to 3-day supply

Cylinders should be used for the backup system, not liquid, which evaporates over time.

Question 20

The higher the flow rate used on a concentrator, the less the delivered O2 percentage.

Answer 20

With most concentrators, 1 to 2 L/min will provide 95% O2. Flows of 3 to 5 L/min provide approximately 85% to 92%.

Question 21

Nondisposable equipment, such as nebulizers and humidifiers, may be cleaned as follows:

Answer 21

a. Clean first with mild soap
b. Rinse
c. Disinfect with a solution recommended by the manufacturer
d. Rinse again
e. Allow the equipment to air dry on a clean
surface to prevent recontamination
f. Repeat the process every 1 to 3 days

Question 22

According to the Centers for Disease Control (CDC), among the products recommended for home disinfection of reusable objects are _______.

Answer 22

bleach, alcohol, and hydrogen peroxide

Question 23

Reusable objects (e.g., tracheostomy tubes) that touch mucous membranes should be disinfected by immersion in ______.

Answer 23

70% isopropyl alcohol for 5 minutes or in 3% hydrogen peroxide for 30 minutes

Additionally, a 1:50 dilution of 5.25% to 6.15% sodium hypochlorite (household bleach) for 5 minutes should be effective.

Question 24

Noncritical items (e.g., blood pressure cuffs, crutches) can be cleaned with a detergent.

Answer 24

Okay.

Question 25

Vinegar is also suggested as an alternative, and is often the disinfectant of choice for home equipment on the NBRC exams. Except for what?

Answer 25

cystic fibrosis patients’ equipment

Question 26

EXAM NOTE

Nebulizing 10 mL of three parts distilled water to one part vinegar through nebulizers and room humidifiers is an appropriate cleaning technique.

Answer 26

Allowing the equipment to soak in this solution for 30 minutes is also an acceptable method of disinfecting equipment.

Question 27

Cannulas should be cleaned with mild soap that does not leave a soap film and then rinsed before a disinfectant is used. They should be replaced EVERY ____.

Answer 27

2 to 4 weeks

Question 28

Medication nebulizers should be rinsed with water and air dried after each treatment. They should be cleaned every day in a mild soap solution, rinsed, disinfected, rinsed again, dried on a paper towel, and placed in a plastic bag until used again.

Answer 28

Okay

Question 29

What type of patients should be monitored for apnea?

Answer 29

Used for infants or pediatric patients who have conditions that cause apnea or bradycardia. Also, infants experiencing apnea from unknown causes and siblings of infants who have died of SIDS should be monitored for apnea.

Other: bronchopulmonary dysplasia (BPD), neuromuscular diseases, tracheostomies, and those receiving mechanical ventilation.