Which of the following home O2 delivery systems would you recommend for a stable COPD patient with restricted activity?
- Aerosol mask mixing O2 from air compressor and O2 cylinder
- O2 conserving device, liquid O2 reservoir + portable supply
- Nasal cannula with concentrator and backup O2 cylinder
- Air-entrainment mask with large-volume O2 cylinder (H or K)
The standard for providing low-flow oxygen at home to a patient with restricted activity is a concentrator with a cylinder back-up in case of a power outage.
Which of the following is a key component of self-management for patients with asthma?
- conditioning exercises
- regular symptom monitoring
- daily bronchodilator use
- avoiding outdoor activities
Key aspects of self-management for patients with asthma that must be addressed include (1) the level of asthma control; (2) medication use (controllers vs. relievers); (3) inhaler techniques; (4) self-monitoring of symptoms and/or peak flow; and (5) use of written action plans. Conditioning exercises usually are included in COPD (not asthma) disease management programs and short-acting bronchodilators should only be used as needed to relieve symptoms.
The doctor of a patient diagnosed with severe obstructive sleep apnea contacts you because after a week of treatment her patient is refusing to continue CPAP therapy. What actions would be appropriate?
- accept the patient's decision and recommend switching to an oral appliance
- recommend the patient undergo reconstructive surgery (uvulopalatopharyngoplasty)
- assess causes of poor compliance and evaluate equipment/interface alternatives
- accept the patient's decision and recommend initiation of modafinil (Provigil) therapy
If a patient refuses or rejects CPAP, the RT should evaluate common causes of poor compliance (e.g., bad sleep habits, mask discomfort/leaks, conjunctivitis, skin breakdown, mouth breathing, nasal problems, etc.) and assess equipment/interface alternatives to improve tolerance, e.g., various mask options, added humidification, ramp feature, auto titration, pressure relief (aka C-flex, EPR), BiPAP or ASV. Modafinil (Provigil) is not a primary therapy for sleep apnea and recommended only for OSA patients who have residual daytime sleepiness despite effective C PAP treatment. Oral appliances would be considered only if the CPAP alternatives fail. And only if noninvasive therapies (CPAP, behavioral strategies, positional therapy, oral appliances) fail should surgery be considered.
A doctor asks you to follow-up on a patient who at her prior visit had moderate but well-controlled asthma. Your follow-up would include which one of the following?
- Assessing the patient's exhaled carbon dioxide level
- Reviewing the patient's self-management and action plans
- Confirming of the patient's daily diet and caloric intake
- Reviewing the patient's allergen antibody blood test results
In following up on patients with asthma, clinicians should assess how well the disease is being controlled and if a step up or step down in therapy is appropriate. In addition, providers should review the patient's daily self-management and action plans, the medications, and the patient's inhaler and peak flow monitoring techniques.
In setting up a home care COPD patient for continuous low flow oxygen therapy via an oxygen concentrator, which of the following additional equipment must you provide?
- a pressure reducing valve
- a back-up gas cylinder
- an emergency generator
- a back-up concentrator
In setting up a home care COPD patient for continuous low flow oxygen therapy via an oxygen concentrator, you must always provide a backup supply (in case of electrical power failure or concentrator breakdown). Normally, the backup is a large compressed gas cylinder.
A patient who previously failed to quit smoking using nicotine replacement therapy asks if there are any other medications that might help decrease the urge to smoke. Which of the following drugs would you recommend that this patient discuss with her doctor?
varenicline (Chantix) adderall (amphetamine) bupropion (Zyban)
A Yes No Yes
B Yes Yes No
C Yes Yes Yes
D Yes No No
- 1 only
- 1 and 2
- 2 and 3
- 1 and 3
Varenicline (Chantix) and bupropion (Zyban) are indicated to support smoking cessation. Chantix is a nicotinic receptor agonist that reduces the craving for cigarettes and decreases their pleasurable effects. Zyban is an antidepressant medication and nicotinic antagonist that also can help reduce nicotine cravings and withdrawal symptoms. Adderall is used to treat attention deficit hyperactivity disorder and can actually increase the urge to smoke!
Which of the following outcomes is NOT an aim of disease management programs designed for patients with COPD?
- reverse the disease progression
- relieve life-altering symptoms
- prevent and treat exacerbations
- improve quality of life
COPD disease management aims to: slow disease progression/reduce mortality; improve health status/quality of life; increase tolerance for activities of daily living; relieve life-altering symptoms; prevent and treat complications/exacerbations. Due to the nature of the disease process, its progression cannot be reversed.
The first step that family and caregivers of infants on home apnea monitoring should be taught in response to a valid (not false) low heart rate alarm is to:
- stimulate the baby
- proceed with CPR
- clear the airway
- reposition the electrodes
The proper sequence of actions for caregivers in response to a low heart rate alarm on a monitored infant is: (1) stimulate the baby; (2) if the baby looks lethargic or has poor color, ensure a clear airway; (3) if no response, proceed with CPR.
Which of the following secretion clearance methods could be considered for a home care patient who lives alone?
A B C D
forced expiratory technique YES YES YES YES
vibratory PEP therapy NO YES YES NO
active cycle of breathing YES YES NO NO
postural drainage, percussion and vibration YES NO NO YES
For a home care patient with intact upper airways who need help with secretion clearance and lives alone directed coughing, forced exhalation, active cycle of breathing, and autogenic drainage methods can be used. Adjuncts like PEP mask therapy and the flutter valve could also be considered for the home-bound patient living alone. Caregiver assistance would be required for traditional postural drainage, percussion and vibration.
Common goals which should be devised in collaboration with patients involved in pulmonary rehabilitation and their families and which should be documented in their plan of care and progress notes include which of the following?
A B C D
improvement in physical activity levels Yes Yes Yes Yes
control of respiratory infections No Yes Yes No
reduction in medical costs/hospitalizations Yes Yes No No
family education, counseling, and support Yes Yes Yes Yes
Common goals for pulmonary rehabilitation patients which should be documented in the care plan and progress notes include the following: patient/family education, counseling and support; control of respiratory infections; basic airway management; improvement in physical activity levels; reduction in hospitalizations and related costs; psychosocial support; and when possible occupational retraining and placement.
Plans are being made for a patient with an intact upper airway and a chronic neuromuscular condition requiring ventilatory support to be discharged to home. Swallow testing indicates that he is able to protect his airway and adequately clear secretions. However, he did not tolerate an in-hospital trial of nasal noninvasive positive-pressure ventilation (NPPV). Which of the following support options would you recommend?
- NPPV via an oronasal mask
- tracheotomy and invasive ventilation
- negative pressure ventilation
- oral intubation and invasive ventilation
For home care patients who can maintain their natural airway but require ventilatory support, NPPV is the most common option. However, some patients cannot tolerate this approach or cannot accommodate any available NPPV interfaces (in this case if a nasal mask is not accepted, it is unlikely that a full face mask will be tolerated). For such patients, consideration should be given to negative-pressure ventilation, using either a chest cuirass or pneumosuit.
Critical pre-discharge education for parents and caregivers of infants being prescribed home apnea monitoring includes which of the following?
A B C D
safe monitor use and alarm response Yes Yes Yes Yes
infant positioning and skin care No Yes Yes No
basic life support/CPR Yes Yes No No
Critical pre-discharge education for parents and caregivers of infants being prescribed home apnea monitoring should include safe monitor use and alarm response, infant positioning and skin care, and training in basic life support/CPR.
Basic principles of infection control in the home care setting include which of the following?
A B C D
-avoiding visits by friends Yes Yes Yes Yes
with respiratory infections
-having caregivers follow Yes No Yes No
proper handwashing technique
-using standard/ transmission-based Yes No No Yes
precautions as appropriate
Basic principles of infection control in the home care setting include: (1) proper handwashing technique by all caregivers; (2) discouraging visits to the patient by friends or relatives with respiratory infections; (3) application of standard and transmission-based precautions as appropriate, and (4) proper cleaning and disinfection of all nondisposable equipment.