EXAM I

Question 1

What settings would a non-rebreather mask be appropriate for? (Hospital or Home)

Answer 1

Hospital

Question 2

How does a pulse dosed system deliver oxygen differently from a traditional system? (Be specific about the breath.)

Answer 2

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.

Question 3

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?

Answer 3

Yes.

Standard and In-line suction catheters are reimbursed.

Question 4

Bonus

How frequently will Medicare reimburse for suction catheters?

Answer 4

?

Question 5

What are common problems to be addressed in a COPD patient’s care plan?

Answer 5

1. Assess and monitor
2. Reduce risk factors
3. Manage stable COPD
4. Managing exacerbations

Question 6

What is an ALTE? An ALTE is an indication for what home care device?

Answer 6

ALTE= Apparent Life-Threatening Event

Apnea Monitor

Question 7

Is it permissible for “hospital-based” RCPS to instruct patients in home respiratory care procedures?

Answer 7

YES

Question 8

Identify 5 members of the discharge planning team who should be involved with the discharge planning process for the home bound respiratory patient

Answer 8

1. Case manager
2. RT
3. RN
4. Physician
5. Patient
6. Family/Caregivers

Question 9

If a patient is 65 years or older, home oxygen therapy is covered by what type of insurance?

Answer 9

Medicare

Question 10

Is it acceptable for the home care RCP to monitor patients by telephone?

Answer 10

NO

Question 11

Are Durable Medical Equipment (DME) items covered by Medicaid?

Answer 11

YES

Question 12

What part of Medicare (Part A or B) coverage reimburses for durable medical equipment ?

Answer 12

Part B

Question 13

When do most people get Medicare Part A coverage?

Part B?

Answer 13

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)

Question 14

How is supplemental oxygen at home prescribed for most people? Are there any measurements needed?

Answer 14

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)

Question 15

Do pulse dosed oxygen systems allow patient o switch to continuous flow?

Answer 15

No, unless it is a hybrid system which switches to continuous flow when inspiration is not detected

Question 16

Name 3 types of oxygen conserving devices or systems presently available.

Answer 16

1. Reservoir cannula
2. Pulse dose or demand flow systems
3. Transtracheal oxygen systems

Question 17

Nasal CPAP units are mainly used in the treatment for home care patients diagnosed with what?

Answer 17

Moderate to Severe Obstructive Sleep Apnea (OSA)

Question 18

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.

Answer 18

> 85%

5 L/min

95%

Question 19

Should patients wash equipment with Antimicrobial dishwashing detergent prior to disinfection?

Answer 19

YES

Question 20

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?

Answer 20

YES

Question 21

The best product to use for home disinfection of equipment is ___________.

Answer 21

White vinegar/water mix (1:1)

Question 22

The least expensive way to give a respiratory home care patient receiving oxygen mobility around the home is a ______________.

Answer 22

Piece together enough oxygen tubing so that the patient will be able to walk freely around their home

Question 23

The non-physician member of the rehabilitation team best able to evaluate respiratory status by inspection, palpation, percussion, and auscultation is the _____________.

Answer 23

Occupational Therapist

Question 24

How do “pulse dosed” systems conserve oxygen?

Answer 24

Pulse dosed systems provide a bolus of oxygen at a relatively high flow rate, only during the first part of inspiration

Question 25

How does the transtracheal catheter benefit the patient?

Answer 25

1. Improved compliance 2. Increased mobility 3. Less accidental disruption during sleep: improved sleep 4. Less facial, nasal, and ear irritation (vs NC) 5. May combine with a pulse dosed oxygen device 6. More cosmetically appealing 7. Reduces the amount of oxygen in use 8. Sense of taste and smell not affected

Question 26

The mustache cannula may allow what benefit to the user?

Answer 26

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 1. Less expensive to operate 2. Reduces the amount of oxygen in use

Question 27

What is the "SCOOP" catheter?

Answer 27

Transtracheal Catheter

Question 28

What are the 3 major oxygen delivery systems used in the home setting?

Answer 28

1. Compressed oxygen tanked 2. Liquid oxygen (LOX) 3. Oxygen concentrator

Question 29

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

Answer 29

56-59 mmHg. OR SpO2 = 89% (requires secondary diagnosis of CHF; cor pulmonale)

Question 30

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

Answer 30

88% 55 mmHg

Question 31

In what cases would a venturi-mask be appropriate for home therapy?

Answer 31

Venturi-Masks are NOT appropriate for home care

Question 32

An oxygen concentrator can deliver oxygen through tubing up to _____ ft

Answer 32

50 feet

Question 33

Do people with end-stage renal disease qualify for Medicare home O2 coverage?

Answer 33

****

Question 34

List the aspects of the patient's home environment that should be evaluated prior to the initiation of home respiratory care.

Answer 34

1. Fire 2. Electrical 3. Safety 4. Health

Question 35

What non-ventilator support (non invasive?) is appropriate for home care patients who develop nocturnal hypoventilation?

Answer 35

BiPAP

Question 36

Ideally, how long should patient teaching sessions be?

Answer 36

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

Question 37

What is typically performed in the physical assessment of a patient during the home visit?

Answer 37

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

Question 38

What criteria are there for discharging a patient from the care of a home care service?

Answer 38

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

Question 39

What are the goals of respiratory home care?

Answer 39

``` Life Support (maintain longevity) Quality of Life Functional Performance Reduce costs (to individual and society) Minimize future hospitalizations ```

Question 40

What respiratory conditions are commonly treated through home care?

Answer 40

Patient who have: 1. Chronic pulmonary disease 2. Have repeated hospitalizations 3. Require ongoing medical care after discharge 4. Are technology dependent 5. Have difficulty performing essential activities of daily life

Question 41

Describe how you would teach a patient to disinfect a small volume nebulizer at home and then verify their understanding.

Answer 41

1. Explain procedure 2. Demonstrate to them 3. Have patient explain and demonstrate until they got it

Question 42

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?

Answer 42

1. If patient ambulates beyond 50 feet 2.

Question 43

According to the American Subacute Care Association, subacute care is a comprehensive, cost effective inpatient level of care for patients who:

Answer 43

1. Had acute event resulting from injury, illness, or exacerbation of a disease process 2. Have a determined course of treatment and though stable, require diagnostic/invasive procedures, but not acute level care 3. Utillize case management/coordination of service

Question 44

List the key members of a typical sub-acute care facility.

Answer 44

1. Patient 2. Physician 3. Nurse 4. RT 5. Physical therapist 6. Speech therapist 7. Dietician 8. Social worker

Question 45

The USE Report described which key findings?

Answer 45

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

Question 46

What is needed to qualify for hospice? What is the goal of hospice?

Answer 46

Life expectancy <6 months and two physicians agree Reduce pain and make patient comfortable