Deck 35: Home Care

Question 1

Which of the following backup equipment needs to be provided for a home-ventilated infant who (1)lacks the ability to breathe spontaneously for at least 4 successive hours,(2)lives 2 hours away by automobile from medical assistance,and (3)requires mechanical ventilation for mobility?

A)Point-of-care blood gas analyzer
B)Second oxygen concentrator
C)Additional source of oxygen
D)Additional ventilator and ventilator circuits

Answer 1

D
A second ventilator,or backup ventilator,should be provided in the home for the child who (1)cannot maintain spontaneous ventilation for at least 4 consecutive hours, (2)lives in an area where a replacement ventilator cannot be provided within 2 hours,or (3)requires mechanical ventilation during mobility.An emergency backup ventilator must be available in the event of a ventilator malfunction.Without a backup ventilator in the home,the home care company must assume the responsibility for providing immediate service.It is also best to have extra ventilator circuits and a spare temperature probe in the home.

Question 2

What is the outcome when delays in funding for the home care services occur?

A)The process continues because eventually the funding will materialize.
B)Only the essential components of the discharge plan are initially implanted.
C)The discharge process is delayed until the caregivers receive education to perform additional services.
D)The discharge is delayed indefinitely.

Answer 2

D
Funding delays are often the greatest hurdle to getting the child home.Without reimbursement,home equipment cannot be obtained.The greatest difficulty arises when little or no reimbursement is available for the ventilator.Community resources,such as nursing,speech therapy,physical therapy,and occupational therapy,are also unattainable without funding.Without reimbursement,discharge is delayed indefinitely.

Question 3

What considerations need to be taken into account when applying external positive end-expiratory pressure (PEEP)to a home ventilator?
I)The ventilator circuit must be able to accommodate the weight of the PEEP valve.
II)The PEEP valve must be able to function at any angle.
III)Thoracostomy tubes need to be available to treat a pneumothorax.
IV)The exhalation ports must be free from obstructions.

A)II and IV only
B)I,II,and III only
C)I,II,and IV only
D)II,III,and IV only

Answer 3

C
Another factor to be considered when selecting a home ventilator concerns the compatibility of the circuit and the positive end-expiratory pressure (PEEP)valve.PEEP is often accomplished by using an external PEEP valve,which can be heavy and may also have exhalation ports that can be easily blocked.The combination of the PEEP valve and circuit must have minimal exhaled resistance.The PEEP valve must also be able to function at any angle;this precludes gravity and water columns for home use.

Question 4

Who is responsible for deciding the type of oxygen delivery system that will be used in the home?

A)Physician
B)Patient
C)Durable medical equipment (DME)company
D)Discharge planner

Question 5

What are the advantages of an oxygen concentrator?

A)It provides an unlimited supply of oxygen.
B)It does not require a power source.
C)It does not require gas analysis.
D)It is ideal for transport situations.

Question 6

What are the goals of discharge planning?
I)To reduce the number of hospitalizations
II)To have the patient resume activities of daily living
III)To reduce the number of emergency room visits
IV)To reduce the patient's length of stay

A)I and IV only
B)I,II,and III only
C)I,II,and IV only
D)II,III,and IV only

Question 7

Before the patient is discharged home,who needs to meet and assess the needs of both the child and family?

A)The family and the physician
B)The nurse and the family
C)The physician and nurse
D)The family and the health care team

Question 8

What is the utility of downloading information from an apnea monitor?

A)It facilitates billing the patient for services.
B)It helps monitor oxygen use.
C)It enables differentiating among different types of apnea.
D)It helps decide the next laboratory evaluation.

Question 9

What effect does an extended hospital stay tend to have on the discharge planning process for a child expected to receive mechanical ventilation at home?

A)It helps the family become more familiar with providing health care at home.
B)It provides the family with the opportunity to earn more income to facilitate the discharge process.
C)It affords the family more time to recruit additional health care providers to be used in the home.
D)It often results in a negative change in the family dynamics.

Question 10

Before a ventilator-dependent child can be discharged home,which of the following criteria must be met?

A)The ventilator setting must be stable for at least 3 weeks.
B)Arterial blood gas measurements must be stable and within normal limits.
C)The patient's Fio₂ must be 0.80 or less.
D)If PEEP is used,it must be no more than 10 cm H₂O.

Question 11

At what point during the patient's admission to the hospital should discharge planning begin?

A)On admission
B)Once the patient gets situated in a private or semiprivate room
C)Once the patient stabilizes
D)When the patient stabilizes and after all resources have been evaluated

Question 12

Which of the following circumstances constitute obstacles to discharging a child who requires home mechanical ventilation?
I)Lack of family access to public transportation
II)Large number of siblings
III)Delays in approval for home care funding
IV)Unsuitable home environment

A)I and II only
B)II and III only
C)III and IV only
D)II,III,and IV only

Question 13

Which of the following infants may benefit from using an apnea monitor at home?
I)Infants who were born preterm
II)Infants who have experienced a life-threatening event
III)Infants who have been diagnosed with gastroesophageal reflux disease
IV)Infants who have experienced an apneic episode for any reason in the hospital

A)II and III only
B)I,II,and IV only
C)I,III,and IV only
D)II,III,and IV only

Question 14

Which of the following is the most important disadvantage of a liquid oxygen system?

A)It is very heavy.
B)It requires a power source.
C)It requires filling every 6 months.
D)It vents regardless of whether the flow is on or off.

Question 15

Why are compressed gas cylinders of oxygen becoming more commonplace for patient transport in the home care setting?

A)Because patients generally cannot afford liquid oxygen
B)Because compressed gas cylinders are being made smaller and lighter
C)Because they are being made safer and people can smoke near them
D)Because the grade of oxygen in compressed gas cylinders is higher than in liquid systems

Question 16

What is a major advantage of using a portable ventilator?

A)It is easy to analyze the inspired fraction of oxygen (Fio₂).
B)No humidification is necessary.
C)It provides a variety of ventilation modes.
D)A variety of power sources can be used.