Question 1

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

Accepted Answer

The information obtained from a download can be used to distinguish the type of apnea, decide the type of medical treatment needed, and determine compliance and when to discontinue the monitor.

Question 2

What is a major advantage of using a portable ventilator?

Accepted Answer

A major advantage of a portable ventilator is the ability to use a variety of power sources, including house current, an internal battery for short periods, and an external battery for extended periods. Some portable ventilators can operate from a car battery by connecting to the cigarette lighter.

Question 3

What are the advantages of an oxygen concentrator?

Accepted Answer

Most concentrators provide greater than 90% oxygen. On some concentrators the flowmeters can be changed to provide low flow rates (see Figure 35-3 in the textbook), whereas others have dual flowmeters to accommodate the varied needs of the patient (see Figure 35-4 in the textbook). The DME provider needs to evaluate each concentrator's specifications before use with pediatric patients to ensure it can be used with low flows. When using concentrators, oxygen cylinders are provided for the patient to use for transport and for backup in the case of an electrical power outage. As long as there is an electrical source, an oxygen concentrator provides an unlimited supply of oxygen and does not need to be refilled.

Question 4

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?

Accepted Answer

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 5

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

Accepted Answer

An apnea monitor may be considered medically necessary for infants who:
$\bullet$have apnea of prematurity.
$\bullet$ are receiving caffeine or theophylline for treatment of apnea or bradycardia.
$\bullet$ have experienced an apparent life-threatening event.
$\bullet$ have pertussis with positive cultures.
$\bullet$are diagnosed with gastroesophageal reflux disease accompanied by apnea, bradycardia, or oxygen desaturation.
$\bullet$ have neurologic or metabolic disorders affecting respiratory control.
$\bullet$ have chronic lung disease and require noninvasive or invasive ventilatory support.
F1F1F1S1F1F1F10 have two siblings who died of sudden infant death syndrome.

Question 6

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

Accepted Answer

In spite of the most valiant attempts at organization, communication, and planning within the discharge process, obstacles to discharge will still occur. The major barriers for chronically ventilated children include failure to obtain qualified nursing staff, delays in approval for home care funding, an unsuitable home environment, complex family issues, and arrangements for out-of-home placement.

Question 7

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

Accepted Answer

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 8

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

Accepted Answer

When patients arrive at a neonatal or pediatric intensive care facility, the unit is already planning for discharge to an alternative site of care.

Question 9

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

Accepted Answer

Before the discharge process begins for a ventilator-assisted child, the following criteria must be met:
$\bullet$At least two adult caregivers must be willing to commit to participate in the necessary training and the child's ongoing care.
$\bullet$ Parents must be in agreement on taking the child home.
$\bullet$ Caregivers must be physically and mentally capable of providing home care for the child.
Once a family makes the decision to commit to caring for their ventilator-assisted child at home, a formal discharge process begins. One of the first steps to be done is to meet with all of the members of the discharge planning team.

Question 10

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

Accepted Answer

Portable cylinders are available in a variety of sizes and are identified by letter designations. At one time the E cylinder was the smallest available in portable cylinders, making liquid oxygen the number one choice for pediatric patients. Today, however, compressed gas cylinders are gaining in popularity thanks to the availability of smaller cylinders with custom-carrying cases and regulators that allow flows as low at 1/32 Lpm.

Question 11

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

Accepted Answer

The three types of oxygen systems available for the home environment are liquid oxygen, oxygen concentrators, and compressed oxygen cylinders. Selection of the system is commonly the responsibility of the DME provider. Regardless of the type of oxygen system provided, it is essential that the DME provider be advised of the specific flow rate the child requires. This will determine which flowmeter to use with the system.

Question 12

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?

Accepted Answer

Family issues are all too often the most difficult barriers to overcome. The longer the hospital stay, the more likely that family dynamics will change. Strained finances, guilt, fatigue, worry, and emotional distress are all issues faced by most families of ventilator-assisted children. However, issues such as divorce, which often results in loss of one of the primary caregivers, and drug abuse and mental illness, are the types of issues that tend to cause the longest delays.

Question 13

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

Accepted Answer

The intent for discharge planning is to reduce the hospital stay, which minimizes medical costs and risk of additional infection.

Question 14

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.

Accepted Answer

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 15

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

Accepted Answer

The entire discharge planning team should meet and assess the needs of both the child and family. Before discharge home, the child must be medically stable and receiving optimal ventilatory, nutritional, and developmental support. Assessment includes evaluation of the family's ability, availability, and commitment to care for their child as well as a psychosocial assessment for parenting risk factors that could potentially result in adverse outcomes. Limitations, including language, physical, and cognitive, may delay discharge until appropriate support can be provided to the family to help overcome these barriers.

Question 16

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

Accepted Answer

A disadvantage to using this system is that the base unit requires regular refilling by the DME provider. Frequency depends on both the oxygen flow rate and the size of the reservoir and can be as often as once a week to every other month. Another disadvantage to the liquid oxygen system is that it vents continually to prevent pressure from building within the reservoir, resulting in a loss of oxygen regardless of whether the flow is on or off.

Quiz 35: Home Care