Deck 21: Long-Term Ventilation

Question 1

Which of the following ventilator requirements for a ventilator-assisted individual demonstrates clinical stability and indicates that the patient most likely is ready for discharge home from an acute care hospital?

A) PC-CMV, f = 14 breaths/min, PIP = 30 cm H₂O, PEEP = 10 cm H₂O, FɪO₂ = 0.5
B) VC-IMV, f = 8 breaths/min, Vᴛ = 400 mL, PS = 5 cm H₂O, PEEP = 5 cm H₂O, FɪO₂ = 0.3
C) VC-CMV, f = 12 breaths/min, Vᴛ = 600 mL, PEEP = 8 cm H₂O, FɪO₂ = 0.6
D) PC-IMV, f = 10 breaths/min, PIP = 25 cm H₂O, PS = 10 cm H₂O, PEEP = 10 cm H₂O, FɪO₂ = 0.8

Answer 1

B
Because the second-generation home care ventilators can deliver PC-CMV and VC-CMV or IMV and PSV and PEEP,the fact that these patients require these modes does not exclude them from being considered for home ventilation.Patients are not considered for home ventilation if they require an FɪO₂ greater than 0.4 and higher levels of PEEP,because this demonstrates clinical instability.

Question 2

The appropriate power source for a wheelchair-mounted ventilator is which of the following?

A) AC current
B) Pneumatic
C) Internal DC battery
D) External DC battery

Answer 2

D
An external DC battery allows the ventilator to be mounted and used on a wheelchair or in a car.Use of an external DC battery enables longer operation,as needed,during transport.

Question 3

Which of the following factors must be considered when estimating a patient's cost of home mechanical ventilation?
1)Type of ventilator selected
2)Accessory medical supplies
3)Need for professional caregivers
4)Adequacy of third-party coverage

A) 1 and 3 only
B) 2 and 4 only
C) 1 and 4 only
D) 1, 2, 3, and 4

Answer 3

D
For homecare patients,ventilator equipment can be bought at a reasonable price; however,in many cases,families may choose to rent the ventilator because regular service,maintenance,and 24-hour emergency services are available as part of the rental contract.Unfortunately,the costs of accessory medical supplies,including items such as suction catheters,skin lotions,and absorbent underpads,may be difficult to estimate and can significantly increase the total cost of care.
The major factor affecting the cost of home care is the need for professional or skilled caregivers.This cost depends on the availability of family members and how much they are willing and able to do.Cost also depends on patient independence and self-care abilities and the number of hours and level of care required from others.
It is important to recognize that inadequate third-party coverage for supplies and equipment,which is almost always passed on to the patient and family,must be factored into the costs of providing LTMV in the home.

Question 4

A VAI with amyotrophic lateral sclerosis and a TT is unable to develop clear secretions from his airway.Which of the following should be considered to manage this patient's airway clearance problem?
1)Manual chest compression and TT suctioning
2)Autogenic drainage and postural drainage
3)Positive expiratory pressure
4)Mechanical insufflation-exsufflation (MI-E)

A) 1 and 4 only
B) 1, 2, and 3 only
C) 2 and 3 only
D) 1, 2, and 4 only

Question 5

The most important factors to consider when choosing a ventilator for home use include which of the following?
1)Sophistication
2)Reliability
3)Versatility
4)Cost

A) 1, 2, and 4 only
B) 2, 3, and 4 only
C) 1, 2, and 3 only
D) 1 and 2 only

Question 6

A minimum of _______ days should be allowed to obtain insurance verification and authorization and to procure equipment before a ventilated patient is transferred home from the acute care hospital.

A) 3⁻⁵
B) 7-14
C) 10-16
D) 21-30

Question 7

Glossopharyngeal breathing is beneficial for patients with which condition?

A) Tracheomalacia
B) Postpolio syndrome
C) Muscular dystrophy
D) Pierre-Robin syndrome

Question 8

A patient with which condition is a suitable candidate for home care ventilation?

A) Flail chest due to trauma
B) Amyotrophic lateral sclerosis
C) Severe exacerbation of asthma
D) Acute respiratory distress syndrome

Question 9

A patient using a negative pressure ventilator is assessed by the respiratory therapist and found to have a blood pressure of 85/40 mm Hg and a heart rate of 130 beats/min and thready.The physician orders compression stockings for the patient,but the clinical status is the same 24 hours after placement of the compression stockings.What is the most likely cause of this patient's hypotension?

A) Diarrhea
B) Dehydration
C) Septicemia
D) Abdominal blood pooling

Question 10

What pressure range may be necessary to achieve a sufficient Vᴛ using a chest cuirass?

A) -10 to -20 cm H₂O
B) -25 to ⁻⁵0 cm H₂O
C) -35 to -60 cm H₂O
D) ⁻⁵0 to -75 cm H₂O

Question 11

The preferred location for ventilator-dependent patients is ________________________.

A) a skilled nursing facility
B) a subacute care unit
C) their own homes
D) a long-term acute care hospital

Question 12

In-hospital evaluation of ventilator-assisted infants should be performed how often for the first 2 years of life?

A) Once a month
B) Once every 2-3 months
C) Once every 4-6 months
D) Once a year

Question 13

What bacteria is most often the cause of ventilator-associated pneumonia in VAIs?

A) Staphylococcus aureus
B) Enterobacter spp.
C) Burkholderia cepacia
D) Streptococcus pneumoniae

Question 14

List the potential locations for patients requiring long-term ventilatory care in order of cost from most expensive to least expensive.
1)Patient's home
2)Long-term acute care facility
3)Intensive care or acute care unit
4)Extended care facility

A) 2, 4, 3, 1
B) 4, 1, 3, 2
C) 1, 2, 3, 4
D) 3, 2, 4, 1

Question 15

Which site for mechanical ventilation of patients provides the least patient independence and quality of life?

A) Intensive care unit
B) Skilled nursing facility
C) Long-term care hospital
D) Chronic assisted ventilator unit

Question 16

The American College of Chest Physicians (ACCP)considers long-term ventilator-assisted patients to be those who require mechanical ventilation for at least _______ hours per day for _______ days or more.

A) 4; 7
B) 6; 14
C) 6; 21
D) 8; 21

Question 17

A patient with muscular dystrophy currently receiving ventilatory support with VC-IMV is being prepared for discharge home.The case manager asks the respiratory therapist to recommend a ventilator that will meet the patient's needs with the least complexity and at the lowest cost.The respiratory therapist should recommend which of the following ventilators?

A) PLV 102
B) LP-6 Plus
C) LTV 1000
D) Lifecare PLV 100

Question 18

A patient with a tracheostomy tube (TT)is being discharged home with a ventilator,which he uses only during the night,without supplemental oxygen.During the day he uses a speaking valve.Which of the following equipment must he have in his home?
1)Suctioning equipment
2)Oxygen concentrator
3)Second mechanical ventilator
4)Manual resuscitator bag

A) 1 and 3 only
B) 1 and 4 only
C) 2, 3, and 4 only
D) 1, 2, 3, and 4

Question 19

One of the goals of long-term mechanical ventilation (LTMV)in the home or alternative care site is which of the following?

A) Permit lung healing
B) Reduce hospitalizations
C) Relieve respiratory distress
D) Improve pulmonary gas exchange

Question 20

A quadriplegic patient is getting ready for discharge home from an acute care hospital.He has a TT and requires mechanical ventilation around-the-clock,but does not need supplemental oxygen.What equipment must he have in his home?
1)Transport ventilator
2)Manual resuscitator bag
3)E-cylinder of oxygen
4)Ventilator circuits

A) 1 and 2 only
B) 3 and 4 only
C) 1, 2, and 4 only
D) 2 and 4 only

Question 21

What is the minimum pressure required to vibrate the vocal cords and produce a quality voice?

A) 1 cm H₂O
B) 2 cm H₂O
C) 3 cm H₂O
D) 4 cm H₂O

Question 22

Some of the difficulties families experience when caring for a patient in the home include which of the following?
1)Loss of work time
2)Loss of privacy when outside caregivers are in the home 24 hours a day
3)Financial stress
4)Transmission of nosocomial infections from patient to family

A) 1 and 3 only
B) 2 and 4 only
C) 1, 2, and 3 only
D) 1, 2, 3, and 4

Question 23

A written report should be completed monthly during the follow-up and evaluation of patients receiving home MV.Which of the following conditions should this monthly report include?
1)ABG analysis
2)Patient and family comprehension of equipment and procedures
3)Proper functioning of the equipment
4)Compliance with the plan of care

A) 2, 3, and 4 only
B) 1, 2, and 3 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Question 24

The advantages of using MI-E in conjunction with PPV include:
1)MI-E with PPV generates optimal peak cough expiratory flow (PCEF)for clearing airway secretions.
2)MI-E with PPV does not cause airway irritation or discomfort.
3)MI-E with PPV can be used with patients with bullous emphysema.
4)MI-E with PPV may improve vital capacity (VC)and arterial oxygen saturation (SₐO₂)associated with mucous plugging.

A) 1, 2, and 4 only
B) 2, 3, and 4 only
C) 2 and 4 only
D) 1, 2, 3, and 4

Question 25

Follow-up assessment of a patient who is home ventilated on a regular service schedule generally includes which of the following?
1)Vital signs
2)Arterial blood gas (ABG)evaluation
3)Oxygen saturation measured by pulse oximeter (SₚO₂)
4)Portable chest radiograph

A) 1 only
B) 2 only
C) 1 and 3 only
D) 1, 2, 3, and 4

Question 26

A VAI patient has expressed the desire to be able to speak.The most appropriate speaking device to use in-line with this ventilator patient is which of the following?

A) Voice TT
B) Passy-Muir
C) Portex Speaking TT
D) Pitt Talking TT

Question 27

Which of the following is an essential step the respiratory therapist must perform when setting up a speaking valve for a ventilator-assisted individual?

A) Turn up the required flow to 6-8 L/min.
B) Make sure the cuff is inflated before applying the valve.
C) Make sure the cuff is deflated before applying the valve.
D) Place the speaking valve in a 22-mm corrugated tube.

Question 28

During an education session with the family of a ventilator-assisted individual who is being prepared for discharge home,the respiratory therapist explains ventilator circuit/suction equipment disinfection.Which of the following is an important instruction that should be part of this teaching?

A) "A white vinegar/distilled water mix can be reused as a disinfectant solution."
B) "Water for humidifiers can be taken directly from the tap."
C) "Suction catheters and plastic containers must be changed after 8 hours."
D) "Medicare will reimburse for all the disposable supplies needed for the ventilator."

Question 29

A VAI patient with a TT is having a trial of cuff deflation to allow for speech.The patient's voice is "weak," and he can speak only two or three words with each exhalation.The respiratory therapist could adjust which ventilator settings to improve the patient's speech?
1)Expiratory time
2)Inspiratory time
3)Volume
4)PEEP

A) 1 and 3
B) 2 and 4
C) 1 and 4
D) 2 and 3