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RES 204 Unit 3 exam Questions With Complete Solutions Describe the type of respiratory patients who typically stay at LTACHs and their LOS correct answer: Provide highly focused care to patients with complex medical conditions, including patients who have been ventilator dependent and difficult to wean a. they often have tracheostomy tube and not ETT Recognize a list of commonly encountered problems associated with ventilator weaning correct answer: 8. Difficulty with weaning/troubleshooting -Respiratory insufficiency -Airway Obstructions -Retention of Secretions -Blood in secretions -Patient anxiety Describe communication/equipment adjuncts that are used with trached and intubated patients correct answer:. Communication a. Boards allow patients to communicate by pointing to words and letters. b. Trach devices allow the patient to speak by directing air past vocal cords i. speaking valves, Passey Muir valve and fenestrated trachs Describe the techniques and issues associated with end-of-life situations for patients on mechanical ventilation correct answer: -Terminal wean for families who need extra time to make a decision.
-Process of removing ventilator support in stages like reducing FIO2, TV, etc. Identify the problems for RTs associated with a new tracheostomy for ventilator patients correct answer: Identify issues associated with trach tube diameters, lengths and angles correct answer: -Extreme care must be taken to manage a new tracheostomy site. -Gentle cleaning -Guard it from --accidental decannulation --excessive movement (stabilize vent connection)
- Do not change the trach for 7-14 days unless major issue or decannulation occurs -Tissues often close making re-insertion difficult and likelihood of pushing into false tract -Done only by ENT or surgeon -If controlled, put in a guide catheter into old tube, remove, and thread new trach over it -If the tracheostomy tube is too short, the distal end can obstruct against the posterior tracheal wall. This can be remedied by using --larger tube --angled tube --tube with a flexible shaft --tube with extra length. Extra length tubes are constructed with extra proximal length (horizontal) or with extra distal length (vertical).
b. the straight port give extra length for large neck patients
- Because the portion of the tube that extends into the trachea is straight and conforms more closely to the natural anatomy of the airway, the angled tube may be better centered in the trachea and exert less pressure along the tracheal wall
- Identify the goal of "downsizing" a tracheostomy tube; use of fenestrated trach tubes; reason that the trach tube "obturator" is needed and kept nearby. correct answer:
- Describe the goal and use for tracheal stoma maintenance devices and trach buttons correct answer: Describe communication issues and developed solutions for patients with tracheostomy tubes correct answer: -frustrations with artificial airways and communication is a significant issue for patients, their families and medical professionals
- Describe the steps of a swallow test, what it is testing for, and what constitutes a failed test and why. correct answer: Recognize a list of indications for tracheostomy tube decannulation correct answer: -Reason for the tracheostomy resolved. --Patient alert, responsive and consenting. --Patient tolerating cuff deflation for a minimum of 12 hours. --Patient managing to protect airway and have a clear chest. --Patient maintaining O2 saturations. --Patient tolerating the use of a speaking valve and/or digital occlusion.
--Patient able to expectorate around the tube into their mouth. --Tracheostomy tube type and size is appropriate. Identify the purpose of a "capping"procedure correct answer: - Occlusion cap in situ for 24 hrs on deflated cuff tube -Forces patient to breath through nose and mouth completely. Therefor supplemental oxygen is through a nasal cannula. Explain how the actual incision location is supported after decannulation and why this is necessary correct answer: above -Day 3 --Clean around site --Decannulate --Keep site covered and clean --Support incision site during speaking and coughing Describe the documentation and identify advantages associated with 6 MWTt correct answer: -6MWT is performed to --Assess medical or surgical procedure --Assess functional capacity --Estimate morbidity and mortality --Determine Oxygen need requirements --Document improvement in Pulmonary rehab. Identify advantages and disadvantages of the ISWT correct answer: -Advantage --Incremental maximal, symptom-limited test --Correlates better with V̊O2 max than 6MWT
Recognize a list of CPET variables and their uses from basic to advanced correct answer: Describe end-points associated with maximal exercise capability and indications for terminating CPET correct answer: -Cardiac arrhythmias --2mm horizontal or down-sloping ST depression or elevation --T-wave inversion or Q waves --V-tach --Sustained supraventricular tachycardia (SVT) --Increasing frequency of multifocal PVC's --Development of 2nd or 3rd degree heart block --Exercise-induced L or R bundle branch block -Other Indications --Progressive chest pain --Sweating and pallor --Systolic pressure > 250mmHg --Diastolic pressure > 120mmHg --Failure of systolic pressure to h or a i of 10mmHg with h workload --Lightheadedness, mental confusion, or headache --Cyanosis --Nausea or vomiting --Muscle cramping Identify contraindications to CPET correct answer: -Recent MI (within 4 wks) -Unstable angina -2nd or 3rd degree heart block
-Rapid ventricular/atrial arrhythmias -Severe aortic stenosis -CHF Describe the role of collection and analysis of expired gases during CPET and the parameters that can be calculated using these results. correct answer: -Anaerobic Threshold --Occurs when the energy demands of the exercising muscles exceed the body's ability to produce energy by aerobic metabolism. Lactic acid threshold typically occurs at 50-60% of V̊O2 max --when respiratory exchange ratio (Vco2/Vo2) reaches 1.0 (n=. at rest or mild exercise) State the purpose of using an exertion scale before and after a CPET. Identify the name of the most common scale used. correct answer: -Cardiovascular response --i. ECG, BP, CO, O -Metabolic and oxygen uptake --i. Anaerobic/ventilatory threshold, lactate, V̊O2 max, V̊O2/kg Match the names of various CPET tests with the body function it is testing correct answer: above State the definition and general goals of pulmonary rehabilitation programs correct answer: -Defined as the restoration of the individual to the fullest medical, mental, emotional, social, and vocational potential
-Those with hypertension -Those with neuromuscular disease -Those with untreated or unstable asthma -Those with angina with exercise Describe pulmonary rehabilitation program design, including format. correct answer: -PR is most effective with follow-up must be ongoing and available to all patients who complete the program
- Describe physical reconditioning components of PR correct answer: Describe the implementation of a pulmonary rehabilitation program, including staffing, facilities, scheduling, class size, equipment, costs, and reimbursement correct answer: b. Physical reconditioning equipment needed --Stationary bicycles, treadmills, rowing machines --Pulse oximeters --Inspiratory resistance devices --Emergency O2 should be in the room. --bronchodilators Describe the role that patient safety plays in a PR program, and strategies to decrease patient injury in the activities. correct answer: -Therapists must supervise at all times due to patient safety concerns. -Fall risk determination necessary to plan safe exercise program. -Evaluation of patient's understanding of disease, communication barriers and best learning style will help better ensure patients understand instructions.
d) Monitor blood pressure and oxygen saturation during exercise List 3 requirements for a patient to be eligible for a PR program including PFT results. correct answer: A. Entry into Pulmonary Rehabilitation -Referral from physician (signed & dated) -Qualifying PFT (within past 12 months) -Proper diagnosis as identified in ICD9 coding (DRG) Recognize a list of activities and information covered in the first and second visit of a new patient in PR program. correct answer: -Before and after --HR RR SaO2 FIO2 BP --iv. total distance walked --v. total rest periods needed --vi. Therapist can then establish first exercise prescription --vii. Give O2 if SpO2 >88% Recognize a list of patient assessment boundaries that are measured during an exercise session and which can lead to early termination of the session. correct answer: -Maximum HR determined by the Karvonen Scale (220-age-resting HR x .6 + resting HR= Maximum HR). -Resting HR less than 120 bpm. -Blood Pressure at rest not to exceed 180/ -Blood Pressure with exercise not to exceed 220/110 unless specified by physician. -If Diabetic - glucose above normal level at least 70 mg/dl Identify the potential hazards associated with pulmonary rehabilitation correct answer: above
