Egan’s Chapter 49 Practice Questions:
1. As the elderly population grows, health services are being provided outside the acute care hospital. These alternatives or post-acute care settings include what?: subacute, rehabilitation, and Skilled Nursing Facilities, and home.
2. As the lactic acid is buffered, CO2 levels rise and the stimulus to breathe increases. The result is what?: it results in an upswing in both CO2 and VE. This is often referred to as the ventilatory threshold.
3. Because _______ of liquid O2 equals ______ of gas, liquid O2 systems can store large quantities of O2 in small spaces.: 1 cubic foot, 860 cubic feet
4. T he cardiopulmonary exercise evaluation serves two key purposes in pulmonary rehabilitation. What are they?: 1) it quantifies the patient’s initial exercise capacity (exercise Rx, target HR), 2) it yields the baseline data for assessing patients progress over time.
5. The Council on Rehabilitation defines rehabilitation as what?: the restoration of the individual to the fullest medical, mental, emotional, social and vocational potential of which he or she is capable.
6. Depending on manufacturer and model, small liquid O2 cylinders hold between __________ pounds of liquid O2.: 45-100 pounds
7. During an exercise evaluation, work levels are increased progressively until 1 of 2 things happen. What are they?: 1) the patient cannot tolerate a higher level, 2) an abnormal or hazardous response occurs
8. Explain a close design formatted program: This is the more traditional format. It has a set time period, usually from 6-16 weeks, with classes meeting 1-3 times a week. Each session lasts 1-3 hours.
9. Explain an open-ended formatted program: patients enter the program and progress through it until they achieve certain predetermined objectives. There is NO time frame. It’s best for self-starting patients.
10. For the RT, working in the post acute care setting is distinctly different form working in an acute care hospital. What are the key differences: resource availability, supervision and work schedules, documentation and assessment, and professional-patient interaction.
11. How are O2 prescriptions based?: they are based on documented hypoxemia, as determined by either blood gas analysis or oximetry
12. How can these goals be accomplished?: oxygen supplementation, frequent administration of high doses of aerosolized B2-agonists, high dose parenteral corticosteroids, and antibiotics if there is evidence of infection.
13. How can these goals be accomplished?: by objective measurements and monitoring lung function, pharmacologic therapy, environmental control, and patient education.
14. How does AARC define respiratory home care?: as those specific forms of respiratory care provided in the patient’s place of residence by personnel trained in the respiratory care working under medical supervision.
15. How do RT’s educate their patients?: By providing information about a disease process, medications, and treatment procedures.
16. How do you calculate MVV: MVV= FEV1 X 35
17. How is COPD defined: as a preventable and treatable disease state characterized by airflow limitation that is not fully reversible
18. How is Emphysema defined: in anatomic terms it is described as a condition characterized by abnormal, permanent enlargement of the airspaces beyond the terminal bronchiole, accompanied by destruction of the walls of the air spaces without fibrosis.
19. if the body cannot deliver sufficient O2 to meet the demands of energy metabolism, blood lactate levels increase above normal. This point is called what?: onset of blood lactate accumulation (OBLA)
20. In 1842, who advocated health education in the public schools?: Horace Mann
21. In 1962, Pierce and associates published results confirming Barach’s insight into the value of what?: Reconditioning
22. in managing a patient with stable COPD, what goals must guide the clinician?: establish diagnosis of COPD, optimize lung function, maximize the patients functional status, simplify the medical regimen as much as possible
23. In treating OSA what meds should be avoided and why?: Benzodiazepines and other sedative-hypnotics should be avoided, because they can potentiate upper airway collapse.
24. Liquid O2 is kept at ______ degrees F: -300
25. Most patients for whom respiratory home care is considered are those with chronic respiratory diseases. What categories of disorders are applicable?: COPD, CF, chronic neuromuscular disorders, chronic restrictive conditions, carcinomas of the lung
26. Of the top 5 diseases that cause death, what are 4 central causes, that render them preventable?: tobacco use, poor diet, physical inactivity, and excessive alcohol use.
27. Patient evaluation begins with what?: a complete patient history: medical, psychological, vocational, and social
28. Patients with COPD often have a tendency to develop what?: severe anxiety, hostility and stress as a direct consequence of their disability.
29. Patients with untreated OSA, compared with the general population have an increased risk of what?: systemic and pulmonary hypertension, stroke, nocturnal arrhythmia, heart failure, and myocardial infarction.
30. Prevention can only occur on 3 levels. What are they?: primary, secondary, and tertiary
31. The primary organization responsible for standard setting and voluntary accreditation of post acute care providers is who?: TJC
32. The primary use of compressed O2 cylinders in alternative settings is for what?: either ambulation (small cylinders) or as a backup to liquid or concentrator supply systems (H/K cylinders)
33. Respiratory home care can contribute to what?: supporting and maintaining life, improving patients physical, emotional, and social well being, promoting patient and family self sufficiency, ensuring cost-effective delivery of care, and maximizing patient comfort near the end of life
34. To determine the patients cardiopulmonary status and exercise capacity, what is performed?: pulmonary function testing and cardiopulmonary exercise evalutation
35. The top 5 causes of death in the united states are what?: Heart disease, cancer, cerebrovascular disease, chronic obstructive lung disease (COLD, bronchitis, and emphysema) and accidents.
36. TRUE or FALSE: In addition, most RTs working in the postacute care environment argue, that only in these settings is their full scope of training really used.: TRUE
37. TRUE or FALSE: In patients with COPD, the PaCO2 usually is generally preserved until airflow is severe (FEV1<1L), when the PaCO2 level may rise: TRUE 38. TRUE or FALSE: “With regard to
38. TRUE or FALSE: “With regard to test preparation, patients should fast 8 hours before the procedure”: TRUE 39. TTOT is indicated only for those patients who meet 1 or more criteria. what are they?: 1) they cannot be adequately oxygenated with standard approaches, 2) they do not comply well when using other devices, 3) they exhibit complications from nasal cannula use, 4) They prefer TTOT for cosmetic reasons, 5) they have
39. TTOT is indicated only for those patients who meet 1 or more criteria. what are they?: 1) they cannot be adequately oxygenated with standard approaches, 2) they do not comply well when using other devices, 3) they exhibit complications from nasal cannula use, 4) They prefer TTOT for cosmetic reasons, 5) they have need for increase mobility
40. Typically the exercise Rx includes 4 related components. What are they?: 1) lower extremity-aerobic exercises, 2) timed walking (6-12 min walk), 3) upper extremity- aerobic exercises, 4)ventilatory muscle training
41. What are some classic symptoms of asthma?: episodic wheezing, shortness of breath, chest tightness, and cough.
42. What are some common clinical features of OSA?: male, age older than 40, upper body obesity (neck >42cm), habitual snoring, fatigue or daytime sleepiness, hypertension.
43. What are some examples of these level?: Primary: use of immunizations, Secondary: early detection of disease (pap smears, mammograms, etc), Tertiary: prevention of acceleration of the disease process once it has occurred. (pulmonary rehab)
44. What are some medical interventions for treating OSA?: positive pressure therapy-(cpap, bipap, auto-titrating devices), oral appliances (enlarge airway or move jaw forward) medications (O2 therapy)
45. What are some other surgical alternatives?: bypass of the upper airway, tracheostomy, reconstruction of the upper airway, and nasal surgery
46. What are some safety measures that have been implemented to minimize risk to patients during an exercise evaluation?: 1) patient should undergo a physical exam including ECG, 2) a physician should be present, 3) emergency resuscitation equipment should be readily available, 4) staff performing test should have their BLS and their ALS, 5) test should be terminated promptly when indicated
47. What are some surgical interventions for treating OSA?: palatal surgery (uvulopalatopharyngoplasty-UPPP, however its not recommended), and maxillofacial surgery
48. What are the 2 most common risk factors for COPD?: cigarette smoking and A1-antitrypsin deficiency
49. What are the causes of diffuse bronchiectasis: CF, ciliary dyskinesia, hypogammaglobulinemia, rheumatoid arthritis, A1 antitrypsin deficiency, serious lung infection
50. What are the causes of local bronchiectasis: foreign body, benign airway tumor, bronchial compression by surrounding lymph nodes
51. What are the general goals of pulmonary rehab?: to control and alleviate the symptoms, restore functional capabilities as much as possible, and improve the quality of life.
52. What are the goals of OSA treatment?: eliminate apnea, hypopnea, and snoring, normalize oxygen sats and ventilation, improve sleep architecture and continuity
53. What are the goals of stable asthma management?: maintain a high quality of life for the patient, uninterrupted by asthma symptoms, side effects from meds or limitations on the job or during exercise.
54. What are the goals to managing emergency acute asthma?: decrease mortality and morbidity and to return the patient to preadmission stability and function as quickly as possible.
55. What are the learning domains?: cognitive, psychomotor, and affective
56. What are the mainstays of management of bronchiectasis?: antibiotics and bronchopulmonary hygiene
57. What are the most common respiratory care services provided in these alternative care settings?: continuous O2 therapy, long term mechanical ventilation, aerosol drug administration, airway care, sleep apnea treatment, sleep/apnea home monitoring, and pulmonary rehab.
58. What can cause central sleep apnea (CSA)?: primary central nervous system lesions, stroke, congestive heart failure, and high-altitude hypoxemia all diminish respiratory control
59. What happens beyond the ventilatory threshold?: metabolism becomes anaerobic, the efficiency of energy production decreases, lactic acid accumulates and fatigue sets in
60. What is by far the most common mode of respiratory care in postacute care settings?: oxygen therapy
61. What is Health Education?: its a process of planned learning designed to enable individuals to make informed decisions and take responsible action regarding their health.
62. What is health promotion?: helps people change their lifestyle in a variety of settings, from the home or school to the workplace or health care agency or institution.
63. What is obtained for assessment of sleep stage and documentation of sleep disruption due to sleep-related breathing disturbance.: electroencephalogram EEG, electrooculogram EOG, chin electromyogram EMG
64. What is one drawback to closed design programs?: its about program completion rather than meeting objectives
65. What is sleep apnea?: repeated episodes of complete cessation of airflow for 10 seconds or longer.
66. What is subacute care?: a comprehensive level of inpatient care for stable patients who (1) have experienced an acute event resulting from injury, illness, or exacerbation of a disease process, (2) have a determined course of tx, and (3) require diagnostics or invasive procedures but not those requiring acute care.
67. What is the goal of acute care?: to apply intensive resources to stabilize patients after severe episodic illness
68. What is the goal of subacute care?: it aims to restore the whole patient back to the highest practical level of function, ideally that of self care.
69. What is the hallmark of bronchiectasis?: chronic production of large quantities of purulent sputum
70. What is the ideal class size?: 3-10 participants
71. What is the overall goal of rehab?: to maximize the the functional ability and to minimize the impact the disability has on the individual, the family, and the community.
72. What is the primary goal of health education?: behavior change
73. What is the primary goal of home care?: to provide quality health care services to clients in their home setting, thus minimizing their dependence on institutional care.
74. What is the RT’s patient demographic for teaching?: RT’s educate patients in all age groups, including geriatric, adult, adolescent and children.
75. What is TTOT: transtracheal oxygen therapy is O2 delivered via a catheter with a small orifice that is inserted through the skin and neck tissue into the trachea.
76. What kind of patients will most likely benefit from participation in pulmonary rehab?: those with persistent symptoms due to COPD who have low maximum O2 uptakes at baseline.
77. What was observed in the patients with COPD who participated in physical reconditioning?: lower pulse rates, resp. rates, minute volumes and CO2 production during exercise.
78. When sleep apnea is suspected, what should be obtained for confirmation of the clinical diagnosis?: an overnight polysomnogram (PSG)