what are Respiratory care services provided in post acute care facilites
- continuous O2 therapy
2.long-term mechanical ventilation
3.aerosol drug therapy
4.airway care
5.sleep apnea treatment and monitoring - pulmonary rehabilitaion
describe what a long term acute care hospital is
- provides care for pt with complex medical conditons, pt who have been vent dependent and difficult to wean
what is the RT role in long term subacute care hospitals
-monitor respiratory status
-implement weaning protocols
-support pt transitions to independent breathing
define what skilled nursing facility is
-comprehensive level of inpatient care for stable pt who:
1.have experienced an acute illness or injury
2.have a determined course of treatment
3.do not require diagnostic or invasive procedures
4.all age groups found at these sites
what is the rt role in subacute care
- target respiratory support
2.assisting with rehabilitation
3.ensuring each pt care plan is followed
where is most acute respiratory care provided
in the comfort of a pt home
what are common clinical conditions treated at home
- COPD
2.cystic fibrosis
3.chronic neuromuscular diseases
4.chronic restrive diseases
5.carcinoma of the lung
what is the role of an RT in home care
- support and maintain life
2.improve pt physical emotional and social well being
3.promote pt and family self sufficiency
4.ensure cost effective delivery of care-limits hospital visits - maximizing pt comfort near the end of life
where do the respiratpry care in subacute and home settings derive from
- AARC clinical practice guidelines
2.Federal CMS-center for medicare and Medicaid services
3.state laws
4.private- sector accreditation standards
which organization is responsible for setting pt care standards
Joint commission
what is the process to determine discharge of pt to post acute care or home
- evaluate appropriate site for discharge determined by pt need
2.when discharge to home, caregivers must be trained and prepared
3.reliable durable medical equipment supplier may need to be involved
what is the goal of discharge planning
prevent hospital readmission with proper preparation and planning
in order to ensure a successful discharge to home what must the RT observe
-confirm non professional care giver can perform certain skils
-RT must demonstrate and verbally confirm caregivers understanding on the following:
-teach caregiver equipment operation
-must be able to troubleshoot equipment
-learns airway clearance methods
-assessment and monitoring pt respiratory status
-emergency situations
what is the most common home care modality
oxygen therapy
what should an O2 therapy prescription include
- flow rate in liters/minute and concentration
2.frequency of use
3.duration of need
4.diagnosis
5.lab evidence (ABG)
what is a the criteria needed for home O2
- resting PaO2 of 55mmHg or less on room air
2.resting SpO2 of less than 88%
3.unable to wean off O2 in hospital without desaturation
what are the supply methods for O2 therapy
- compressed O2 cyclinder
-used for abulation or as backup to liquid or concentrator no electricity needed
2.liquid O2 system
-no electricity needed, high concentration of O2
- Oxygen concentration
*most common method
what are the delivery methods of O2
- nasal cannula
*most common for long term care
2.transtracheal O2 therapy
-used in selective, conserves the use of O2 and has cosmetic advantages
3.demand- flow O2 system
-pt who are active
-used flow sensor and valve to synchronize gas delivery
which criteria must be meet for NIV to be used in home care
- pt is mentally competent
2.cooperative and not under sedation
3.supplemental O2 therapy is minimal (fio2<40)
4.spo2 can be maintained at >90% by airway clearance
5.no history of seizures
6.no facial traumas - do not need high vent settings
how to chose ventilatory selection
-vent depends on need of pt
-back up vent should be provided for pt who can not maintain spontaneous vent for more than 4 hrs
-vent used should be dependable and easy for caregiver to operate
-vents must be portable if pt is mobile
-electrically powered ventilators often best choice
what type of vents do COPD pt perfer
pressure limited over volume cycled ventilation
what vents do neuromuscular disorders perfer
volume ventilation
what is the biggest challenge with NPPV
-getting a good seal
-pt comfort
-leak free interface
what should be monitored daily for vent pt in alternative sites
vital signs
lung sounds
sputum production
