Kettering review - Section G

How long can Cotinine be detected in blood & urine?

2-4 days after smoking

What is Cotinine?

A breakdown product of nicotine

State the name of the test that is used to determine if a pt develops cardiac arrhythmias, angina or excessive hypoxemia

A simple test - 6/12 min walk

Describe the most effective way to avoid cross contamination w/ aerosolized meds

Admin it w/ a MDI

Explain the goal of any home care program

Allow pt to care for themselves @ home (increase functional capacity) Pt/fam will need to learn how to do all txs & recognize problems

Define a nosocomial infection

An infection acquired @ least 72 hours after admin to a hospital or other health care facility

State the objectives of a pulmonary rehab progem

1.) Alleviate or control as many medical symptoms of resp impairment as possible 2.) Teach the pt how to max their ability to carry out ADL

Describe the advantages of electronic charting vs manual charting

1.) Automation of day-to-day procedures 2.) Standardization of care 3.) Improved accuracy of charting 4.) Bedside data entry is more efficient & accurate

List the meds & category of each that could be recommended to help a pt quit smoking

1.) Bupropion hydrochloride (Zyban or Wellbutrin) (anti-depressant) 2.) Varenicline (Chantix) (prescription med)

Describe the methods that can be incorporated into a smoking cessation program to improve compliance in the program

1.) COHb levels in blood 2.) Exhaled CO levels (FECO) 3.) Cotinine levels in blood & urine

List 2 different types of documents that can be utilized in an interdisciplinary plan of care

1.) Clinical practice guidelines 2.) Standardized plan of care

Describe the 3 routes for transmission of infections

1.) Contact (direct & indirect) 2.) Respiratory droplets 3.) Airborne droplet nuclei

Identify the components included in Expanded Precautions

1.) Contact Precautions 2.) Droplet Precautions 3.) Airborne infection isolation (NIOSH-approved respirator) 4.) Protective equipment

List the 3 options for delivering O2 in the home

1.) Cylinders 2.) Liquid bulk O2 systems 3.) O2 concentrators

List the 4 different *chemical* methods of disinfection & sterilization available

1.) Ethylene oxide sterilization (ETO, gas sterilization) - sterilizes equipment by alkylation of enzymes 2.) Alkaline glutarakdehyde (Cidex) - disinfection or sterilization process 3.) Acid glutaraldehyde (Sonacide) - disinfection of sterilization process 4.) Alcohol - disinfection process

List 6 techniques that are included in the protocol for the prevention of VAP

1.) Gentle suctioning 2.) Use of closed suction 3.) Regular oral hygiene 4.) Post-pyloric feeding 5.) Keeping pts head elevated 30-45 degrees 6.) Not routinely changing vent circuit

List the items that are included in Standard Precautions

1.) Hand washing 2.) Gloves 3.) Masks, eye protection, face shields 4.) Gowns 5.) Pt care equipment 6.) Occupational health & blood borne pathologies 7.) Pt placement

Describe the 3 settings in which pulmonary rehab can be utilized

1.) Hospital 2.) Outpt rehab clinics 3.) Home care

Identify the important safety principles for a pt receiving O2 therapy from a concentrator system

1.) Instruct pts to routinely check & change filters 2.) A properly grounded electrical outlet is required 3.) A backup system (cylinder) must be available in care of power failure

List 6 of the topics included in a smoking cessation program

1.) Instruction 2.) Group counseling & support 3.) Nicotine replacement therapy 4.) Supplemental O2 (if indicated) 5.) Pulmonary rehab 6.) Behavioral modification 7.) Stress reduction

Describe the items that are considered bio-hazardous materials

1.) Lab waste (specimen cultures, research cultures, vaccines, culture dishes) 2.) Human blood/bodily fluids

List the evaluations that are performed during a pulmonary stress test

1.) O2 sats 2.) Baseline RR & rate @ which dyspnea occurs 3.) BP 4.) Baseline HR & rate @ which dyspnea occurs 5.) ECG (@ least 3 leads) 6.) Presence of joint pain/stiffness

State the criteria used to determine if a pt w/ COPD could benefit from home O2

1.) PaO2 < 55 torr on rm air 2.) Exercise limitation that is responsive to O2 therapy 3.) Pulse ox @ rest, exercise & sleep is suggested 4.) Polycythemia or cor pulmonale

Describe the 3 most common factors responsible for transmitting nosocomial infections

1.) Peronnel (primary cause) 2.) Droplet nuclei 3.) Equipment

State the 4 features &/or purposes of utilizing automated medication dispensing systems

1.) Provides improved pt safety & control of meds 2.) Provides access to pt meds by multiple health care practitioners 3.) Maintains accurate data about what med was dispensed, when & who obtained the med 4.) Assists w/ management of med inventory

State 2 conditions that can result from the use of aerosol devices

1.) Pseudomonas aeruginosa 2.) Serratia

List 4 examples of data that can be entered into a pt's electronic chart

1.) Pt data 2.) New therapy orders 3.) Tx times 4.) Vent settings

List the techniques included as part of a pulmonary rehab program

1.) Pursed-lip breathing 2.) Diaphragmatic breathing training 3.) Cough control techniques 4.) Exercise conditioning 5.) Nutritional balance - increase protein/fat, low carbs

State the 4 *physical* methods of disinfection & sterilization

1.) Steam under pressure (steam autoclave) 2.) Pasteurization - disinfection process using moderate temps to kill vegetative organisms 3.) Incineration - best method of tx contaminated disposable items & supplies 4.) Irradiation - gamma rays used to sterilize pre-packaged equipment

List the 4 basic steps necessary for setting up a home care program

1.) Survey home & make modifications to assure safety & infection control 2.) Instruct pt in proper use of equipment 3.) Train pt/fam to recognize problems/emergencies 4.) Infection control

Explain exactly what a resp care protocol would specify

1.) When tx or services are indicated 2.) Provide guidelines for the best method of delivery & discontinuing therapy

Describe the cause of VAP

Aspiration of bacteria that have colonized the upper GI tract or oropharynx

Define medial waste

Bio-hazardous or sharps waste & waste which is generated, produced or researched pertaining to diagnosing, tx, or immunization, testing biologicals & home generated sharps waste

What disinfection/sterilent should be used on a blood spill?

Bleach

Identify the possible cause of SOB associated w/ using a TTO2

Catheter could be obstructed w/ secretions (remove & clean)

What disinfection/sterilent should be used on fiberoptic bronchoscope?

Cidex

Define sterilization

Complete destruction of all microorganisms

What would be considered the most appropriate delivery method for a back-up O2 system in the home?

Cylinders, when liquid or a concentrator is used

Containers & bottles should be labeled w/ the ____________ & ______________ & used within _____________ hours of opening

Date & time, 24 hrs

Describe the purpose of a smoking cessation program

Designed to assist individuals to quit smoking

Explain the operation of a pulsed-dose O2 delivery system

Device senses the start of inspiration & delivers O2 only during *inspiration*

Explain how the RT should prepare equipment that will be removed from the room of a pt who is HIV+

Double bag equipment prior to gas sterilization

Describe the proper procedure for removing contaminated equipment from an isolation area

Double-bagged & labeled before returning to cleaning area

What disinfection/sterilent should be used on O2 flowmeters?

ETO

What disinfection/sterilent should be used on the Bird Mark VII?

ETO

Describe a respiratory care protocol/therapist driven protocol (TDP)

Guidelines for admin resp care procedures to specific pt's

Define disinfection

Process of destroying vegetative pathogenic microorganisms

Describe 1 method for decreasing the chances of cross contamination & disease transmission from hospital equipment

Single pt use

Identify the parties that are involved in the updates to the goals, outcomes or plan of actions of an interdisciplinary plan of care

The individual who identified the problem, or by the team member w/ the expertise to address the problem

Explain the rationale for utilizing an O2 conservation device for home O2 therapy

To reduce costs & increase duration of cylinder flow

Explain how equipment can transmit organisms in the hospital

Transmit organisms as a result of inadequate disinfection or sterilization techniques or contamination

Describe proper disposal of sharps

Placed in puncture-resistant & tamper-proof containers

Describe the situation in which a pulsed-dose O2 delivery system would be indicated

Used in place of a flowmeter w/ low flow O2 devices (NC, reservoir cannula, TT catheter) & connected to a 50 psi gas source

Cylinders are indicated for pts _________________________

Who use small amounts of O2 intermittently

One-way valves or sampling chambers are recommended for use w/ _______________

Wright Respirometers & other equipment used w/ multiple pts

Describe how transtracheal O2 (TTO2) is admin to pt

Method of delivering low-flow therapy directly to airway by a surgically implanted catheter Bypasses nose/mouth by surgically inserting a soft, large-bore catheter into the trachea btwn 2nd-3rd tracheal rings Catheter is then secured around neck w/ a metal beaded chain necklace O2 is supplied via O2 connecting tubing