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Decreasing Accidental Mortality of Ventilator-Dependent Children at Home: A Call to Action

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doi: 10.1097/NHH.0b013e318247202b
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Decreasing Accidental Mortality of Ventilator-Dependent Children at Home: A Call to Action


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GENERAL PURPOSE: To provide registered professional nurses with an understanding of the accidental mortality of ventilator-dependent children at home and methods to decrease that mortality.

LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to:

  1. List causes of accidental mortality of and care disruptions for ventilator-dependent children at home.
  2. Discuss nurses' skills assessment at the Ventilator Assisted Children's Home Program (VACHP) and training strategies to decrease accidental mortality of ventilator-assisted children.
  1. In the VACHP, a child in the Chronic Lung Disease category could have
    1. aspiration pneumonia.
    2. hypoxic ischemic encephalopathy.
    3. cardiac disease.
    4. central hypoventilation syndrome.
  2. In the last 20 years the accidental death rate of VACHP children has been
    1. 7.4%.
    2. 11.9%.
    3. 23.1%.
    4. 27.5%.
  3. The primary causes of preventable death in ventilator-dependent children at home include all of the followingexcept
    1. inadequate training.
    2. improper response to emergencies.
    3. inadequate equipment.
    4. lack of vigilance by clinicians.
  4. VACHP families indicated home care was frequently disrupted by
    1. short shifts and multiple nurses each day.
    2. the lack of available nurses.
    3. required equipment upgrades.
    4. high turnover among the staff.
  5. When VACHP assessed the skill level of their nurses, they found deficiencies in
    1. tracheostomy care (59%).
    2. respiratory assessment (85%).
    3. tracheostomy tube change (92%).
    4. suctioning of the tracheostomy (95%).
  6. One hundred percent of the nurses were deficient in what area?
    1. troubleshooting ventilator alarms
    2. tracheostomy emergencies
    3. CPR with a tracheostomy
    4. tracheostomy string change
  7. Introduction to training methodology for ventilator care on Day 2 included
    1. proper pediatric respiratory assessment.
    2. CPR for the child with a tracheostomy.
    3. avoiding ventilator alarms.
    4. psycho-social aspects of home care.
  8. VACHP research revealed nurses
    1. in home care usually have skills assessed via return demonstration.
    2. usually have tracheostomy experience in hospital settings under supervision.
    3. have specific training in CPR on children with tracheostomies.
    4. may not receive ongoing training in ventilator care.
  9. The VACHP nurses who identified themselves as experienced in tracheostomy home care averaged what score on a pre-training assessment?
    1. 60%
    2. 70%
    3. 80%
    4. 90%
  10. As noted by the authors, skill level requires validation before providing autonomous home care by
    1. written examination.
    2. return demonstration.
    3. verbal examination.
    4. simulator proficiency.
  11. According to Schmalenberg et al. (2008), structures that foster clinical competency in home care nurses include all of the followingexcept
    1. educational training.
    2. self-assessment.
    3. patient care review sessions.
    4. application of evidence-based best practices.
  12. Corbridge et al. (2010) report that students in their program greatly preferred
    1. simulation training.
    2. online teaching.
    3. CD-ROM instruction.
    4. group instruction.
  13. In the scenario of a child with a mucous plug, the first step for the nurse is to
    1. deliver manual breaths via resuscitation bag.
    2. place the child back on ordered equipment.
    3. report the incident to the MD.
    4. suction the child.
  14. If the mucous plug is not cleared by the initial intervention, the nurse should
    1. deliver manual breaths via a resuscitation bag.
    2. dial 911 and wait for Emergency Services to arrive.
    3. change the tracheostomy tube.
    4. perform tracheal suctioning.
  15. In addition to training received at the agency, each VACHP nurse should be observed
    1. suctioning a tracheostomy.
    2. changing a tracheostomy tube.
    3. using a resuscitation bag.
    4. performing a respiratory assessment.
  16. Boroughs & Dougherty (2011) note that since 2000 nursing research has led to alterations in
    1. respiratory medications.
    2. preventing aspiration.
    3. suctioning.
    4. securing tracheostomies.
  17. The Visiting Nurse Association of America (2008) reported what staff vacancy rate?
    1. 5%
    2. 10%
    3. 15%
    4. 20%
  18. Usually cardiac arrest in infants and children is the terminal result of
    1. a primary cardiac cause.
    2. congenital anomalies inconsistent with life.
    3. end-stage kidney failure.
    4. progressive respiratory failure.
  19. Asphyxia in children progresses from systemic hypoxia to
    1. hypertension.
    2. bradycardia.
    3. hypercapnea.
    4. acidosis.
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