RESP 101 - Assessment and Caring for a Respiratory Patient

1. Evaluate Data in the patient record:
   1. Patient history (admission data, orders, meds, DNR, social history)
   2. Physical exam and trends relative to the cardiopulmonary system and trends (e.g. vitals, physical)
   3. Lab data (CBC, electrolytes, C&S, Sputum)
   4. Summarize major legal and medical consideration in medical records documentation
   5. Trends in noninvasive monitoring (pulse oximetry, vital signs)
2. Perform clinical assessment by interviewing patient to evaluate:
   1. Level of consciousness and orientation, emotional state, and ability to cooperate.
   2. Level of pain
   3. Presence of dyspnea, sputum production, and exercise tolerance
   4. Patient and family medical history (e.g. smoking history, environmental exposure)
   5. Activities of daily living
   6. Learning needs (e.g. literacy, learning style, culture)
3. Perform clinical assessment by inspection of patient to evaluate:
   1. General appearance
   2. Determine airway patency (HTCL, jaw thrust)
   3. Cough, sputum amount and characteristics
   4. Skin integrity (pressure ulcers, stoma site)
4. Perform clinical assessment by palpation of patient to evaluate:
   1. Pulse, rhythm, force
   2. Accessory muscle activity
   3. Asymmetrical chest movements, tactile fremitus, crepitus, tenderness, secretions in the airway and tracheal deviation
5. Perform clinical assessment by diagnostic chest percussion of patient.
6. Perform clinical assessment by auscultation of patient to evaluate:
   1. breath sounds
   2. blood pressure
7. Obtain patient data by performing and evaluating procedures to gather and evaluate clinical information:
   1. Noninvasive monitoring
   2. Peak flow
   3. Sputum induction
8. Obtain patient data by recommending diagnostic procedures:
   1. Lab procedures (e.g. blood tests for electrolytes, CBC, Sputum gram stain, Sputum culture and Sensitivity)
   2. Noninvasive monitoring, pulse oximetry
9. Assemble/Troubleshoot Equipment:
   1. Noninvasive monitoring devices (e.g., pulse oximeter)
   2. Oxygen devices
   3. Gas delivery (e.g., concentrator, liquid, cylinder, flowmeter, regulators, blenders, air compressor)
   4. Humidifiers
   5. Nebulizers
   6. Gas analyzers
   7. Artificial airways
   8. Suctioning equipment (e.g., regulator, canister, tubing, catheter)
   9. Manual resuscitation devices
   10. Lung expansion equipment for IS
   11. Aerosolized medication devices (e.g., MDI, spacers, holding chambers, DPI, soft mist inhalers)
10. Ensure infection control by demonstrating knowledge of:
    1. Using disinfection and high level sterilization techniques by selecting appropriate agents
       1. Critical versus non-critical (e.g., EKG machine, ventilators, laryngoscope blade, endoscopy scope, temperature probe, etc…)
    2. Ensure infection control by monitoring effectiveness (surveillance) of disinfection or sterilization procedures
    3. Ensure infection control by proper handling of biohazard materials
    4. Adhering to infection control policies and procedures (e.g., standard precautions, isolation)
11. Perform quality control procedures on flowmeters and gas analyzers.
12. Maintain a patient airway including the care of artificial airways:
    1. Positions patient to maintain a patent airway
    2. Establishes and manages a patient’s airway (nasopharyngeal, oropharyngeal)
       1. Introduces ETT, tracheostomy tube, and speaking valves
    3. Performing tracheostomy care
    4. Maintaining adequate humidification
    5. Demonstrates proper use of BVM by monitoring and modifying resuscitation based on patient’s response (e.g., VT, rate, flow)
13. Performing airway clearance and lung expansion techniques to include consideration of indications, hazards, and contraindications:
    1. Incentive Spirometry
    2. Assisted cough (e.g., huff, abdominal thrust)
    3. Suctioning (e.g., nasotracheal, oropharyngeal)
14. Support oxygenation and ventilation in acute, long-term and home care settings:
    1. Indications, hazards, and contraindications of oxygen and humidification therapy and bland aerosols
    2. Initiate and modify oxygen therapy devices (e.g., high and low flow)
    3. Performs oxygen calibration and analysis
15. Administer medications and specialty gases to include consideration of indications, hazards and contraindications:
    1. Heliox
    2. NO
    3. Bronchodilators
    4. Mucolytics
16. Ensure modifications are made to modalities (e.g., oxygen, humidification, medial gas, bland and medicated aerosol therapies, lung expansion, suctioning, artificial airways, and BVM) that are included in the respiratory care plan by:
    1. Treatment termination for life threatening adverse events
    2. Recommending initiation of treatment based on patient response
    3. Discontinuing treatment based on patient response
17. Make recommendations for change based on patient assessment:
    1. Patient positioning
    2. Oxygen therapy
    3. Humidification
    4. Airway clearance
    5. Hyperinflation
18. Conduct patient and family education
    1. Safety and infection control
    2. Home care and related equipment
    3. Lifestyle changes (e.g., smoking cessation, exercise)
    4. Disease management
19. Provide Respiratory Care Techniques in High risk situations for cardiopulmonary emergencies (e.g., rapid response team, transport inside hospital, and obstructed/lost airway)
20. Discusses and performs appropriate interprofessional communication

Laboratory data

Patient Assessment

Oxygen Transport

Oxygen Therapy

Regulating devices

Compressed gas storage

Oxygen Analyzers

Specialty gas therapy

Humidity therapy

Bland nebulizer therapy

Environmental therapy

Airway management (naso, oro and tracheostomy care)

Manual resuscitators

Airway clearance (suctioning, directed cough)

Bland nebulizer therapy

Lung expansion techniques (IS)

Infection Control

Cardiopulmonary emergencies

Evaluations

Patient Education

Effective interprofessional communication

Pharmacology overview (devices and medications)

Procedures:

1. Hand Washing
2. Patient Interview and History/Communication
3. Medical Records (Review of and Charting)
4. Physical Exam of the Chest (Inspection, Palpation, Percussion, Auscultation)
5. Vital Signs including Pulse Oximetry
6. Cylinders, Regulators and Flowmeters
7. Oxygen Therapy Devices (NC, SM, Partial and NRB Masks,VM and Membrane Cartridge)
8. Standard Precautions/Isolation Techniques
9. Humidification
10. Oxygen Analysis
11. Large Volume Nebulizers (Bland)
12. Medicated Aerosols (SVN, MDI, DPI and Slow Mist)
13. Peak Flow
14. Incentive Spirometry
15. Directed Cough Techniques
16. Airways (Oro and Nasopharyngeal Airways)
17. Manual Resuscitation
18. Tracheostomy Care
19. Suctioning
    TOTAL PROCEDURES: 19