RESP 102 - Advanced Assessment and Care of a Cardiopulmonary Patient

1. Retained knowledge, skills, and competency from RESP 101 - Assessment and Caring for a Respiratory Patient .
2. Evaluate data in the patient record:
   1. Lines, drains and airways (artificial airways)
   2. Laboratory results (CBC, electrolytes, coagulation studies, Sputum C&S)
   3. Blood gas analysis and/or hemoximetry (co-oximetry) results
   4. PFT results (spirometry, lung volumes, DLCO)
   5. Trends in monitoring results (pulmonary mechanics and capnography)
3. Perform clinical assessment by auscultation to obtain heart sounds and rhythm.
4. Perform procedure to gather clinical information to include indications, hazards, contraindications and equipment gathering:
   1. 12 lead ECG
   2. Noninvasive monitoring (capnography)
   3. Mechanics of spontaneous ventilation (VT, minute volume, maximal inspiratory pressure and vital capacity)
   4. Blood gas sample collection
   5. Cuff management
   6. Spirometry outside or inside a pulmonary function laboratory
   7. Test of respiratory muscle strength (MIP/MEP)
5. Evaluate procedure results:
   1. 12 lead ECG
   2. Noninvasive monitoring (capnography)
   3. Mechanics of spontaneous ventilation (VT, minute volume, maximal inspiratory pressure and vital capacity)
   4. Blood gas sample collection
   5. Cuff management
   6. Spirometry outside or inside a pulmonary function laboratory
   7. Test of respiratory muscle strength (MIP/MEP)
6. Recommend diagnostic procedures:
   1. Pulmonary function testing
   2. Noninvasive monitoring (capnography)
   3. Blood gas and/or hemoximetry (co-oximetry)
   4. ECG
7. Assemble and troubleshoot equipment:
   1. CPAP/NPPV with patient interfaces
   2. Patient breathing devices
   3. Hyperinflation devices
   4. Secretion clearance devices
   5. Portable spirometer
   6. Noninvasive monitoring devices (capnometer)
8. Perform quality control procedures:
   1. Spirometry results
   2. Lung volume results
   3. Noninvasive monitors
9. Maintain a patent airway including the care of artificial airways:
   1. Proper positioning of a patient
   2. Establishes and manages a patient’s airway (Tracheostomy tube, laryngectomy tube, exchanging artificial airways)
10. Performs airway clearance and lung expansion:
    1. Postural drainage, percussion, or vibration
    2. Mechanical devices (high frequency chest wall oscillation, intrapulmonary percussive ventilation, vibratory PEP, insufflation/exsufflation).
    3. Hyperinflation therapy
11. Support oxygenation and ventilation:
    1. Initiating and adjusting oxygen therapy
    2. Minimizing hypoxemia (patient positioning, secretion removal)
    3. Initiating and adjusting mask or nasal CPAP and noninvasive through mechanical ventilator settings
12. Administer aerosolized medications to include consideration of indications, hazards and contraindications:
    1. Bronchodilators
    2. Mucolytics/proteolytics
    3. Steroids
13. Ensure modifications are made to the respiratory care plan modalities (pharmacology, lung expansion, bronchial hygiene, and artificial airways)
    1. Treatment termination for life threatening adverse events
    2. Recommend starting treatment based on patient response
    3. Discontinuing treatment based on patient response
14. Make recommendations for changes based on patient assessment:
    1. Patient position
    2. Airway clearance
    3. Hyperinflation
15. Make recommendations for pharmacological interventions based on patient assessment:
    1. Bronchodilators
    2. Anti-inflammatory
    3. Mucolytics and proteolytics
    4. Changes to drug, dosage, administration frequency, mode, or concentration
16. Provide respiratory care in high-risk situations for cardiopulmonary emergencies (e.g., rapid response team, obstructed/lost airway, etc…)
17. Assist a physician/provided in performing tracheostomy.

Review aerosol therapy

Pharmacology

Hyperinflation Therapy (IPPB, PEP, PAP)

CPAP, NPPV

Arterial Blood Gas

Bronchial hygiene therapy (CPT, Flutter, HFCWO, PAP, Acapella, percussors and Autogenic Drainage)

Introduction to pulmonary function testing and quality control

Tracheostomy tube change

Capnography

Assist Physician with tracheostomy procedure

12-Lead EKG

Evaluations

Procedures:

1. Hyperinflation
   1. EzPAP
   2. CPAP
2. Bronchial Hygiene
   1. CPT
   2. Vibratory Pep
   3. MetaNeb (as determined by campus location)
3. Spirometry
4. Weaning Parameters
5. 12 Lead EKG
6. Radial Artery Blood Gas Puncture
7. Tracheostomy Tube Change
8. CPAP/NPPV
9. Sputum inductions
10. Capnography (nasal)
    TOTAL PROCEDURES: 13