RESP 107 - Clinical Applications of Assessment and Caring for a Respiratory Patient

1. Complete all required hospital clinical orientation policies and procedures (OSHA Blood borne Pathogens, HIPAA, Fire Safety, Electrical)
2. Retain knowledge, skill and competencies from pre-requisite courses.
3. Demonstrate proper patient safety (body mechanics)
4. Review policies and procedures for the Respiratory Care Department
5. Explain the various methods of patient identification within the hospital setting
6. Evaluate data in the patient record
   1. Patient history (admission data, orders, meds, DNR, social history)
   2. Physical exam relative to the cardiopulmonary system (vitals, physical findings)
   3. Lab data (CBC, electrolytes, C&S, Sputum)
   4. Monitor trends (fluid balance, vital signs, and pulse oximeter)
   5. Determination of patient’s pathophysiological state
7. Perform clinical assessment by interviewing 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. Learning needs (literacy, culture and preferred learning styles)
   5. Patient and family medical history (e.g., smoking history, environmental exposure)
   6. Activities of daily living
8. Perform clinical assessment by inspection of patient to evaluate:
   1. General appearance
   2. Characteristics of the airway (patency)
   3. Cough, sputum amount, color and consistency
   4. Skin integrity (pressure ulcer, stoma site)
9. Perform clinical assessment by palpation of patient to evaluate
   1. Heart rate, rhythm and force
   2. Respiratory accessory muscle activity
   3. Asymmetrical chest movements, tactile fremitus, crepitus, tenderness, secretions in the airway and tracheal deviation
10. Perform clinical assessment by diagnostic chest percussion of patient.
11. Perform clinical assessment by auscultation of patient to evaluate:
    1. Heart rate, rhythm
    2. Breath sounds
    3. Blood pressure
12. Obtain patient data by performing and evaluating procedures to gather and evaluate clinical information:
    1. Noninvasive monitoring (pulse oximetry)
    2. Peak flow
    3. Sputum induction
13. Obtain patient data by recommending diagnostic procedures
    1. Blood tests (e.g. electrolytes, CBC)
    2. Sputum for gram stain, culture and sensitivities
    3. Non-invasive monitoring (pulse oximetry)
14. Assemble and troubleshoot equipment:
    1. Medical gas delivery interfaces (mask, cannula, heated high-flow nasal cannula)
    2. Medical gas delivery, metering, and/or clinical analyzing devices (concentrator, liquid system, flowmeter, regulator, gas cylinder, blender, air compressor, gas analyzers)
    3. Humidifiers
    4. Nebulizers
    5. Metered dose inhalers (MDI), spacers and valved holding chambers
    6. Dry powdered devices
    7. Resuscitation devices (self-inflating resuscitator, flow-inflating resuscitator, AED)
    8. Suctioning equipment (regulator, canister, tubing catheter)
    9. Gas delivery, metering and clinical analyzing devices (cylinder, flowmeter, regulators)
    10. Hyperinflation devices
    11. Non-invasive monitoring devices (pulse oximetry, capnometer)
15. Ensures infection control
    1. Adhering to infection prevention policies and procedures
    2. Adhering to disinfection policies and procedures
    3. Proper handling of biohazardous materials
16. Perform quality control procedures on flowmeters and gas analyzers
17. Maintain a patent airway by providing adequate humidification
18. Performing airway clearance and lung expansion techniques to include consideration of indications, hazards, and contraindications:
    1. Suctioning for example nasotracheal, oropharyngeal, artificial airways
    2. Assisted cough (huff, quad)
    3. Hyperinflation (IS)
19. Supports oxygenation by initiating and adjusting oxygen therapy (low flow and high flow, membrane)
20. Administer aerosolized medications to include consideration of indications, hazards, and contraindications
21. Ensure modifications are made to modalities (e.g., oxygen, humidification, bland and medicated aerosol therapies, hyperinflation, 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
22. Recommends pharmacologic interventions by using classifications, indications, hazards, contraindications and dosages for various agents (e.g., bronchodilators, anti-inflammatory drugs, mucolytics and proteolytics)
23. Utilizes evidence based medicine principles
    1. Classification of disease severity
    2. Recommendations for changes in a therapeutic plan when indicated
24. Provides respiratory care in cardiopulmonary emergencies (cardiac arrest, obstructed airway)
    1. Medical emergency team (MET)/rapid response team
25. Maintain records specifying therapy administered, date, time, frequency of therapy, medication, and vital signs (paper or electronic charting)
26. Identify the appropriate way to communicate with hospital personnel (i.e., physicians, nurses, respiratory care practitioners, and other allied health professionals)
27. 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

Hospital policies and procedures orientation, hospital orientation

Standard Precautions and Infectious Disease Protocols

Health Insurance Portability and Accountability Act

Respiratory care department policies and procedures

Documentation in a patient’s medical record

Patient identification, observation and interaction

Interprofessional personnel communication

Patient assessment

Cleaning and disinfection

Oxygen therapy

Hyperinflation therapy

Humidity therapy

Bland aerosol

Medicated aerosol (SVN, MDI, DPI, Slow Mist Inhaler)

Manual Resuscitation

Evaluations

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, 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. Incentive Spirometry
14. Airways (Oro and Nasopharyngeal Airways)
15. Tracheostomy Care
16. Suctioning
17. Peak Flow
18. Manual Resuscitation
    TOTAL PROCEDURES: 18