Miami Dade College
Medical Campus
School of Health Sciences
Respiratory Care Program
RET 2834 Respiratory Care Clinic 3
MIAMI DADE COLLEGE – MEDICAL CAMPUS
SCHOOL OF HEALTH SCIENCES
RESPIRATORY CARE PROGRAM
COURSE OUTLINE
RET 2834 RESPIRATORY CARE CLINIC 3
COURSE OVERVIEW:
RET 2834 is designed to allow the student to develop psychomotor skills related to critical care procedures of Respiratory Care. The student is responsible for all objectives in prerequisite and co-requisite courses. During the course, the student is provided with the opportunity to apply and discuss the theory and techniques as learned in prerequisite and co-requisite courses.
Clinic Days: ______Clinic Location: ______
Clinic Location: ______
Instructor: ______Office #: ______
Phone #: ______E-mail: ______
Office Hours: ______
EVALUATIONS:
1st Clinic Evaluation 35%
2nd Clinic Evaluation 45%
Quizzes 20%
RET 2834 TABLE OF CONTENTS
MODULE 1.0 PATIENT DATA EVALUATION
MODULE 2.0 PHYSICAL ASSESSMENT
MODULE 3.0 PERFORM PROCEDURES TO COLLECT CLINICAL INFORMATION
MODULE 4.0 ARTERIAL BLOOD GASES
MODULE 5.0 AIRWAY MANAGEMENT
MODULE 6.0 MECHANICAL VENTILATION
MODULE 7.0 PHARMACOLOGY
MODULE 8.0 PATHOPHYSIOLOGY
MODULE 1.0 PATIENT DATA EVALUATION
General Objective:
Upon completion of the module, the student will demonstrate an ability to review data in the patient record as integral part of the overall patient assessment.
Specific Objectives:
1.0 Collect, evaluate and discuss pertinent clinical information derived from the patient’s medical record:
1.1 Patient history e.g.,
· Present illness / · Progress notes· Admission notes / · Diagnoses
· Respiratory care orders / · DNR status
· Medication history / · Patient education (previous)
1.2 Physical examination relative to the cardiopulmonary system e.g., vital signs, physical findings
1.3 Laboratory data e.g.,
· CBC / · Culture and sensitivities· Electrolytes / · Sputum Gram stain
· Coagulation studies
1.4 Pulmonary function results
1.5 Blood gas results
1.6 Imaging studies e.g., Radiograph, CT, MRI
1.7 Monitoring data, e.g.,
· Respiratory, e.g., rate, tidal and minute volume, I:E / · Pulmonary compliance, airways resistance, work of breathing
· Noninvasive, e.g., pulse oximetry, Capnography, VD/VT, transcutaneous O2/CO2
1.8 Cardiac Monitoring, e.g.,
· ECG, heart rate, rhythm, BP / · Hemodynamic monitoring, e.g., CVP, PA pressure, cardiac output/index1.9 Maternal and Perinatal / Neonatal History and Data, e.g.,
· Apgar scores / · L/S ratio· Gestational age
1.10 Sleep study results e.g., diagnosis, treatment
MODULE 2.0 PHYSICAL ASSESSMENT
General Objective:
Upon completion of the module, the student will demonstrate the ability to perform a physical assessment.
Specific Objectives:
2.0 Collect, evaluate and discuss pertinent clinical information derived from a physical examination of the patient:
2.1 Interview the patient to determine:
a. Level of consciousness and orientation, emotional state, and ability to cooperate
b. Level of pain
c. Presence of dyspnea, sputum production, and exercise tolerance
d. Social history, e.g., smoking, substance abuse
e. Learning needs
2.2 Assess patient’s overall cardiopulmonary status by inspection to determine:
a. General appearance e.g.,
· Venous distention
· Edema
· Accessory muscle activity
· Chest wall movement
· Diaphoresis
· Cyanosis
· Breathing pattern
b. Airway assessment e.g., macroglossia, neck range of motion
c. Cough, sputum amount and character
d. Apgar score, gestational age, transillumination of the chest
2.3 Assess patient’s overall cardiopulmonary status by palpation
a. Pulse, rhythm, force
b. Asymmetrical chest movements, tactile fremitus, crepitus, tenderness, secretions in the airway, and tracheal deviation
2.4 Assess a patient’s overall cardiopulmonary status by percussion
2.5 Assess patient’s overall cardiopulmonary status by auscultation
a. Breath sounds
b. Heart sounds and rhythm
c. Blood pressure
2.6 Review a chest radiograph to determine
a. Quality of imaging e.g., patient positioning, exposure
b. Position of endotracheal or tracheostomy tube
c. Position of indwelling tubes and catheters
d. Presence of foreign bodies
e. Position of or change in hemidiaphragms or mediastinum
2.7. Review lateral neck radiographs e.g., epiglotitis, foreign body
MODULE 3.0 PERFORM PROCEDURES TO COLLECT CLINICAL INFORMATION
General Objective:
Upon completion of the module, the student will demonstrate the ability to perform procedure to collect pertinent clinical information.
Specific Objectives:
3.0 Perform procedure and interpret results for:
a. 12-lead ECG
b. Transcutaneous monitoring
c. Pulse oximetry and Capnography
d. Tidal volume, minute volume, vital capacity, and peak flow
e. Bedside spirometry e.g., FVC, FEV1
f. Arterial sampling – percutaneous or line
g. Arterialized capillary blood sampling
h. Timed walk test e.g., 6 min.
i. Oxygen titration with exercise
j. Blood gas / hemoximetry analysis
k. Hemodynamic monitoring, e.g., blood pressure, CVP
l. Lung mechanics e.g.,
Plateau pressure, Airway resistance, MIP/MEP, Compliance, SVC
n. Ventilator graphics, e.g., pressure / volume loop
o. Tracheal tube cuff pressure and/or volume
p. Auto-PEEP assessment
MODULE 4.0 ARTERIAL BLOOD GASES (ABG)
General Objective:
Upon completion of the module, the student will be able to perform procedures related to arterial blood gases.
Specific Objectives:
4.1 Develop a statement that explains the procedure in terms that the patient and/or family can understand
4.2 Collect and assemble necessary supplies to obtain an ABG sample via arterial puncture and arterial line
4.3 Locate, palpate and assess the sites most commonly used for ABG sampling
4.4 Perform the Modified Allen’s Test on a patient when obtaining samples from the radial artery
4.5 Demonstrate the safe procedure for obtaining an arterial sample and post-puncture care
4.6 Prepare an anaerobic blood gas sample for transport
4.7 Evaluate ABG sample results with regards to acid-base balance, ventilation status, and oxygenation status
4.8 Use the proper procedures to record and communicate the blood gas sample results
MODULE 5.0 AIRWAY MANAGEMENT
General Objective:
Upon completion of the module, the student will be able to perform procedures related to artificial airways.
Specific Objectives:
Specific Objectives:
5.6 Establish the need for and perform or assist with endotracheal intubation; inclusive of assessment and confirmation of endotracheal tube (ETT) placement, and securing the ETT
5.4 Establish the need for and aseptically perform endotracheal suctioning
5.7 Measure and adjust ETT or tracheostomy tube (TT) cuff pressure/volume
5.8 Establish the need for and perform ETT extubation or TT decannulation
5.9 Aseptically perform TT and stoma care
MODULE 6.0 MECHANICAL VENTILATION
General Objective:
Upon completion of the module, the student will be able to perform procedures related to continuous mechanical ventilation.
Specific Objectives:
6.1 Discuss the indications for continuous mechanical ventilation
6.2 Collect and assemble equipment and supplies necessary to initiate continuous mechanical ventilation and perform operational verification procedure (OVP)
6.3 Set up various modes of ventilation, e.g., AC-VC, AC-PC, SIMV-VC, SIMV-PC, PSV, PRVC, APRV, NIPPV (Bi-PAP), PEEP/CPAP and HFOV
6.4 Appropriately set ventilator alarms
6.5 Identify, analyze, and interpret waveforms and data generated by the patient-ventilator system
6.6 Perform calculations and maneuvers to verify and document the patient’s response to mechanical ventilation, e.g., dynamic compliance, static compliance (inspiratory pause), airway resistance, auto-peep (expiratory pause)
6.7 Perform required documentation for a patient-ventilator system check on a ventilator flow sheet
6.8 Make recommendations and modifications to the ventilator settings based on patient assessment and data collection, e.g., ABG
6.9 Administer aerosolized medications in-line with the ventilator circuit using MDI or SVN
6.10 Safely change the ventilator circuit
6.11 Collect, measure and evaluate the objective data required for determining ventilator discontinuation success, e.g., spontaneous breathing parameters, MIP, RSBI, P/F ratio, CBC, electrolytes, CS, VD/VT, etc.
6.12 Record relevant data in patient chart and appropriate departmental records, and communicate pertinent information regarding patient’s clinical status to appropriate members of the heath care team
6.13 Participate in physician/patient rounds
MODULE 7.0 PHARMACOLOGY
General Objective:
Upon completion of the module, the student will be able to properly administer and take appropriate actions related to respiratory medications and have an understanding of other medications patients receive.
Specific Objectives:
7.1 Identify and discuss respiratory medications including trade and generic name, route of administration, dosage, actions, indications, contraindications, hazards, and adverse reactions.
7.2 Identify all non-respiratory medications used by the assigned patient and the reason each is administered
7.3 Properly administer respiratory medications via MDI, DPI (if not on ventilator) or SVN
7.4 Monitor patient response to aerosolized medications and properly respond to adverse reactions
7.5 Record relevant data in patient chart and appropriate departmental records, and communicate pertinent information regarding patient’s clinical status to appropriate members of the heath care team
MODULE 8.0 PATHOPHYSIOLOGY
General Objective:
Upon completion of the module, the student will be able to discuss the pathophysiology related to the patient's treated during clinical rotations.
Specific Objectives:
8.1 Analyze available patient data (medical record, physical exam) and determine the pathophysiologic state of the patient
8.2 Describe the main pathologic features presented by the patient and their relationship to patient's disease or condition
8.3 Determine appropriateness of prescribed therapy and goals as they relate to the pathophysiologic state of the patient and recommend changes to the respiratory care plan when indicated
RET 2834
Respiratory Care Clinic 3
SKILLS LAB COMPETENCIES
Student Name ______MDC ID ______Date ______
RET 2834 SKILLS LAB – TASKS COMPLETION RECORD
Student Name: ______
Task description / DATE / Instructor InitialsMODIFIED ALLEN’S TEST / RADIAL ARTERY PUNCTURE
ASSIST WITH ORAL ENDOTRACHEAL TUBE INTUBATION
SECURING AN ORAL ENDOTRACHEAL TUBE – TAP ING
MEASURING ETT OR TT CUFF PRESSURE AND/OR VOLUME
TESTING VENTILATOR FUNCTION AND SETTING UP A VENTILATOR
(VOLUME CONTROL / PRESSURE CONTROL)
PATIENT-VENTILATOR SYSTEM ASSESSMENT
CHANGING PATIENT-VENTILATOR CIRCUIT
ADMINISTRATION OF AEROSOLIZED MEDICATION VIA MDI DURING CONTINUOUS MECHANICAL VENTILATION
ADMINISTRATION OF AEROSOLIZED MEDICATION VIA SVN DURING CONTINUOUS MECHANICAL VENTILATION
ASSESSMENT OF WEANING PARAMETERS ON A PATIENT (VE, f, VT, RSBI, MIP)
REMOVAL OF AN ORAL ENDOTRACHEAL TUBE FROM THE PATIENT'S AIRWAY – EXTUBATION
CARE OF THE PATIENT WITH A TRACHEOSTOMY TUBE
INITIATING A PEDIATRIC/NEONATAL VENTILATOR
(Accomplished in RET 2714L Perinatal and Pediatric Respiratory Care Lab)
INITIATING AND MANAGING HFOV
(Accomplished in RET 2714L Perinatal and Pediatric Respiratory Care Lab)
DCE ______DATE ______
Instructors will date and initial the Skills Lab – Task Sheet Completion Record as the student successfully completes each task. The Task Sheet Completion Record will be collected by the DCE and placed in the student’s record at the end of Skills Laboratory.
MODIFIED ALLEN’S TEST / RADIAL ARTERY PUNCTURE
STUDENT NAME: ______
Procedure / Satisfactory / Unsatisfactory1. Verifies physician’s order and reviews chart for pertinent data; e.g., contraindications for procedure, special precautions / ð / ð
2. Gathers the necessary equipment
a. Arterial blood gas kit (3 cc pre-heprinized syringe, 22-23 gauge needle, rubber stopper, sterile gauze, alcohol prep pad, band aid, biohazard bag, ice if a delay in analysis is expected) / ð / ð
3. Washes hands using the appropriate hand-hygiene procedure and initiates standard and/or transmission based precautions / ð / ð
4. Introduces self to patient, verifies the patient’s identity, identifies the patient’s learning needs, and explains the procedure in terms the patient/family can understand / ð / ð
5. Verify the oxygen adjunct, FiO2, or ventilator settings that the physician requested the blood gas be done on / ð / ð
6. Performs Modified Allen’s Test to verify collateral circulation to the hand on a conscious patient
a. Occlude the radial and ulnar arteries of one hand
b. Instruct the patient to open and close the hand at least 3 times until the palm of the hand become blanched (pale)
c. Release the ulnar artery – the palm should flush within 10 – 15 seconds. If it doesn’t perform the test on the other hand
d. Positive Allen’s test must be documented on the patient’s medical record and reported to the patient’s nurse and/or physician / ð / ð
7. Performs Modified Allen’s Test to verify collateral circulation to the hand on an unconscious patient
a. Occlude the radial and ulnar arteries of one hand
b. Raise the patient’s arm until the hand blanches
c. Lower the patient’s are to the level of the heart and release the ulnar artery – the palm should flush within 10 – 15 seconds. If it doesn’t perform the test on the other hand
d. Positive Allen’s test must be documented on the patient’s medical record and reported to the patient’s nurse and/or physician / ð / ð
8. Prepares the blood gas kit / ð / ð
9. Positions the patient’s arm and prepare the puncture site with the alcohol prep pad / ð / ð
10. Palpates the radial artery and performs the arterial puncture using a 45° angle with the bevel of the needle facing up / ð / ð
11. Obtains the appropriate amount of arterial blood, removes the needle and immediately compresses the artery / ð / ð
MODIFIED ALLEN’S TEST / RADIAL ARTERY PUNCTURE
12. Continues to compress the puncture site (5 minutes, more time is required for patients receiving anticoagulant therapy) until bleeding has stopped and dresses the site with a band aid / ð / ð
13. Expels air from the syringe, safely removes needle, caps the syringe using the rubber stopper, and thoroughly mixes the sample to ensure that it is heparinized / ð / ð
14. Completes the patient sample label (date, time, patient name, O2 adjunct, FiO2 or ventilator settings, puncture site, body temperature) and adheres it to the blood sample / ð / ð
15. Places the sample in a sealed biohazard bag (with ice if analysis will be delayed more than 10 minutes) / ð / ð
16. Correctly removes and disposes of PPE and washes hands / ð / ð
17. Ensures the safety and comfort of the patient before leaving patient's room / ð / ð
18. Records relevant data in patient chart and appropriate departmental records, and communicates pertinent information regarding patient’s clinical status to appropriate members of the heath care team / ð / ð
19. Transports the specimen to the Arterial Blood Gas Laboratory for analysis / ð / ð
RATING
Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: ______Date: ______
Comments/Remedial Action Plan: ______
______
______
Student Signature: ______Date: ______
ENDOTRACHEAL INTUBATION
STUDENT NAME: ______
Procedure / Satisfactory / Unsatisfactory1. Verifies physician’s order / ð / ð
2. Gathers the necessary equipment:
a. PPE
b. suction regulator
c. suction collection canister
d. Yankauer suction device
e. sterile H2O
f. bag-valve-mask (BVM)
g. oxygen source
h. flow meter
i. laryngoscope and blades
j. ETT with stylet
k. Surgical lubricant
l. CO2 detector
m. cloth tape
n. tongue blade
o. stethoscope
p. Cuff pressure manometer / ð / ð
3. Washes hands using the appropriate hand-hygiene procedure and initiates standard and/or transmission based precautions / ð / ð
4. Performs the appropriate assessment of the patient / ð / ð
5. Ensures that the patient is being hyperoxygenated and hyperventilated with 100% oxygen, using a bag-valve-mask (BVM) with an oropharyngeal airway in place / ð / ð
6. Selects the appropriate laryngoscope blade and tests the function of its lamp / ð / ð
7. Selects the appropriate sized endotracheal tube (ETT), verifies the function of the cuff and lubricates the tube / ð / ð
8. Inserts the stylet into the ETT, ensures that it is not protruding from the end of the tube or through the Murphy Eye (lateral lumen) / ð / ð
9. Positions the patient; places a rolled towel under the patient’s head, attempting to align the mouth, pharynx and larynx / ð / ð
10. Inserts and maneuvers the laryngoscope in an appropriate manner, suctioning if needed / ð / ð
11. Visualizes the glottis (requests cricoid pressure if needed) and advances the ETT through the glottis until the cuff passes the vocal cords (must complete within 15 seconds) / ð / ð
ENDOTRACHEAL INTUBATION