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Clinical - Respiratory Care RSPT-2361 Full Term Spring 2015 Section 002.12425 3-0-15 Credits 01/20/2015 to 05/16/2015 Modified 01/28/2015  Meeting Times

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Clinical - Respiratory Care RSPT-2361 Full Term Spring 2015 Section 002.12425 3-0-15 Credits 01/20/2015 to 05/16/2015 Modified 01/28/2015  Meeting Times St. Philip's College · - · RSPT-Respiratory Care Tech Clinical - Respiratory Care RSPT-2361 Full Term Spring 2015 Section 002.12425 3-0-15 Credits 01/20/2015 to 05/16/2015 Modified 01/28/2015 Meeting Times Mondays & Fridays 6:45 am - 2:45 pm Area Assigned Hospitals Contact Information Email: [email protected] Office: CHP 330E Phone: (210) 486-2457 Instructor Campus Office Hours: TUESDAYS 8:30 a.m. - 9:30 a.m., 4:15 p.m. - 5:00 p.m. WEDNESDAYS 8:30 a.m. - 11:30 a.m., 1:00 p.m. - 4:30 p.m. THURSDAYS 8:30 a.m. - 9:30 a.m., 1:00 p.m. - 5:00 p.m. Additional Days & Times By Appointment Materials TEXTBOOKS AND REQUIRED MATERIALS Clinical Practitioner’s Pocket Guide to Respiratory Care, 7th Edition, Dana F. Oakes, Health Educator Publications, Inc. ISBN: 978-0-932887-31-3. Hemodynamic Monitoring: A Bedside Reference Manual, 2010 Edition, Dana F. Oakes, Health Educator Publications, Inc., ISBN: 978-0- 932887-41-2 Oakes’ Neonatal/Pediatric Respiratory Care: A Critical Care Pocket Guide, 2009 Edition, Dana F. Oakes, Health Educator Publications, Inc., ISBN: 978-0-932887-39-9 Respiratory Care Program Level II Clinical Competency Evaluation Packet – to be supplied by instructors. Ceil Blue Scrub outfit Stethoscope 1 of 32 Bandage Scissors AH Clinical Uniform Patch Lab Coat - waist length Clipboard - one that has storage capacity preferred White athlectic shoes Access to ACES files containing Clinical Competency Evaluation Manual & Clinical Rotation Forms/Documents Description A health-related work-based learning experience that enables the student to apply specialized occupational theory, skills, and concepts. Direct supervision is provided by the clinical professional. Prerequisite(s) INRW 0420 MATH 0320 Objectives Course Objectives by Area of Rotation: Adult Intensive Care Unit (AICU) 1. Collect, assess, and trend the following patient data: a. patient history, admitting diagnosis/present illness, physician orders, progress notes, etc. b. level of consciousness c. orientation to time, place, and person d. chest inspection, to include appearance, configuration, palpation, percussion, auscultation. e. presence of dyspnea/work of breathing f. sputum production g. breath sounds h. electrocardiogram i. blood pressure j. heart rate k. respiratory rate l. pulse oximetry m. fluid intake/output n. nutritional status 2 of 32 2. Collect and assess the following laboratory data: a. CBC b. chemistry c. electrolytes d. coagulation studies e. gram stain & C&S for sputum, urine, blood, etc. f. arterial blood gases (collect, analyze, interpret & make recommendations) g. pulmonary function testing 3. View and assess chest and upper airway (lateral neck) radiographs for the following: a. normal radiographic findings and landmarks b. position of all tubes & lines (NG/feeding, Swan-Ganz, pacemaker, CVP, chest tubes, etc.) c. presence of or changes in pneumothorax (pleural air/fluid) d. presence of or changes in subcutaneous emphysema/extra pulmonary air e. consolidation/atelectasis f. pulmonary infiltrate/pulmonary edema g. position of, or changes in hemidiaphragms, mediastinal shift h. hyperinflation i. presence/position of foreign bodies j. upper airway obstruction k. CT/MRI procedures 4. Perform/monitor and document the following patient, airway, & ventilator competencies: a. oropharyngeal/nasopharyngeal airway placement, including appropriate selection of equipment. b. endotracheal/tracheostomy tube placement (evaluates for proper position and secure). c. tracheal tube cuff pressure/volume monitoring (cuff inflation/deflation techniques). d. airway suctioning to include equipment utilized, patient reaction, results obtained (specimen collection), and instillation of irrigant solution. e. ventilator monitoring to include mode, mechanical/spontaneous tidal volume, FIO2, PEEP/CPAP, flow rate, minute volume, PIP, I:E ratio, compliance, airway resistance, MAP, all alarm settings. f. volume, time, and flow waveform data g. troubleshoot/modify ventilator and settings based upon patient response and physician order. 3 of 32 h. ventilator weaning criteria to include spontaneous tidal volume, vital capacity, MIP/NIF, FIO2, weaning device utilized, patient monitoring to include vital signs & hemodynamic monitoring, and VD/VT ratio calculation. i. extubation procedures to include endotracheal extubation & change-out of tracheostomy tube or tracheostomy care procedure. j. apply computer technology to patient management (waveform analysis, documentation, etc.) k. chest tube and pleural drainage systems 5. Monitor, assess, and trend the following patient hemodynamic data: a. CVP, MAP, PAP, PCWP (define, monitor, assess, and trend) b. cardiac output c. cardiac index d. pulmonary vascular resistance/systemic vascular resistance e. stroke volume f. shunt studies g. mixed venous O2 (perform, assess, and trend) h. arterial-venous oxygen content difference (calculate and trend) i. observe triple lumen catheter systems j. observe arterial catheter systems k. observe ECG monitoring systems l. recognize cardiac arrhythmias and discuss their treatment 6. Perform , assess, and document the following therapeutic procedures in the critical care setting: a. MDI with spacer and with mechanical ventilation, including equipment selection and correction of malfunction b. SVN therapy (w & w/o mechanical ventilation), including equipment selection and correction of malfunction. c. humidification therapy (w & w/o mechanical ventilation), including equipment selection and correction of malfunction. d. high and low flow oxygen therapy, including equipment selection and correction of malfunction e. lung inflation therapeutics to include incentive spirometry, IPPB, & deep breathing exercises, including equipment selection and correction of malfunction. f. secretion mobilization procedures (cough techniques, CPT, etc.) g. BiPAP 7. Additional Adult ICU objectives: 4 of 32 a. observe and/or assist physician with bronchoscopy procedure. b. observe and /or assist physician with intubation/tracheostomy procedure. c. observe and/or assist physician with thoracentesis procedure d. observe and/or assist physician with insertion of lines & catheters. e. observe bedside for resuscitation devices (bag/mask), including appropriate selection and correction of malfunction. Adult ICU Rotation Required Activities: 1. Select a minimum of one (1) mechanically ventilated patient per clinical day with the assistance of your instructor and/or the therapist assigned to the ICU. 2. Assess your assigned patient(s) with the provided assessment worksheets at least once each clinical day. 3. Perform all respiratory care duties (ventilator checks, suctioning, circuit changes, humidification, therapeutics, ABG’s, view x-rays, etc.) on your patient per the facilities SOP or at the request of your instructor. 4. Perform therapeutics on additional patients within the ICU as assigned. 5. Perform additional respiratory care competencies as assigned by your instructor or therapist. 6. Submit a minimum of one (1) patient assessment and one (1) SOAP on an assigned patient each clinical day. Adult ICU Grading Criteria: Performance Evaluation 20% Clinical Competencies 30% Patient Assessment 25% SOAP Documentation 25% 100% Neonatal Intensive Care Unit (NICU) 1. Collect, assess, and trend the following patient data: a. patient history (or maternal history if newborn), admitting diagnosis/present diagnosis, physician orders, progress notes, etc. b. chest inspection; to include chest movement (symmetrical/non-symmetrical), configuration, auscultation (lungs and heart). c. sputum description d. bilateral breath sounds e. electrocardiogram f. echocardiogram (if available) g. blood pressure h. heart rate 5 of 32 i. respiratory rate j. pulse oximetry k. apnea/bradycardia episodes l. fluid intake/output m. nutritional intake (amount of TPN, formula) n. head sonogram (if available) 2. Collect and assess the following laboratory data: a. CBC (if available) b. chemistry c. HCT and HGB (if CBC not available) d. coagulation studies (if available) e. gram stain, culture & sensitivity (sputum, blood, & urine) f. arterial blood gases (results, interpretation, recommendations) 3. View and assess chest/abdomen radiographs for the following: a. normal radiographic findings and landmarks b. position of all tubes and lines (OG/feeding, chest tubes, ETT, etc.) c. presence of or changes in pneumothorax (pleural air/fluid) d. presence of or changes in subcutaneous emphysema/extra pulmonary air e. consolidation/atelectasis f. pulmonary infiltrate/pulmonary edema g. position of or changes in hemidiaphragms/mediastinal shift h. hyperinflation i. heart size, location, shape j. upper GI contrast studies (i.e., contrast study to R/O reflux) k. upper airway abnormalities (i.e., T/E fistula, tracheal stenosis) l. CT/MRI procedures 4. Perform/monitor and document the following patient, airway and ventilator competencies: a. nasopharyngeal prongs (patency, select appropriate size, proper insertion, securing). 6 of 32 b. endotracheal/tracheostomy tube placement (proper placement and secure). c. airway suctioning to include equipment utilized, patient response, results obtained, specimen collection, and instillation of irrigant solution (normal saline). d. ventilator monitoring to include: AVEA: mode, flow rate, vent rate, spontaneous respiratory rate, inspiratory time, I:E ratio, PIP, MAP, PS, PEEP, FIO2, upper pressure limit, sensitivity,, inspiratory time %, pause time %, inspiratory rise Time %, minute volume, inspiratory tidal volume, expiratory tidal
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