RCP 715 - Resp Therapy Practicum IV

1. Perform routine patient care techniques involved in respiratory care unsupervised.
   1. Perform intermittent positive pressure breathing therapy.
   2. Perform postural drainage and percussion.
   3. Perrform hand held aerosol therapy.
   4. Supervise use of metered dose inhalers.
   5. Administer medical gas therapy.
   6. Perform arterial puncture and analysis of blood specimens.
   7. Perform pulse oximetry.
2. Perform routine monitoring of persons being supported on mechanical ventilation.
   1. Assess patient response to mechanical ventilation using noninvasive clinical assessments.
   2. Utilize capnometry to evaluate patient response to mechanical ventilation.
   3. Utilize pulse oximetry to evaluate patient response to mechanical ventilation.
   4. Utilize hemodynamic monitoring to evaluate patient response to mechanical ventilation.
   5. Evaluate patient ability to be weaned from mechanical ventilation.
   6. Perform studies to determine optimum PEEP.
3. Change ventilator parameters and modes under supervision.
   1. Identify situations in which parameter and/or mode changes are indicated.
   2. Suggest appropriate changes to physican.
   3. Verify written physican order for changes of parameter or mode.
   4. Assure that ordered change is appropriate to accomplish desired objective(s).
   5. Evaluate patient baseline status.
   6. Make ordered changes of mode/parameter.
   7. Readjust other parameters and alarms as needed.
   8. Evaluate patient response to change(s).
   9. Evaluate appropriateness of changes.
   10. Document changes made and patient response.
   11. Suggest modifications based on patient response to changes made.
4. Change ventilator circuits with supervision and assistance.
   1. Identify when circuits need changed.
   2. Obtain all needed equipment and supplies.
   3. Provide for patient ventilation during circuit change.
   4. Assess baseline status of patient.
   5. Change circuit utilizing Universal Precautions.
   6. Test new circuit to assure patency.
   7. Reestablish patient ventilation.
   8. Evaluate circuit/ventilator function and patient condition.
   9. Correct any problems identified.
   10. Document circuit change.
5. Wean persons from mechanical ventilators.
   1. Determine if indication for initiation of mechanical ventilation has been reversed.
   2. Assess psychological readiness for weaning.
   3. Evaluate physical readiness for weaning.
   4. Determine appropriate method for warning from ventilation.
   5. Initiate weaning.
   6. Monitor patient response to weaning.
   7. Modify weaning to reduce ventilator share of load as tolerated by patient condition.
   8. Document weaning which has been performed.
6. Explain the rationale for ventilaor mode and parameter changes ordered by physicans.
   1. Identify changes ordered.
   2. Assess patient.
   3. Evaluate clinical and laboratory data pertinent to changes ordered.
   4. Determine clinical goals/objectives for ordered changes.
   5. Explain how the ordered changes will accomplish the clinical goal(s).
7. Interpret information from physiologic monitors used in critical care settings.
   1. Obtain data from cardiac monitors, pulse oximeters, transcutaneous monitors, hemodynamic monitors and blood pressure monitors.
   2. Evaluate the quality of data obtained from physiologic monitors.
   3. Relate the information obtained from the monitors to the clinical picture of the patient.
   4. Explain the significance of physiologic data to patient care.
   5. Use physiologic data to suggest modifications in patient care.
8. Manage time to complete all assigned care at the correct time.
9. Sample arteial and mixed venous blood percutaneously and from indwelling lines.
   1. Verify ordered blood sampling.
   2. Verify need for arterial blood gas/Ph analysis.
   3. Determine needed method for blood sampling.
   4. Obtain blood sample.
   5. Utilize universal precautions.
   6. Handle samples correctly.
10. Analyze blood and gas samples to determine pH, PC02, PO2, HCO3, THb, O2Hb, COHb and MetHb.
    1. Assure analyzer(s) are calibrated properly.
    2. Introduce samples correctly.
    3. Observe analysis to assure no problems occur.
    4. Verify appropriateness of data in relation to patient clinical situation.
    5. Report data obtained from analysis.
    6. Utilize universal precautions in handling of samples.
11. Recommend therapeutic interventions based on Blood Gas/pH data.
    1. Interpret blood gas/pH data.
    2. Relate blood gas/pH data to clinical situation.
    3. Identify interventions which would positively impact acid base and oxygenation status.
    4. Recommend changes in ventilation and oxygenation to correct acid base and oxygenation problems.
12. Protect patients and self from infectious disease.
    1. Explain the different types of isolation.
    2. Wash hands properly.
    3. Utilize proper personal protective equiment in patient care.
    4. Follow established guidelines in providing care to persons in isolation.
    5. Implement universal precautions when providng patient care.
13. Utilize techniques to maintain bronchail hygiene and airwar patency.
    1. Intubate persons as needed.
    2. Humidify inspired gases to maintain hygiene.
    3. Suction natural and artificial airwars.
    4. Assist physicians in performance of bronchoscopy.
    5. Evaluate persons to determine readiness for extubation.
    6. Extubate persons when indicated.
    7. Monitor patient tolerance of weaning.