RESP 303 - Introduction to Respiratory Care Procedures (5 credit hours)
Bethene L. Gregg, PhD, RRT
By appointment on Fridays
10 - 12 Tuesday and Thursday
1020/21 Orr Major
Monday or Wednesday 9 - 12 or 1 - 4
Foundations of Respiratory Care, Wyka, Mathews, & Clark (eds.) 2002. Delmar, Albany, NY.
Mosby's Respiratory Care Equipment. Pilbeam and Cairo, 2004, Mosby, Inc., St. Louis Mo.
Egan's Fundamentals of Respiratory Care. Scanlan, Wilkins, and Stoller (eds.) 1999 Mosby, Inc., St. Louis Mo.
This course introduces the fundamental theory, equipment, and procedures of respiratory care. Students will be expected to learn why, when, and how to safely administer medical gases, humidity and aerosol therapy, intermittent positive pressure breathing (IPPB), incentive spirometry (IS), and chest physical therapy (CPT) aka postural drainage and clapping (PD & C). Patient assessment techniques and basic skills of suctioning, CPR, and airway management will also be covered in this course.
Students are expected to develop and PRACTICE AS NEEDED the skills and procedures covered in class. Procedures are to be practiced whenever possible under simulated clinical conditions. When there are several equipment stations set up during a lab session, it is the student's responsibility to rotate through all the stations and to arrange additional practice time outside of the scheduled lab times AS NEEDED. Proficiency in all procedural psychomotor skills is expected prior to actual patient application on the clinic and will be assessed by performance skill evaluations or check-offs. Students are expected to read the assigned lab exercises prior to lab time and work as independently as possible (ie. think about it before you ask a question). Students are responsible for gathering the equipment prior to lab when necessary and for storing the non-disposable and discarding the used disposable equipment after lab. Practice lab exercises, performance checkoffs and other course materials are listed under the lab. Quizzes accompany each unit and accessed under Content --> Quizzes.
Written Comprehensive FINAL - There will be no retakes for unsatisfactory performance on the Written Comprehensive Final. There will be no make-up exam for unexcused absences.
LAB PRACTICUM FINAL - Each student will be scheduled for a 30 minute lab Practicum examination. There will be no retakes for unsatisfactory performance on the LAB FINAL. There will be no make-up exams for unexcused absences. Due to time restrictions of finals week, any student over 10 minutes late will be counted absent and not permitted to reschedule the LAB Practicum FINAL. Failure to take the Lab Practicum will result in a 25% drop in grade for the course.
THERE WILL BE NO RETAKES ON LAB FINAL!
Learning assistance, academic performance enhancement, and psychological services at KUMC are free, confidential, and available at Student Counseling & Educational Support Services by calling 913-588-6580 or visiting G116 Student Center.
Any student in this course who needs an accommodation because of a disability in order to complete the course requirements should contact the instructor or the Equal Opportunity / Disability Specialist (913-588-7813, TDD 913-588-7963) as soon as possible.
Grades: Final grades will be based on the following:
20% Attendance, Threaded Discussion, Performance Skills (Lab Checklists) and Quizzes including Pop Quizzes.
15% Midterm Examination
15% Lab Midterm
25% Comprehensive Final Examination
25% Lab Practicum Final
A > 87% B 79 - 87% C 70 - 78%
Students must achieve a "C" or better to pass this course and continue in the program. Attendance is required.
P 303 Objectives
- Identify the different medical gases according to uses, physical characteristics, and degree of flammability.
- Calculate cylinder duration time.
- Calculate duration of a liquid reservoir.
- Match the threaded connection to its safety system.
- Describe hydrostatic testing.
- Match cylinder standards to the appropriate regulatory agencies of the standards.
- Identify true statements describing fractional distillation of oxygen.
- Identify components of a bulk oxygen and piping system.
- Flowmeter, Regulator Objectives
- Describe three factors that affect the rate of gas flow through on orifice.
- Describe the function of a pressure regulator.
- Describe the effect of laminar versus turbulent flow on airway resistance.
- Relate Poiseuille's law to factors increasing airway resistance.
- Describe the normal contributions to airway resistance.
- Write the equation for Raw.
- Discuss the relationship of flowrate and pressure gradient in cases of increased airway resistance.
- State the four "Ss" and name a therapy for each.
- List examples of chronic airflow limitation.
- Discuss two reasons for a reduction in peak flow.
- Identify normal values for ventilatory parameters, blood pressure, and pulse.
- Match the five most common bedside pulmonary function tests to their descriptions.
- Predict the lowest acceptable ranges for vital capacity and NIF necessary to deep breathe and cough effectively.
- Describe proper handling and operation of equipment used in assessment.
- Describe possible hazards associated with assessment techniques.
- Identify common anatomical landmarks of the neck and thorax.
- Name and palpate the common pulse points of the body.
- Demonstrate the proper handling and operation of equipment used in assessment and discuss the information that the various tests provide.
- State 3 reasons for palpation.
- State 3 reasons to use percussion.
- Discuss the possible findings when palpating the alignment of the trachea.
- Discuss the physical signs that differentiate lung consolidation, pneumothorax, and pleural effusion.
- Demonstrate proper technique in performing percussion, palpation, and auscultation.
- Follow clinical assessment flowchart to determine appropriate therapy for a simulation patient situation.
- Describe the common pathophysiologic mechanisms discussed in class.
- Describe the clinical manifestations of the common pulmonary disorders.
- Measure blood pressure and pulse.
- State normal values for BP/HR.
- Define and discuss hypertension and hypotension.
- Describe changes in blood pressure with large muscle mass versus small muscle mass exercise.
- Describe the physiological causes of hypoxemia.
- State the four clinical causes of hypoxemia.
- List the clinical signs and symptoms of hypoxia and hypercarbia.
- Discuss the four types of hypoxia.
- Relate each of the four types of hypoxia to the appropriate stage of oxygenation.
- Match the blood gases with each type of hypoxia.
- Calculate oxygen content.
- Calculate percent shunt.
- Describe the indications for high versus low flow oxygen systems.
- Match the O2 delivery device to its capabilities and limitations.
- Calculate O2:Air ratios and total flow.
- Discuss the hazards of oxygen therapy.
- Define refractory hypoxemia in terms of an O2 challenge.
- State the rationale, indications and hazards of hyperbaric oxygen therapy.
- Describe oximetry and what it measures.
- Describe the different principles of operation of the four types of oxygen analyzers.
- Describe the effects of oxygen toxicity and the mechanisms of lung damage.
- Evaluate the oxygenation status when given transcutaneous PO2s.
- List factors affecting the accuracy of a pulse oximeter.
- List precautions in using TcMs to monitor PtcO2.
- Evaluate the oxygenation status when given arterial blood gases and minute volume.
- List the formulas and values indicating the degree of arterial hypoxemia.
- Interpret SaO2s and SvO2s for a given situation.
- State the normal range for transcutaneous oxygen.
- Interpret mixed venous blood gases.
- Practice using patient information in formulas to evaluate the ventilatory status.
- Practice classifying arterial blood gases and the acid/base status.
Humidity, aerosol and chest physical therapy
- Calculate the percent relative humidity.
- Match the following terms to their definitions:
- dew point
- potential humidity
- actual humidity
- humidity deficit
- body humidity
- Identify true statements describing how the factors affecting the rate of evaporation relate to the design of humidifiers.
- Describe the effect of temperature on potential, actual and relative humidity.
- Calculate the weight of water vapor necessary to saturate one liter of air when given the relative and potential humidity of the liter of air.
- Select true statements that describe the structure and functional of the upper and lower airway.
- Identify true statements describing pulmonary defense mechanisms.
- List three consequences of ciliary escalator impairment.
- List the three functions of the upper airway.
- Identify patients situations requiring 100% body humidity.
- List two purposes of humidifiers.
- Identify true statements describing the difference between a humidifier and an aerosol generator.
- Describe how a baffle affects the stability of an aerosol.
- List the three clinical uses of aerosols.
- Match the type of nebulizers to its indication.
- Identify true statements describing penetration and deposition due to the following:
- inertial impaction
- kinetic activity
- ventilatory pattern
- Identify true statements describing how the following nebulizers generate an aerosol: jet, hydrosphere,ultrasonic.
- Define Bernoulli's principle.
- List the two factors affecting air entrainment and oxygen concentration.
- Describe how air entrainment affects aerosol output and density.
- Describe the ventilatory pattern that would best enhance aerosol penetration and deposition.
- List two reasons to stop an aerosol treatment when giving a beta adrenergic drug.
- Describe how to determine the effectiveness of an aerosol treatment.
- Identify true statements describing the hazards associated with aerosol therapy.
- Identify true statements describing the mechanism of bronchospasm and its reversal.
- List the indication for aerosol therapy.
- Identify true statements describing the goals of CPT.
- Label given drainage positions with the appropriate lobe.
- Identify general precautions and contraindications for the CPT techniques.
- Describe the cough mechanism and proper cough instruction.
- List important points in moving patients consistent with proper body mechanics.
- List two precautions when using a mechanical percussor.
IS and IPPB
- State the rationale, indications, and complications of IPPB therapy.
- Demonstrate proper technique in administering IPPB and IS therapy to lab partner.
- State the indications and contraindications for incentive spirometry (IS).
- Identify true statements describing the function of IPPB or IS devices.
- Explain how to evaluate the effectiveness of IPPB or IS therapy.
- Give a mask IPPB treatment to manikin.
- Give an IPPB treatment to the tracheostomy manikin.
- Measure exhaled volumes on test lung to determine the best volume.
- Recognize the symptoms of a heart attack.
- Recognize risk factors associated with heart attack.
- Identify the course of action if you suspect a person is having a heart attack.
- Recognize the difference between clinical and biological death.
- Perform the sequence of events of CPR for:
- One rescuer
- Two rescuer
- Unconscious obstructed adult/child
- Chocking adult/child becomes unconscious
- Infant CPR
- Obstructed unconscious infant
- Identify the most common cause of airway obstruction in an unconscious victim.
- Recognize the technique and rationale for head tilt
Artificial airways and airway maintenance
- Demonstrate proper placement technique of oropharyngeal and nasopharyngeal airways.
- Demonstrate skill in placing esophageal obturator airway.
- Demonstrate skill in intubating with and without EOA in place for adult and infant manikins.
- Demonstrate changing an endotracheal tube.
- Identify true statements describing artificial airways, intubation, and extubation.
- Demonstrate skill in extubation of manikin.
- Explain the steps to checking endotracheal or tracheostomy cuff pressures.
- Demonstrate taping of endotracheal tube.
- Perform the steps in establishing an airway during an emergency for adults
- Perform the steps in establishing an airway during an emergency for children and infants.
- Perform the steps for checking cuff pressure.
- Perform the steps for extubation.
Bagging adult, child, and infant manikins
- Demonstrate ventilation of adult manikin with > 800 ml tidal volume using bag and mask.
- Demonstrate ventilation of child manikin with > 300 ml tidal volume using bag and mask.
- Demonstrate ventilation of infant manikin with 100 ml tidal volume using bag and mask.
- Demonstrate skill in slow bag refill technique.
- State the 3 ways to increase delivered oxygen with a bag and analyze the FDO2 when using these techniques
- Identify true statements describing manual resuscitators and bagging
Nasotracheal, endotracheal tube suctioning and trach care
Demonstrate proper technique in nasotracheal suctioning by inserting a suction catheter to the level of the oropharynx
- Demonstrate proper technique in endotracheal tube suctioning by suctioning a simulated intubated patient with an open and closed system
- Demonstrate proper technique in trach care.
- Identify true statements describing suctioning and trach care.
- Demonstrate steps in obtaining a sputum sample
- Obtain a "sputum sample" on ETS manikin.
- Demonstrate trach care on trach manikin.
Cleaning and sterilization
- Identify which microorganisms are common contaminants of respiratory care equipment.
- Describe the transmission of pathogenic microorganisms and the prevention of nosocomial infections.
- Identify true statements describing the factors important in sterilization suing the chemical methods.
- Match the biological indicators used with autoclaving, ETO and radiation methods of sterilization.
- List the toxic chemicals produced when 1) ETO contacts water droplets, and 2) a previously gamma irradiated object is ETO sterilized.
- Match respiratory therapy equipment to the preferred method of disinfection.
- Identify true statements pertaining to the changing of respiratory equipment.
- Describe important features of a cleaning/disinfection area within a central service or respiratory care dept.