Free Essay

Elderly Patients

In: Other Topics

Submitted By Labratre
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Pages 18
|CognitiveLevel||3rd Ed. Page References|
A. Review Data in the Patient Record|4|||4||
1. Patient history e.g.,• present illness• admission notes• respiratory care orders• medication history• progress notes• diagnoses• DNR status• patient education (previous)|||||pp 33, 82, 47|
2. Physical examination relative to the cardiopulmonary system e.g., vitalsigns, physical findings|||||pp 33-35, 35-45, 47, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177|
3. Laboratory data e.g.,• CBC• electrolytes• coagulation studies• culture and sensitivities• sputum Gram stain|||||pp 45-47|
4. Pulmonary function results|||||pp 47, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197|
5. Blood gas results|||||pp 47, 124-126, 126-127, 127-128, 151-153, 153-155, 156-158, 158-163|
6. Imaging studies e.g.,• radiograph• CT• MRI|||||pp 33-45, 47, 151-153, 175-177|
7. Monitoring data||||||
a. fluid balance|||||pp 139-140|
b. pulmonary mechanics e.g., maximum inspiratory pressure, vitalcapacity|||||pp 47, 139, 191-194, 194-196|
c. respiratory e.g.,• rate• tidal and minute volume• I:E|||||pp 47, 139, 191-194, 194-196|
d. pulmonary compliance, airways resistance, work of breathing|||||pp 47, 137-139, 141-143|
e. noninvasive e.g.,• pulse oximetry• VD/VT• capnography• transcutaneous O2 / CO2|||||pp 20-21, 47, 137-139, 167-172, 172-175|
8. Cardiac monitoring|||||pp 35-45, 158-163|
a. ECG data results e.g., heart rate, rhythm|||||pp 35-45, 103-111, 158-163|
b. hemodynamic monitoring results e.g.,• blood pressure• CVP• PA pressure• cardiac output / index|||||pp 35-45, 111-119, 158-163|
9. Maternal and perinatal / neonatal history and data • Apgar scores• gestational age• L / S ratio|||||pp 167-172, 172-175|
B. Collect and Evaluate Additional Pertinent Clinical Information|6|11|1|18||
1. Assess a patient's overall cardiopulmonary status by inspection todetermine|||||pp 35-45, 49-50, 50-64|
a. general appearance e.g.,• venous distention• edema• accessory muscle activity• chest wall movement• diaphoresis• clubbing• cyanosis• breathing pattern|||||pp 35-45, 49-50, 50-64, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177|
b. airway assessment e.g., macroglossia, neck range of motion|||||pp 49-50, 50-64|
c. cough, sputum amount and character|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177|
d. Apgar score, gestational age, transillumination of chest|||||pp 167-172, 172-175|
2. Assess a patient's overall cardiopulmonary status by palpation todetermine|||||pp 35-45, 139-140|
a. pulse, rhythm, force|||||pp 35-45, 75-77, 139-140|
b. asymmetrical chest movements, tactile fremitus, crepitus,tenderness, secretions in the airway, and tracheal deviation|||||pp 35-45, 49-50, 50-64, 139-140|
3. Assess a patient's overall cardiopulmonary status by percussion|||||pp 139-140|
4. Assess a patient's overall cardiopulmonary status by auscultation todetermine presence of|||||pp 35-45, 139-140, 151-153, 155-156, 158-163|
a. breath sounds|||||pp 35-45, 50-64, 139-140, 151-153, 153-155, 155-156, 156-158, 158-163|
b. heart sounds and rhythm|||||pp 35-45, 139-140, 151-153, 155-156, 158-163|
c. blood pressure|||||pp 35-45, 139-140, 151-153, 155-156, 158-163|
5. Interview a patient to determine|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
a. level of consciousness and orientation, emotional state, and ability tocooperate|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
b. level of pain|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
c. presence of dyspnea, sputum production, and exercise tolerance|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
d. nutritional status|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
e. social history e.g., smoking, substance abuse|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
f. advance directives e.g., DNR status|||||pp 33-35, 82, 151-153, 153-155, 155-156, 156-158 |
6. Assess a patient’s learning needs||||||
7. Review a chest radiograph to determine|||||pp 35-45, 139-140|
a. position of endotracheal or tracheostomy tube|||||pp 35-45, 139-140|
b. presence of, or change in, cardiopulmonary abnormalities e.g.,• pneumothorax• consolidation• pleural fluid• pulmonary edema|||||pp 35-45, 139-140|
c. position of indwelling tubes and catheters|||||pp 35-45, 167-172, 172-175|
d. presence of foreign bodies|||||pp 35-45, 49-50, 175-177|
e. position of or change in hemidiaphragms or mediastinum|||||pp 35-45, 151-153, 155-156, 156-159|
8. Review lateral neck radiographs e.g., epiglottitis, foreign body|||||pp 35-45, 175-177|
9. Perform procedures||||||
a. 12-lead ECG|||||pp 103-11|
b. transcutaneous monitoring|||||pp 167-172, 172-175|
c. pulse oximetry and capnography|||||pp 20-21, 50-64, 137-139|
d. tidal volume, minute volume, vital capacity, and peak flowmeasurements|||||pp 139, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196 |
e. bedside spirometry e.g., FVC, FEV1|||||pp 139, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
f. arterial sampling - percutaneous or line|||||pp 121-122|
g. arterialized capillary blood sampling|||||pp 167-172, 172-175|
h. timed walk test e.g., 6-minute||||||
i. oxygen titration with exercise|||||pp 111-119, 151-153, 153-155, 155-156, 156-158, 158-163|
j. blood gas / hemoximetry analysis|||||pp 124-126, 126-127, 127-128, 139|
k. cardiopulmonary calculations e.g., P(A-a)O2, VD / VT|||||pp 18-19, 122-124, 140-141|
l. hemodynamic monitoring e.g., blood pressure, CVP||||||
m. lung mechanics e.g.,• plateau pressure• MIP• MEP• airways resistance• compliance|||||pp 137-139, 141-143, 191-194, 194-196|
n. apnea monitoring|||||p 190|
o. overnight pulse oximetry|||||pp 20-21, 151-153, 153-155, 155-156, 156-158, 158-163, 163-165|
p. tracheal tube cuff pressure and / or volume|||||pp 64-67|
q. arterial line insertion||||||
r. stress testing e.g., ECG, pulse oximetry|||||pp 119-120|
s. pulmonary function laboratory studies|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197|
t. CPAP / BIPAP titration during sleep|||||pp 163-165|
10. Interpret procedure results including||||||
a. 12-lead ECG e.g.,• rate• irregular rhythm• artifacts|||||pp 103-11|
b. transcutaneous monitoring|||||p 171|
c. pulse oximetry and capnography|||||pp 20-21, 50-64, 137-139|
d. tidal volume, minute volume, vital capacity, and peak flowmeasurements|||||pp 139, 191-194, 194-196|
e. bedside spirometry e.g., FVC, FEV1|||||pp 139, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194|
f. arterial sampling - percutaneous or line|||||pp 121-122, 139|
g. arterialized capillary blood sampling|||||p 171|
h. timed walk test e.g., 6-minute||||||
i. oxygen titration with exercise|||||pp 111-119, 151-153, 153-155, 155-156, 156-158, 158-163|
j. blood gas / hemoximetry analysis|||||pp 21, 124-126, 126-127, 127-128|
k. cardiopulmonary calculations e.g., P(A-a)O2, VD / VT|||||pp 18-19, 122-124, 140-141|
l. hemodynamic monitoring e.g., blood pressure, CVP|||||pp 140-141, 158-163|
m. lung mechanics e.g.,• plateau pressure• MIP• MEP|||||pp 141-143, 196|
n. apnea monitoring|||||p 190|
o. overnight pulse oximetry|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 163-165|
p. tracheal tube cuff pressure and/or volume|||||pp 66-67|
q. arterial line insertion|||||pp 20-21|
r. stress testing e.g., ECG, pulse oximetry|||||pp 20-21, 119-120|
s. pulmonary function laboratory studies|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197|
t. CPAP / BIPAP titration during sleep|||||pp 163-165|
C. Recommend Procedures to Obtain Additional Data|1|3|0|4||
1. Radiographic and other imaging studies|||||pp 35-45, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177|
2. Diagnostic bronchoscopy e.g., evaluate hemoptysis, atelectasis|||||pp 69-71|
3. Sputum Gram stain, culture and sensitivities e.g., pneumonia|||||pp 199-200|
4. Bronchoalveolar lavage (BAL)|||||pp 156-158|
5. Pulmonary function testing|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
6. Lung mechanics e.g., compliance, airways resistance|||||pp 137-139, 141-143|
7. Blood gas analysis, pulse oximetry, and transcutaneous monitoring|||||pp 20-21, 124-126, 126-127, 127-128, 167-172, 172-175|
8. ECG|||||pp 103-111|
9. Capnography|||||pp 50-64|
10. Hemodynamic monitoring e.g., blood pressure, CVP|||||pp 111-119, 158-163|
11. Sleep studies|||||pp 163-165|
A. Manipulate Equipment by Order or Protocol|4|10|8|22||
1. Oxygen administration devices|||||pp 7-18|
a. low-flow devices e.g., nasal cannula|||||pp 7-18|
b. high-flow devices e.g., air entrainment mask|||||pp 7-18|
c. high-flow nasal cannula|||||pp 7-18|
2. CPAP devices – mask, nasal, or bilevel|||||pp 20, 167-172, 172-175|
3. Humidifiers|||||pp 23-27|
4. Nebulizers|||||pp 20, 27-31|
5. Resuscitation devices e.g., manual resuscitator (bag-valve), mouth-to-valvemask resuscitator|||||pp 77-79|
6. Ventilators||||||
a. pneumatic, electric, fluidic, and microprocessor|||||pp 86-93, 129-131|
b. noninvasive positive pressure|||||pp 129-131|
7. Artificial airways|||||pp 50-64|
a. oro- and nasopharyngeal airways|||||pp 50-64|
b. endotracheal tubes|||||pp 50-64|
c. tracheostomy tubes and devices|||||pp 50-64|
d. speaking tubes and valves|||||pp 50-64|
e. intubation equipment|||||pp 50-64|
f. laryngeal mask airway (LMA)|||||pp 50-64|
g. esophageal-tracheal Combitube®|||||pp 50-64|
8. Suctioning devices|||||pp 64-67|
9. Gas delivery, metering, and clinical analyzing devices||||||
a. gas cylinders, regulators, reducing valves, connectors andflowmeters, and air / oxygen blenders|||||pp 1-7, 7-18|
b. oxygen conserving devices e.g., reservoir cannula, pulse-dose|||||pp 7-18, 187-190|
c. oxygen concentrators|||||pp 187-190|
d. air compressors||||||
10. Point-of-care analyzers e.g., blood gas, electrolytes|||||p 128|
11. Patient breathing circuits||||||
a. continuous mechanical ventilation|||||pp 129-131|
b. IPPB|||||pp 86-93|
c. CPAP and PEEP valve assemblies||||||
d. non-invasive ventilation|||||pp 129-131|
12. Environmental devices|||||pp 7-18, 27-31, 175-177|
a. aerosol (mist) tents|||||pp 7-18|
b. oxygen hoods|||||pp 7-18, 167-172, 172-175|
13. Incentive breathing devices|||||pp 93-94|
14. Airway clearance devices||||||
a. percussors and vibrators|||||pp 96-100|
b. positive expiratory pressure (PEP) devices|||||pp 100-102|
c. vibratory PEP devices|||||pp 100-102|
15. Manometers e.g., aneroid, digital, water||||||
16. Respirometers e.g., flow-sensing devices|||||pp 197-198|
17. ECG monitors|||||pp 103-111|
18. ECG machines (12-lead)|||||pp 103-111|
19. Vacuum systems e.g.,• pumps• regulators• collection bottles• pleural drainage devices|||||pp 64-67|
20. Oximetry monitoring devices e.g., pulse oximeter, transcutaneous|||||pp 20-21, 167-172, 172-175|
21. Metered dose inhalers (MDI) and MDI spacers|||||pp 27-31|
22. Dry powder inhalers|||||p 185|
23. Bedside screening spirometers|||||pp 197-198|
24. CO, He, O2 and specialty gas analyzers|||||p 21|
25. Bronchoscopes|||||pp 69-71|
B. Ensure Infection Control|0|2|1|3||
1. Assure cleanliness of equipment by• selecting or determining appropriate agent and technique fordisinfection and/or sterilization• performing procedures for disinfection and/or sterilization• monitoring effectiveness of sterilization procedures|||||pp 187-190, 199-200, 201-202|
2. Assure proper handling of biohazardous materials|||||p 202|
3. Incorporate ventilator-associated pneumonia protocol|||||p 149|
4. Implement infectious disease protocols e.g.,• avian flu• SARS• transmission prevention|||||pp 202-203|
5. Adhere to infection control policies and procedures e.g., StandardPrecautions|||||pp 86-93, 202-203|
C. Perform Quality Control Procedures For: |1|3|0|4||
1. Blood gas analyzers, co-oximeters|||||p 128|
2. Gas analyzers|||||pp 20, 21|
3. Point-of-care analyzers|||||p 128|
4. Pulmonary function equipment|||||pp 191-194, 194-196|
5. Mechanical ventilators||||||
6. Gas metering devices e.g., flowmeter||||||
7. Noninvasive monitors e.g., transcutaneous||||||
8. Record and monitor QC data using accepted statistical methods||||||
A. Maintain Records and Communicate Information|2|3|0|5|pp 47, 86-93, 96-100, 100-102|
1. Record therapy and results using conventional terminology as required inthe health care setting and/or by regulatory agencies|||||pp 47, 86-93, 96-100, 100-102|
a. specify therapy administered, date, time, frequency of therapy,medication, and ventilatory data|||||pp 47, 86-93, 96-100, 100-102|
b. note and interpret patient's response to therapy|||||pp 47, 86-93, 96-100, 100-102|
1) effects of therapy, adverse reactions, patient's subjective andobjective response to therapy|||||p 47|
2) verify computations and note erroneous data|||||p 47|
3) auscultatory findings, cough and sputum production andcharacteristics|||||pp 47, 35-45|
4) vital signs|||||p 47|
5) pulse oximetry, heart rhythm, capnography|||||pp 47, 20-21|
2. Communicate information|||||p 47|
a. regarding patient's clinical status to appropriate members of the health care team|||||p 47|
b. relevant to coordinating patient care and discharge planning|||||p 47|
3. Accept and verify patient care orders|||||p 47|
4. Apply computer technology to|||||p 47|
a. document patient management|||||p 47|
b. monitor workload assignments|||||p 47|
c. patient safety initiatives e.g., drug dispensing, order entry|||||p 47|
5. Communicate results of therapy and alter therapy by protocol(s)|||||p 47|
6. Explain planned therapy and goals to a patient in understandable termsto achieve optimal therapeutic outcome|||||p 47|
7. Educate a patient and family concerning smoking cessation and health management|||||p 47|
B. Maintain a Patent Airway Including the Care of Artificial Airways|2|2|3|7||
1. Properly position a patient|||||pp 49-50, 50-64|
2. Insert oro- and nasopharyngeal airways|||||pp 50-64|
3. Perform endotracheal intubation|||||pp 50-64|
4. Maintain position in the airway and appropriate cuff inflation of:|||||pp 50-64|
a. LMA|||||pp 50-64|
b. esophageal-tracheal Combitube®|||||pp 50-64|
c. endotracheal tube|||||pp 50-64|
d. tracheostomy tube|||||pp 50-64|
5. Assess tube placement|||||pp 50-64|
6. Perform tracheostomy care|||||pp 50-64|
7. Change tracheostomy tubes|||||pp 50-64|
8. Maintain adequate humidification|||||pp 23-27|
9. Perform extubation|||||pp 64-67|
C. Remove Bronchopulmonary Secretions|1|3|0|4||
1. Perform:|||||pp 151-153, 153-155, 155-156, 156-158, 158-163|
a. postural drainage, percussion, or vibration|||||pp 96-100, 151-153, 153-155, 155-156, 156-158, 158-163|
b. nasotracheal suctioning|||||pp 64-67, 151-153, 153-155, 155-156, 156-158, 158-163|
c. oropharyngeal suctioning|||||pp 64-67, 151-153, 153-155, 155-156, 156-158, 158-163|
d. airway clearance using mechanical devices e.g., high frequencychest wall oscillation, vibratory PEP|||||pp 100-102, 151-153, 153-155, 155-156, 156-158, 158-163|
2. Suction artificial airways|||||pp 64-67, 151-153, 153-155, 155-156, 156-158, 158-163|
3. Administer aerosol therapy with prescribed drugs|||||pp 27-31, 151-153, 153-155, 155-156, 156-158, 158-163, 179-185|
4. Instruct and encourage bronchopulmonary hygiene techniques|||||pp 96-100, 100-102, 151-153, 153-155, 155-156, 156-158, 158-163|
D. Achieve Adequate Respiratory Support|2|5|1|8||
1. Instruct a patient in:|||||pp 93-94|
a. deep breathing and incentive spirometry techniques|||||pp 93-94|
b. inspiratory muscle training techniques|||||pp 93-94|
2. Initiate and adjust|||||pp 7-18|
a. IPPB therapy|||||pp 7-18, 86-93|
b. continuous mechanical ventilation settings|||||pp 7-18, 131-137, 145-146, 146-147, 149|
c. noninvasive ventilation|||||pp 129-131|
d. elevated baseline pressure e.g., CPAP, PEEP|||||pp 131-137|
3. Select ventilator graphics e.g., waveforms, scales|||||pp 147-149|
4. Initiate and select appropriate settings for high frequency ventilation|||||pp 144-145|
5. Administer medications|||||pp 151-153, 155-156, 156-158, 158-163|
a. aerosolized|||||pp 27-31, 151-153, 155-156, 156-158, 158-163, 175-177, 179-185|
b. dry powder preparations|||||pp 151-153, 155-156, 156-158, 158-163, 185|
c. endotracheal instillation|||||pp 79-81, 151-153, 155-156, 156-158, 158-163|
6. Administer oxygen|||||pp 7-18|
7. Initiate and modify weaning procedures|||||pp 143-144|
8. Position patient to minimize hypoxemia||||||
9. Prevent procedure-associated hypoxemia e.g., oxygenate before andafter suctioning and equipment changes|||||pp 64-65|
10. Apply disease-specific ventilator protocols (e.g. ARDS-Net protocol)|||||pp 129-131|
E. Evaluate and Monitor Patient's Objective and Subjective Responses toRespiratory Care|3|7|5|15||
1. Recommend and review a chest radiograph|||||pp 35-45, 155-156, 175-177|
2. Obtain a blood gas sample:|||||pp 167-172, 172-175|
a. by puncture|||||pp 121-122, 167-172, 172-175|
b. from an arterial or pulmonary artery catheter|||||pp 167-172, 172-175|
c. from arterialized capillary blood|||||pp 167-172, 172-175|
3. Perform:||||||
a. transcutaneous monitoring|||||pp 167-172|
b. pulse oximetry||||||
c. blood gas and hemoximetry analyses|||||p 21|
d. capnography|||||pp 50-64|
e. hemodynamic assessment|||||pp 111-119|
4. Interpret results of:||||||
a. blood gases|||||pp 124-126, 126-127, 127-128|
b. hemoximetry e.g., carboxyhemoglobin|||||p 21|
c. hemodynamics|||||pp 111-119|
d. pulse oximetry|||||pp 20-21|
e. capnography|||||pp 50-64, 137-139|
5. Observe for:||||||
a. changes in sputum characteristics|||||pp 33-35|
b. signs of patient-ventilator dysynchrony||||||
6. Measure and record vital signs, monitor cardiac rhythm, and evaluate fluid balance - intake and output|||||pp 139-140|
7. Perform and interpret results of pulmonary function testing:|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
a. spirometry|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197|
b. compliance and airways resistance|||||pp 137-139, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197|
c. lung volumes|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
d. DLco|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
e. exercise|||||pp 119-120, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
f. bronchoprovocation studies|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
8. Recommend blood tests e.g., hemoglobin, potassium||||||
9. Monitor airway pressures, and adjust and check alarm systems|||||pp 137-139|
10. Measure FIO2 and/or oxygen flow|||||pp 7-18, 20|
11. Auscultate the chest and interpret changes in breath sounds|||||pp 35-45, 50-64|
F. INDEPENDENTLY MODIFY Therapeutic Procedures Based on the Patient’s Response|2|9|7|18||
1. Terminate treatment based on patient's response to therapy|||||pp 86-93, 96-100|
2. Modify treatment techniques:|||||pp 23-27|
a. IPPB|||||pp 86-93|
b. incentive breathing devices|||||pp 93-94|
c. aerosol therapy:|||||pp 27-31, 175-177|
1) modify patient breathing patterns|||||pp 27-31, 175-177|
2) change type of equipment and change aerosol output|||||pp 27-31, 175-177|
3) change dilution of medication|||||pp 27-31, 175-177|
4) adjust temperature of the aerosol|||||pp 27-31, 175-177|
d. oxygen therapy:|||||pp 7-18, 167-172, 172-175, 175-177|
1) change mode of administration, flow, and FIO2|||||pp 7-18, 167-172, 172-175, 175-177|
2) set up or change an O2 blender|||||pp 7-18, 167-172, 172-175, 175-177|
3) set up an O2 concentrator or liquid O2 system|||||pp 175-177, 187-190|
e. specialty gas therapy e.g., He / O2, NO|||||p 19|
1) change mode of administration|||||p 19|
2) adjust flow or gas concentration|||||p 19|
f. bronchial hygiene therapy|||||pp 96-100, 100-102|
1) alter patient position and duration of treatment and techniques|||||pp 96-100, 100-102|
2) coordinate sequence of therapies e.g.,• chest percussion• postural drainage• PEP|||||pp 96-100, 100-102|
g. management of artificial airways|||||pp 64-66|
1) reposition or change endotracheal or tracheostomy tube|||||pp 50-64|
2) change type of humidification equipment|||||pp 23-27|
3) initiate suctioning|||||pp 64-67|
4) inflate and / or deflate the cuff|||||pp 64-67|
5) perform tracheostomy care|||||pp 50-64|
h. suctioning:||||||
1) alter frequency and duration of suctioning|||||pp 64-66|
2) change size and type of catheter|||||pp 64-66|
3) alter negative pressure|||||pp 64-66|
4) instill irrigating solutions|||||pp 179-185|
i. mechanical ventilation:||||||
1) improve patient synchrony|||||pp 145-146, 146-147, 149|
2) enhance oxygenation|||||pp 131-137,145-146, 146-147, 149|
3) improve alveolar ventilation|||||pp 131-137,145-146, 146-147, 149|
4) adjust I : E settings|||||pp 145-146, 146-147, 149|
5) modify ventilator techniques|||||pp 145-146, 146-147, 149|
6) adjust noninvasive positive pressure ventilation|||||pp 129-131|
7) monitor and adjust alarm settings|||||pp 137-139|
8) adjust ventilator settings based on ventilator graphics|||||pp 147-149|
9) change type of ventilator|||||pp 129-131|
10) change patient breathing circuitry|||||p 149|
11) alter mechanical dead space|||||pp 131-137|
12) initiate procedures for weaning|||||pp 143-144|
G. RECOMMEND Modifications in the Respiratory Care Plan Based on thePatient’s Response|3|10|4|17||
1. Recommend:||||||
a. institution of bronchopulmonary hygiene procedures|||||pp 151-153, 153-155, 155-156, 156-158, 158-163|
b. treatment of pneumothorax||||||
c. sedation and/or use of muscle relaxant(s)||||||
d. adjustment of fluid balance||||||
e. adjustment of electrolyte therapy||||||
f. insertion or change of artificial airway||||||
g. weaning from mechanical ventilation|||||pp 143-144|
h. extubation|||||pp 64-67|
i. discontinuing treatment based on patient response||||||
2. Recommend changes in:||||||
a. patient position||||||
b. inhaled drug dosage or concentration|||||pp 179-185|
c. FIO2 and oxygen flow|||||pp 7-18, 167-172, 172-175|
3. Recommend changes in mechanical ventilation to:|||||pp 131-137|
a. improve patient synchrony|||||pp 131-137|
b. enhance oxygenation|||||pp 131-137, 145-146, 146-147, 149|
c. improve alveolar ventilation|||||pp 131-137, 145-146, 146-147, 149|
d. adjust I : E settings|||||pp 131-137|
e. modify ventilator techniques||||||
f. adjust noninvasive positive pressure ventilation|||||pp 129-131|
g. monitor and adjust alarm settings|||||pp 137-139|
h. adjust ventilator settings based on ventilator graphics|||||pp 147-149|
i. change type of ventilator|||||pp 129-131|
j. change patient breathing circuitry|||||p 149|
k. reduce auto-PEEP|||||pp 129-131, 147-149|
l. reduce plateau pressure|||||pp 129-13p|
4. Recommend pharmacologic interventions including use of:|||||pp 179-185|
a. bronchodilators|||||pp 179-185|
b. antiinflammatory drugs e.g.,• leukotriene modifiers• corticosteroids• cromolyn sodium|||||pp 179-185|
c. mucolytics and proteolytics e.g.,• acetylcysteine• RhDNAse• hypertonic saline|||||pp 179-185|
d. cardiovascular drugs e.g., ACLS protocol agents|||||pp 75-77, 79-81|
e. antimicrobials e.g., antibiotics|||||pp 179-185|
f. sedatives|||||pp 179-185|
g. analgesics|||||pp 179-185|
h. paralytic agents|||||pp 179-185|
i. diuretics|||||pp 179-185|
j. surfactants|||||pp 179-185|
k. vaccines e.g., pneumovax, influenza|||||pp 179-185|
H. Determine the Appropriateness of the Prescribed Respiratory Care Plan and Recommend Modifications When Indicated by Data|1|3|0|4||
1. Analyze available information to determine the pathophysiological state|||||p 187|
2. Review:|||||p 187|
a. planned therapy to establish therapeutic plan|||||p 187|
b. interdisciplinary patient and family plan|||||p 187|
3. Determine appropriateness of prescribed therapy and goals for identifiedpathophysiological state|||||p 187|
4. Recommend changes in therapeutic plan when indicated|||||p 187|
5. Perform respiratory care quality assurance|||||p 187|
6. Develop:|||||pp 48, 187|
a. quality improvement program|||||pp 48, 187|
b. respiratory care protocols|||||pp 48, 187|
7. Monitor outcomes of:|||||pp 48, 187|
a. quality improvement programs|||||pp 48, 187|
b. respiratory care protocols|||||pp 48, 187|
8. Apply respiratory care protocols|||||pp 48, 187|
I. Initiate, Conduct, or Modify Respiratory Care Techniques in an Emergency Setting|1|1|1|3||
1. Treat cardiopulmonary emergencies according to:|||||pp 49-50, 75-77, 79-81|
a. BCLS|||||pp 49-50, 75-77, 79-81|
b. ACLS|||||pp 49-50, 75-77, 79-81|
c. Pediatric Advanced Life Support (PALS)|||||pp 49-50, 75-77, 79-81|
d. Neonatal Resuscitation Program (NRP)|||||pp 49-50, 75-77, 79-81|
2. Treat a tension pneumothorax|||||pp 158-163|
3. Participate in:|||||pp 82-83|
a. land / air patient transport|||||pp 82-83|
b. intra-hospital patient transport|||||pp 82-83|
c. disaster management|||||p 83|
d. medical emergency team (MET) e.g., rapid response team|||||pp 79-81|
J. Act as an Assistant to the Physician Performing Special Procedures|1|1|0|2||
1. Intubation|||||pp 50-64|
2. Bronchoscopy|||||pp 69-71|
3. Thoracentesis|||||pp 158-163|
4. Tracheostomy|||||pp50-64|
5. Chest tube insertion|||||pp 71-74, 151-153|
6. Moderate (conscious) sedation|||||pp 184-185|
7. Cardioversion|||||pp 81-82|
8. Ultrasound||||||
K. Initiate and Conduct Pulmonary Rehabilitation and Home Care|1|1|0|2||
1. Monitor and maintain home respiratory care equipment|||||pp 187-190|
2. Explain planned therapy and goals to a patient in understandable terms to achieve optimal therapeutic outcome|||||pp 187-190|
3. Educate a patient and family in health management||||||
4. Interact with a case manager||||||
5. Counsel a patient and family concerning smoking cessation|||||pp 187-190|
6. Instruct patient and family to assure safety and infection control||||||
7. Modify respiratory care procedures for use in home|||||pp 187-190|

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