Respiratory Care (RC)
Courses
RC 125 Beginning Principles of Respiratory Care (4 Hours)
Prerequisites: Admission to the respiratory care program
This is an introduction to the basic therapeutic modalities used in respiratory care, including patient safety and comfort considerations, infection control and standard precautions, medical gas delivery, humidity and aerosol therapy, basic respiratory pharmacology, secretion clearance techniques and lung expansion therapy. Emphasis is on patient assessment, clinical application of therapies, therapy evaluation and communication techniques. The roles of respiratory care in the health care system and basic respiratory care service scope, organization and operation are also introduced. Students will have the opportunity to work with patients after two to three weeks of introductory lecture and lab demonstration and practice. Enrollment in this course requires that you be current in payment of a professional liability fee of $16.00. This fee is required once per calendar year based on enrollment in selected courses and must be in place prior to the start of classes. Students will be notified via their JCCC student email account if they are required to pay a $16 fee. 6 hrs. lecture, 16 hrs. lab/wk. Summer.
RC 130 Respiratory Care Equipment (4 Hours)
Prerequisites: Admission to the respiratory care program
This course is an introduction to basic respiratory care equipment. The operation, function, calibration, troubleshooting and maintenance for oxygen administration devices, aerosol generators, humidifiers and hyperinflation devices will be addressed. Medical gas production and storage will also be addressed. 6 hrs. lecture, 8 hrs. lab/wk. Summer.
RC 135 Cardiopulmonary Medicine I (1 Hour)
Prerequisites: Admission to the respiratory care program
This is the first of three courses that provide a detailed review of the respiratory and cardiac system anatomy and physiology and the clinical implications of normal and abnormal function. 2 hrs./wk. Summer.
RC 220 Cardiopulmonary Physiology (2 Hours)
Prerequisites: Successful completion of the summer sequence of respiratory care courses
This is a comprehensive study of the physiology and pathophysiology of the pulmonary, cardiovascular and renal systems as they relate to respiratory care. 2 hrs./wk. Fall.
RC 230 Clinical Topics and Procedures I (4 Hours)
Prerequisites: Successful completion of the summer sequence of respiratory care courses
This course supplements the fall clinical experiences. Concepts, techniques and procedures learned in the summer semester are reinforced. The student will develop new understandings and skills in the acute care, basic emergency care and introductory-level critical care settings. Emphasis will be on arterial blood gas procurement and analysis, cardiac rhythm assessment and management, airway equipment and management procedures, patient management of obstructive lung disorders, perioperative care and chest trauma. In addition, basic mechanical ventilation concepts and techniques will be addressed as they relate to physiologic effects, ventilator commitment, management and basic troubleshooting. 3 hrs. lecture, 3 hrs. lab/wk. Fall.
RC 231 Clinical Topics and Procedures II (4 Hours)
Prerequisites: Successful completion of the fall sequence of respiratory care courses
This course supplements the spring clinical experiences. Concepts, techniques and procedures learned in the fall semester are reinforced. The student will refine understandings of and skills in the acute care, basic emergency care and critical care settings. Emphasis will be on ventilator management of patients with specific lung insults, neurological compromise and cardiac problems. Advanced mechanical ventilation concepts and techniques will be addressed as they relate to physiologic effects, management and troubleshooting. Home care, pulmonary rehabilitation, physician-assisted procedures, cardiopulmonary stress testing, patient case management and department management will be addressed. 3 hrs. lecture, 3 hrs. lab/wk. Spring.
RC 233 Respiratory Care of Children (2 Hours)
Prerequisites: RC 230
The focus will be on the respiratory care of neonatal and pediatric patients, with emphasis on the management of cardiopulmonary disease states unique to children. Information will be based on developmental anatomy and physiology, pathology, diagnostic/laboratory assessments, and associated patient management in the acute, critical, emergency care, transport and home care settings. 2 hrs./wk. Spring.
RC 235 Cardiopulmonary Medicine II (2 Hours)
Prerequisites: Successful completion of the summer sequence of respiratory care courses
This is the second in a series of three courses that provide a detailed review of the physical and diagnostic assessments of the cardiopulmonary patient and the related clinical implications of the assessment finding. 2 hrs. lecture/wk. Fall.
RC 236 Cardiopulmonary Medicine III (2 Hours)
Prerequisites: Successful completion of the fall sequence of respiratory care courses
This is the third in a series of three courses that provide a detailed review of pulmonary disorders, their pathology and their management. 2 hrs. lecture/wk. Spring.
RC 240 Cardiopulmonary Pharmacology (2 Hours)
Prerequisites: Successful completion of the summer sequence of respiratory care courses
This course acquaints the student with general principles of pharmacology and provides a comprehensive review of all drugs and drug groups that are either administered by respiratory-care practitioners or play an integral part in the management of patients they may encounter. Emphasis is on the clinical application of pharmacological agents, their therapeutic effects, mechanism of action and adverse effects, rather than the biochemistry involved. 2 hrs. lecture/wk. Fall.
RC 271 Clinical Practice I (6 Hours)
Prerequisites: Successful completion of the summer sequence of respiratory care courses
This course is the clinical application of respiratory care therapeutic and diagnostic procedures. Students will have the opportunity to work with patients under close supervision to further develop their skill and understanding of basic respiratory care procedures for adults and children. The course objectives progress throughout the semester to involve the student initially in basic care of the less critically ill patient. As their comfort level and exposures progress, students are allowed to work with the more critically ill patients. Enrollment in this course requires that you be current in payment of a professional liability fee of $16.00. This fee is required once per calendar year based on enrollment in selected courses and must be in place prior to the start of classes. Students will be notified via their JCCC student email account if they are required to pay a $16 fee. 24 hrs./wk. Fall.
RC 272 Clinical Practice II (6 Hours)
Prerequisites: Successful completion of the fall sequence of respiratory care courses
This course is the clinical application of respiratory care therapeutic and diagnostic procedures. Students will have the opportunity to work with patients under close supervision to further develop their skill and understanding of critical respiratory care procedures for adults and children. Students will also be involved in specialty activities to include physician rounds, pulmonary rehabilitation, home care, and pulmonary function. Enrollment in this course requires that you be current in payment of a professional liability fee of $16.00. This fee is required once per calendar year based on enrollment in selected courses and must be in place prior to the start of classes. Students will be notified via their JCCC student email account if they are required to pay a $16 fee. 24 hrs./wk. Spring.
RC 125
- Title: Beginning Principles of Respiratory Care*
- Number: RC 125
- Effective Term: Spring/Summer 2014
- Credit Hours: 4
- Contact Hours: 135
- Lecture Hours: 58
- Lab Hours: 45
- Other Hours: 32
Requirements:
Prerequisites: Admission to the respiratory care program
Description:
This is an introduction to the basic therapeutic modalities used in respiratory care, including patient safety and comfort considerations, infection control and standard precautions, medical gas delivery, humidity and aerosol therapy, basic respiratory pharmacology, secretion clearance techniques and lung expansion therapy. Emphasis is on patient assessment, clinical application of therapies, therapy evaluation and communication techniques. The roles of respiratory care in the health care system and basic respiratory care service scope, organization and operation are also introduced. Students will have the opportunity to work with patients after two to three weeks of introductory lecture and lab demonstration and practice. Enrollment in this course requires that you be current in payment of a professional liability fee of $16.00. This fee is required once per calendar year based on enrollment in selected courses and must be in place prior to the start of classes. Students will be notified via their JCCC student email account if they are required to pay a $16 fee. 6 hrs. lecture, 16 hrs. lab/wk. Summer.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
By the end of the semester, each student should be able to do the following for real and simulated situations.
- Review existing data in the patient record and make appropriate documentation entries in patient and/or department records.
- Adhere to infection control policies and procedures and practice proper body kinetic and patient safety and comfort measures.
- Demonstrate the ability to perform a cardiopulmonary patient assessment.
- Recognize the cardiopulmonary implications of patient assessment findings.
- Analyze available data to determine common cardiopulmonary pathophysiologic states and respiratory disorders.
- Review planned therapy to establish therapeutic goals and/or appropriateness of prescribed therapy and recommend changes in therapeutic plan, as indicated.
- Discuss the indications, contraindications and possible adverse effects relating to the use of therapeutic procedures used to maintain a patent airway, remove bronchopulmonary secretions and achieve adequate lung expansion and oxygenation.
- Demonstrate the ability to perform therapeutic procedures used to maintain a patent airway, remove bronchopulmonary secretions and achieve adequate lung expansion and oxygenation.
- Develop interpersonal skills so as to communicate effectively in the health care setting.
- Discuss the scope, organization and operation of respiratory care services and the integration of respiratory care services in the health care system.
- Discuss the ethical and legal implications of respiratory care practice.
Content Outline and Competencies:
I. Recordkeeping
A. Review of existing record
1. Review appropriate data in the patient record and recommend
procedures to obtain additional data, as indicated, to gain a total
picture regarding the patient’s cardiopulmonary status:
a. Patient demographics
b. Chief complaint/diagnosis
c. History of present illness
d. Past medical history
e. Social history
f. Occupational history
g. Current medications
h. Results of diagnostic procedures
i. Recent progress notes
j. Physician orders
B. Documentation
1. Demonstrate proper recordkeeping techniques using conventional
terminology as required in a health care setting and/or by regulating
agencies.
2. Describe proper documentation of verbal and telephone orders.
3. Identify the proper course of action when faced with an
incomplete, unclear, incorrect or potentially harmful order.
4. Explain the concept of SOAP in recordkeeping.
5. Describe computer applications of recordkeeping.
6. Evaluate the importance of making correct chart entries and how
to correct errors made in chart entries.
II. General Safety and Patient Comfort Considerations
A. Body mechanics and patient safety and comfort considerations
1. Demonstrate application of good body mechanics principles in the
following:
a. Lifting and carrying an object
b. Moving a patient to the head of the bed with and without aid
c. Moving a patient from bed to stretcher with assistance
d. Assisting a patient from bed to chair
e. Assisting a patient in walking
f. Assisting a falling patient
g. Turning a patient
2. Describe, using appropriate medical terminology, and demonstrate
appropriate patient positioning for therapeutic procedures and patient
comfort:
a. Supine
b. Prone
c. Fowler’s/Semi-Fowler’s
d. Trendelenburg
3. Identify potential safety hazards in a patient care setting and
suggest methods of eliminating the hazard.
4. Explain the general rules for responding to fire and disaster
emergencies in the patient care setting.
5. Differentiate among Class A, B and C types of fire
extinguishers.
6. Recall and demonstrate, as indicated, the appropriate measures to
treat cardiopulmonary collapse according to BCLS protocols.
B. Infection control and standard precautions
1. Identify sources of common nosocomial or iatrogenic infections.
2. Name common respiratory pathogens and identify the organisms as
to morphology, colony structure and characteristics.
3. Describe and demonstrate appropriate infection control and
standard precaution measures utilized in the patient care setting, to
include appropriate hand washing, use of personal protective equipment and
handling of non-disposable and disposable equipment and materials.
4. Describe the potential risks to health care workers in caring for
patients with bloodborne infectious diseases, such as Hepatitis B or HIV.
5. Describe the measure that should be taken if a health care worker
is exposed to blood or other body fluids.
6. Describe other infection control measures used to minimize
airborne contamination, wound and skin infections, etc.
III. Assessment of Overall Patient Cardiopulmonary Status
A. Patient interview/history
1. Review appropriate data in the patient record and recommend
procedures to obtain additional data, as indicated, to gain a total
picture regarding the patient’s cardiopulmonary status.
2. Identify the main points to be covered in a patient interview so
as to ascertain signs and symptoms indicating a cardiopulmonary disorder.
3. Apply appropriate medical terminology in describing a
patient’s:
a. Level of consciousness
b. Level of cooperation
c. Orientation to time, place and person
d. Presence of dyspnea, orthopnea and WOB
e. Cough and sputum characteristics
f. Education level
g. Knowledge of prior disease, medication and therapy
h. Age and language appropriateness
4. Demonstrate effective communication skill as it applies to
patient/practitioner interactions in light of the conditions described in
the previous objective.
B. Patient cardiopulmonary physical assessment
1. Recall the anatomy of the thorax, the major muscles of
respiration, and the lung lobes.
2. Locate the following structures on a diagram and/or partner:
a. Suprasternal notch
b. Manubrium of sternum
c. Body of sternum
d. Xiphoid process
e. Sternal angle
f. Costal margin
g. Costal angle
h. Costochondral junctions
i. Ribs 1-12
j. Intercostal spaces 1-8
k. C7; T1; T6 vertebrae
l. Clavicles
m. Scapulae
n. Carina
o. Transverse fissure
p. Oblique fissure
3. Locate the following topographical marks on a diaphragm and/or
partner:
a. Mid-clavicular lines
b. Anterior, mid-, and posterior axillary lines
c. Mid-scapular lines
d. Vertebral line
e. Mid-sternal line
4. Locate the lung lobes, transverse fissure and oblique fissure of
the patient or partner and use appropriate thorax anatomy and
topographical terminology in describing the location.
5. Identify accessory muscles that can be used in breathing and
their role in inspiration and expiration.
6. Demonstrate the ability to obtain the following measures:
a. Respiratory rate
b. Pulse
c. Blood pressure
7. List and apply the normal ranges, units of measure, related
abbreviations and the medical terms indicating abnormal results of each of
the following measures:
a. Temperature
b. Blood pressure
c. Pulse
d. Respiratory rate
8. Convert Centigrade temperature to Fahrenheit temperature and vice
versa.
9. Demonstrate the ability to inspect, palpate, percuss and
auscultate a patient and/or lab partner.
10. Describe each of the following terms relating to INSPECTION of
the patient and chest:
a. General appearance
b. Muscle wasting
c. Venous distention
d. Peripheral (pedal) edema
e. Diaphoresis
f. Clubbing
g. Cyanosis
h. Capillary refill
i. Chest configuration
j. Diaphragmatic movement
k. Breathing pattern
l. Accessory muscle use
m. Asymmetrical chest movement
n. Retractions
o. Nasal flaring
p. Quality of cough
q. Sputum amount and characteristics
r. COPD posturing
s. Room observation
11. Describe the appropriate PALPATION technique and the expected
outcomes in pulmonary disorders in evaluating the patient and the chest
for the following:
a. Tracheal location
b. Chest wall excursion
c. Fremitus
d. Apical pulse
e. Peripheral pulses
f. Airway secretions
g. Crepitus
h. Areas of tenderness
12. Describe the appropriate PERCUSSION technique and the expected
percussion sound (tympany, hyperresonance, resonance, dullness or
flatness) for identified pulmonary disorders.
13. Describe the appropriate AUSCULTATION technique and where the
following sounds may normally be heard:
a. Vesicular
b. Bronchial
c. Bronchovesicular
d. Blood pressure
14. Describe and recognize the following adventitious (abnormal)
chest sounds and list at least one cause for each:
a. Crackles (rales)
b. Rhonchi
c. Wheeze
d. Stridor
e. Pleural rub
f. Bronchophony
g. Egophony
h. Whispered pectoriloquy
15. Describe the various abnormal breathing patterns and apply the
appropriate terms to specific patient scenarios or conditions:
a. Hypoventilation
b. Hyperventilation
c. Kussmaul’s breathing
d. Biot’s breathing
e. Cheyne-Stoke’s breathing
f. Tachypnea
g. Bradypnea
h. Orthopnea
i. Dyspnea
j. Eupnea
k. Apnea
16. Given a list or patient scenario, spell, define and/or apply
appropriate terms and abbreviations related to patient interview and
assessment.
C. Pulmonary lab assessment
1. Recall the basic anatomy and function of the following
structures:
a. Nose
b. Conducting airways
c. Alveolar/capillary membrane
d. Heart
e. Arterial & venous vessels
2. Describe the mechanical movement of air on inspiration and
expiration.
3. Describe and/or diagram blood flow through the heart and lungs.
4. Explain the process of internal and external gas exchange.
5. Identify normal arterial blood gas values, using correct units of
measurement.
6. Correctly interpret basic arterial blood gas examples.
7. Relate pulse oximetry to patient oxygenation status.
8. Recall normal lung volumes and capacities and use the appropriate
related abbreviations.
9. Using a diagram, appropriately label lung volumes and
capacities.
10. Describe normal, obstructive and restrictive findings on
pulmonary function testing.
11. Demonstrate the ability to obtain the following measures:
a. Bedside pulmonary function measurements (MIP, VC, Ve, VT,
PEFR)
b. Pulse oximetry
12. Describe the equipment and patient instruction necessary to
perform bedside pulmonary function measurements (MIP, VC, Ve, VT, PEFR).
13. List and apply the normal ranges, units of measure, and related
abbreviations for bedside pulmonary function measurements (MIP, VC, Ve,
VT, PEFR).
14. Given a list or patient scenario, spell, define and/or apply
appropriate terms and abbreviations related to pulmonary lab assessment.
D. Clinical lab assessment
1. List the normal ranges, related abbreviations and the medical
terms indicating abnormal results for each of the following:
a. Red blood count
b. White blood count
c. Platelet count
d. Electrolytes--Na, K, Cl, Ca
e. Hemoglobin and hematocrit
f. Coagulation studies
2. Given a list or patient scenario, spell, define and/or apply
appropriate terms related to the clinical lab assessment.
E. Basic radiologic assessment
1. Using the appropriate medical terms and abbreviations, describe
the normal appearance of structures in the thorax on a posterior-anterior
(PA) chest film.
2. Identify changes relating to atelectasis, pleural effusion and
pneumothorax that would be seen on the chest film.
F. Basic EKG assessment
1. Recognize a normal EKG.
2. Identify normal, bradycardic and tachycardic rates.
3. Appropriately contact other health care personnel when anything
other than a normal EKG is seen.
IV. Introduction to Cardiopulmonary Pathophysiologic States
A. Common pathophysiologic states
1. Differentiate between hypoxia and hypoxemia.
2. Describe the various types of hypoxia and hypoxemia.
3. Identify clinical manifestations of mild and severe hypoxia.
4. Define shunt and deadspace and give at least two disorders for
each that cause changes from normal.
5. Given a list or patient scenario, spell, define and/or apply
appropriate terms and abbreviations related to patient interview and
assessment.
B. Common respiratory disorders
1. Spell, describe and/or apply to descriptions each of the
following pulmonary disorders:
a. Asthma k. Epiglottitis
b. Bronchitis l. Cystic fibrosis
c. Emphysema m. ARDS
d. Tuberculosis n. Pulmonary edema
e. Bronchiectasis o. Pulmonary embolism
f. Pneumonia p. Flail chest
g. Atelectasis q. Pneumothorax
h. Cor pulmonale r. Pleural effusion
i. Croup s. Hemothorax
j. Bronchiolitis t. Empyema
V. Gas and Humidity Therapy
A. Rationale and clinical indications
1. Identify the rationale, clinical indications, contraindications,
possible hazards and complications for oxygen therapy, humidity therapy
and gas mixture therapy.
2. Given patient situations, determine therapeutic goals and
recommend changes in therapeutic plan, as indicated.
3. Given a list, spell, define and calculate, as appropriate, terms
and abbreviations related to gas and humidity therapy.
B. Patient instruction and application techniques
1. Select and obtain the appropriate gas and humidity equipment to
implement the respiratory care plan.
2. Assemble, check for proper function and identify/correct
malfunctions for selected equipment.
a. Oxygen and gas mixture administration devices
1) Nasal cannula
2) Simple mask
3) PRB and NRB reservoir masks
4) Face tents
5) Air entrainment devices
6) Trach collars and t-pieces
7) Titration accessories
8) Oxygen mist tents
9) Oxygen hoods
10) Transtracheal oxygen
11) Oxygen conservers
12) CPAP
b. Humidification devices
1) Bubble
2) Passover
3) Cascade
4) Wick
5) Heat moister exchange
c. Gas delivery/metering/analyzing devices
1) Cylinder/bulk system/manifold
2) Oxygen concentrator
3) Air compressors
4) Liquid oxygen system
5) Regulators & reducing valves
6) Flowmeter
7) Blenders
8) Oxygen analyzer
9) Pulse oximeter
3. Explain planned therapy and goals to patient in understandable
terms.
4. Demonstrate the ability to appropriately deliver gas and humidity
therapy.
5. Evaluate and monitor patient’s response and equipment operation
of delivered therapy and recommend/make necessary modifications, as
indicated.
6. Record therapy and results in patient and/or department record
using conventional terminology.
7. Communicate information regarding clinical status to appropriate
members of the health care team.
VI. Aerosol Therapy
A. Rationale and clinical indications
1. Identify the rationale, clinical indications, contraindications,
possible hazards and complications for aerosol therapy.
2. Given patient situations, determine therapeutic goals and
recommend changes in therapeutic plan, as indicated.
3. Given a list, spell and define terms and abbreviations related to
aerosol therapy.
B. Patient instruction and application techniques
1. Select and obtain the appropriate aerosol equipment to implement
the respiratory care plan.
2. Assemble, check for proper function and identify/correct
malfunctions for selected equipment.
a. Small and large volume medication nebulizers
b. MDI, MDI w/spacer
c. Large reservoir nebulizers
d. Ultrasonic nebulizers
e. Oxygen mist tents
3. Explain planned therapy and goals to patient in understandable
terms.
4. Demonstrate the ability to appropriately deliver aerosol
therapy.
5. Evaluate and monitor patient’s response and equipment operation
of delivered therapy and recommend/make necessary modifications, as
indicated.
6. Record therapy and results in patient and/or department record
using conventional terminology.
7. Communicate information regarding clinical status to appropriate
members of the health care team.
VII. Introduction to Respiratory Pharmacology
A. Maintenance of a patient airway or removal of bronchopulmonary
secretions
1. Describe the oral, parenteral and inhalation routes of drug
administration.
2. Define “principal effect” and “side effect.”
3. Explain the role and common side effects associated with each of
the following in achieving bronchodilation:
a. Parasympatholytics
b. Methylxanthines
c. Sympathomimetics
d. Corticosteroids
4. Explain the role and common side effects associated with other
inhaled agents or other agents commonly used in the care of respiratory
patients:
a. Muckokinetic agents
b. Anti-asthmatic agents
c. Leukotriene agents
d. Antibiotics
B. Patient instruction and application techniques
1. Demonstrate the ability to properly dispense a prescribed amount
of medication using syringe, needle, dropper, and unit dose vials.
2. Explain planned aerosol therapy and goals to patient in
understandable terms to achieve optimal therapeutic outcome.
3. Evaluate and monitor patient’s response and equipment operation
of delivered therapy and recommend/make necessary modifications, as
indicated.
4. Record therapy and results in patient and/or department record
using conventional terminology.
5. Communicate information regarding clinical status to appropriate
members of the health care team.
6. Demonstrate the ability to reference drugs and their related
information by using the Physician’s Desk Reference (PDR).
7. Given a list or patient scenario, spell, define and/or apply
appropriate terms and abbreviations related to pharmacology.
VIII. Airway Clearance Techniques
A. Rationale and clinical indications
1. Identify the rationale, clinical indications, contraindications,
possible hazards and complications for airway clearance techniques.
2. Given patient situations, determine therapeutic goals and
recommend changes in therapeutic plan, as indicated.
3. Discuss the rationale and requirements of an effective cough.
4. Describe methods of obtaining a sputum sample.
5. Describe possible macroscopic and microscopic findings of sputum
examination.
6. Given a list, spell and define terms and abbreviations related to
airway clearance techniques.
B. Patient instruction and application techniques
1. Select and obtain the appropriate airway clearance equipment to
implement the respiratory care plan.
2. Assemble, check for proper function and identify/correct
malfunctions for selected equipment.
a. Vacuum systems
b. Open and in-line suction catheters
c. Mechanical vibrators/percussors
d. Flutter valves
e. HFCWO (Therapy Vest)
f. Specimen collectors/traps
g. Oral (Yankaur) suction devices
h. IPV
i. PEP or other PAP therapy
3. Explain planned therapy and goals to patient in understandable
terms.
4. Demonstrate the ability to appropriately deliver the various
therapies for airway clearance, to include:
a. Splinting
b. Deep breathing and cough
c. Oropharyngeal, nasotracheal, endotracheal and tracheal
suction
d. Chest physiotherapy (postural drainage, vibration and
percussion)
e. Flutter
f. HFCWO
g. Autogenic drainage
h. IPV
i. PEP or other PAP therapy
5. Evaluate and monitor patient’s response and equipment operation
of delivered therapy and recommend/make necessary modifications, as
indicated.
6. Record therapy and results in patient and/or department record
using conventional terminology.
7. Communicate information regarding clinical status to appropriate
members of the health care team.
IX. Lung Expansion Techniques
A. Rationale and clinical indications
1. Identify the rationale, clinical indications, contraindications,
possible hazards and complications for lung expansion techniques.
2. Given patient situations, determine therapeutic goals and
recommend changes in therapeutic plan, as indicated.
3. Explain the physiologic effects of lung expansion techniques.
4. Relate volume, flow, and time during the delivery of IPPB.
5. Given a list, spell and define terms and abbreviations related to
lung expansion techniques.
B. Patient instruction and application techniques
1. Select and obtain the appropriate lung expansion equipment to
implement the respiratory care plan.
2. Assemble, check for proper function and identify/correct
malfunctions for selected equipment.
a. IPPB
b. CPAP/BiLevel PAP
c. IS
d. IPPB and CPAP/BiLevel PAP breathing circuits and patient
adjuncts
3. Explain planned therapy and goals to patient in understandable
terms.
4. Demonstrate the ability to appropriately deliver the various
therapies for lung expansion.
5. Evaluate and monitor patient’s response and equipment operation
of delivered therapy and recommend/make necessary modifications, as
indicated.
6. Record therapy and results in patient and/or department record
using conventional terminology.
7. Communicate information regarding clinical status to appropriate
members of the health care team.
X. Respiratory Care and the Health Care System
A. Ethical and legal implications
1. Discuss the ethical and legal implications of respiratory care
practice.
2. Discuss ways to address ethical and legal situations that may be
encountered.
3. Given a list, define and appropriately apply applicable ethical
and legal terms and principles.
B. Interpersonal relations and communication
1. Describe the role and function of the various members of the
health care team.
2. Recognize the respiratory care practitioner’s role in advancing
the individual, the institution and the profession’s perception by
others.
3. Discuss the skills necessary for effective communication and the
creation of positive impressions with patients, family members and
visitors, peers and other health care team members.
4. Identify stress factors that may be part of a RCP’s work and
mechanisms for relief.
5. Demonstrate appropriate nonverbal, verbal, and written
communication with patients, family members and visitors, peers and other
health care team members.
C. Scope, organization and overall operation of RC services
1. Describe a typical hospital organization chart from student
through top administrator.
2. Identify the role of each of the following members of a
respiratory department:
a. Medical director
b. Department (technical) director
c. Supervisor
d. Staff therapist
e. Student
3. Describe the scheduling process that may be used in respiratory
services.
4. Define/describe the following terms:
a. FTE d. Patient evaluation system
b. Job description e. Protocols
c. Triage f. Outcome measures
5. Describe how respiratory employers are typically evaluated.
6. Describe how workloads may be assigned and how productivity is
determined.
7. Identify the scope of services that may be offered in large,
medium and small patient care arenas.
D. Introduction to the health care delivery system
1. Define the following terms:
a. PPO
b. HMO
c. Medicare/Medicaid
d. DRG’s
e. Capitation
f. Gatekeeping
2. Describe the evolution of health care in the United States.
3. Evaluate today’s health care picture.
4. Discuss the RCP’s status and responsibilities in today’s
health care delivery system.
Method of Evaluation and Competencies:
Written examinations = 50% of total grade Each exam may contain questions from previous modules. Each module exam will be scaled to 100 points. Comprehensive final exam = 30% of total grade A score of 75% or greater must be achieved on the comprehensive final for successful completion of the course, regardless of overall average. A second comprehensive exam may be taken after showing evidence of further study as directed by faculty. A maximum of two exams may be taken. Lab Exercises/Questions = 10% of total grade Lab activities are required and most will require a sign-off by the instructor. Student Clinic Book check-offs = 10% of total grade Lab competencies and clinic practice - “Satisfactory” or “Satisfactory/Needing Improvement” evaluation by instructor Clinic practice will begin after initial didactic and laboratory preparation as noted on the course schedule. The written evaluation for clinical performance will be pass/fail with each component of the evaluation evaluated as being “satisfactory” or “needing improvement.” In addition, procedural check-offs will be documented in the student blue book. A midway clinical evaluation will be completed to acquaint the student with the evaluation process and to provide formal feedback. All “needing improvement” ratings with an “*”, as determined by the clinical instructor, warrant action that minimally requires remediation. It may also require a faculty decision regarding program promotion and constitute a reason to fail RC 125, regardless of didactic performance. Grading Scale: A = 92 - 100% B = 83 - 91% C = 75 - 82% D = 67 - 74% F = 0 - 66% W = Withdrawal initiated by college deadline Note: Assignments received late (or after a deadline) are not eligible for full point consideration.
Caveats:
- Students will have provided proof of health conducive to being in a health care environment. In addition, drug screening and other requirements may be imposed by clinical agencies. Students are responsible for any and all costs related to their health care or other imposed requirements. Students will also need to provide their own transportation to and from scheduled clinical activities. They will also need to be dressed and prepared appropriately as outlined in the Program Administrative Handbook.
- Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students are expected to comply with the attendance and other program policies described in the Program Administrative Guideline Handbook.
- A grade of “C” or better is required for the course for program promotion to subsequent respiratory course work.
- Students will need basic word processing and Internet skills for the completion of some papers, exercises and projects.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.
RC 130
- Title: Respiratory Care Equipment*
- Number: RC 130
- Effective Term: Spring/Summer 2014
- Credit Hours: 4
- Contact Hours: 82
- Lecture Hours: 50
- Lab Hours: 32
Requirements:
Prerequisites: Admission to the respiratory care program
Description:
This course is an introduction to basic respiratory care equipment. The operation, function, calibration, troubleshooting and maintenance for oxygen administration devices, aerosol generators, humidifiers and hyperinflation devices will be addressed. Medical gas production and storage will also be addressed. 6 hrs. lecture, 8 hrs. lab/wk. Summer.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
- Describe and apply principles of gas physics that relate to gas properties, gas behaviors and atmospheric conditions.
- Describe and apply principles of gas production and storage.
- Describe and contrast, as indicated, the function, features and adjunct equipment options of basic respiratory equipment: a) Reducing valves, regulators and flowmeters, b) Gas delivery systems, c) Oxygen and gas mixture administration devices, d) Humidity devices, e) Aerosol devices, f) Oxygen analyzers, g) Pulse oximeters, h) Blenders, i) Hyperinflation equipment.
- Demonstrate the ability to set up, check for correct function, and troubleshoot, as indicated, the respiratory equipment listed above.
- Describe, including computations, and set up appropriate equipment to ensure adequate patient flow for a required FIO2.
- Describe the cleaning, disinfecting and sterilizing methods used with respiratory equipment and methods used to evaluate the effectiveness of these techniques.
- Describe issues regarding safe use of equipment, to include equipment selection, preventive maintenance, quality improvement and practitioner competency.
Content Outline and Competencies:
I. Gas Physics
A. Gas properties
1. Define density and compute the density of a gas or gas mixture
based on its molecular weight.
2. Define critical temperature and critical pressure.
3. Identify the molecular weight, mass, density, boiling point,
critical temperature and critical pressure for frequently used medical
gases.
4. Define and compute basic gas laws.
a. Boyle’s
b. Guy-Lussac’s
c. Charles’
d. Henry’s
e. Graham’s
f. Dalton’s
g. Poiseuille’s
B. Behaviors of gas
1. Describe kinetic activity of gases.
2. Describe Brownian motion.
3. Describe the different types of flow of gas through a tube.
a. Laminar flow
b. Turbulent flow
c. Tracheobronchial flow
d. The Reynolds Number
C. Atmospheric gases and conditions
1. Identify the gases and their percentages which make up the
atmosphere.
2. Define and compute changes from one to the other for ATPS, BTPS
and STP.
3. Describe how atmospheric pressure is measured and list common
readings for one atmosphere of pressure.
4. Describe barometric pressure changes at higher altitudes and
below the sea.
5. Verify that oxygen percentage is constant and calculate changes
in partial pressure at higher and lower atmospheric pressures.
II. Gas Production and Storage
A. Gas production
1. Describe methods of gas production for frequently used medical
gases.
2. Outline the steps involved in fractional distillation of oxygen.
3. Identify the purity requirements for medical gases.
4. Identify the agencies which regulate medical gas production.
B. Gas storage
1. Define bulk storage as it applies to medical gases.
2. Describe four bulk systems found in hospitals.
3. Describe hospital piping systems, zone valves and alarms.
4. Describe gas cylinder identification, construction and safety
issues.
a. U.S. and international color coding
b. Proper labeling of contents
c. Cylinder construction
d. Cylinder testing
e. Cylinder maintenance codes
f. Safety systems
5. Recognize agencies which regulate medical gas storage and
transport.
6. Compute the possible duration for liquid or gas cylinders based
on the liter flow to be used.
7. Describe the medical gas systems used in the home environment.
a. Oxygen concentrators
b. Liquid systems
c. Cylinder options
III. Reducing Valves, Regulators and Flowmeters
A. Reducing valves
1. Define a reducing valve and describe its function.
a. Preset vs. adjustable
b. Single stage vs. multi-stage
c. Working pressures
2. Describe and identify safety systems used in conjunction with
reducing valves.
B. Regulators
1. Define a regulator and describe its function.
a. Preset (Thorpe tube) vs. adjustable (Bourdon gauge)
b. Single stage vs. multi-stage
c. Working pressures
2. Compare a regulator to a reducing valve.
3. Describe and identify safety systems used in conjunction with
regulators.
C. Flowmeters
1. Define a flowmeter and describe its function.
2. Determine the presence of pressure compensation in flowmeters.
3. Differentiate among the different types of flowmetering devices.
a. Bourdon gauges
b. Thorpe tube
c. Kinetic tube
4. Describe the safety systems used in conjunction with flowmeters.
IV. Oxygen and Gas Mixture Administration Devices
A. Identify patient devices used for oxygen and gas mixture
administration.
1. Nasal cannula
2. Nasal catheter
3. Simple mask
4. Partial rebreathing masks
5. Non-rebreathing masks
6. Face shield (tent)
7. Venturi (HAFOE) devices
8. Aerosol masks
9. Tracheostomy masks (shield)
10. T-piece (Briggs adapter)
11. Tents
12. Hoods
13. CPAP masks
14. Blenders
15. Oxygen conserving devices
a. Transtracheal oxygen catheters
b. Reservoir devices
c. Demand/pulse dose systems
B. Identify the concentrations available with all oxygen and gas
mixture administration devices and describe how the concentration is
accomplished.
C. Identify the oxygen administration devices requiring humidity.
D. Identify the oxygen administration devices generally used with
aerosol generators.
E. Compute air entrainment ratios and total flow delivered to the
patient for HAFOE devices.
F. Demonstrate the ability to assemble, check for equipment function
and troubleshoot oxygen and gas administration devices.
V. Humidity Equipment
A. Define the terms related to humidity equipment.
1. Humidity
2. Humidifier
3. Absolute humidity
4. Relative humidity
5. Body humidity
6. Percent body humidity
7. Humidity deficit
8. Dew point
9. Saturation
10. Super saturation
11. Vapor pressure
B. Describe each of the following equipment used to provide humidity
including the method of humidity formation and humidity output.
1. Bubblers
2. Passover humidifiers
3. Large reservoir heated humidifiers
4. Heat moisture exchangers
5. Humidity tents
C. Identify oxygen and gas mixture administration devices that can be
used with humidifiers discussed.
D. Demonstrate the ability to set up, check for function and
troubleshoot humidifiers, including continuous water feed systems as
applicable.
VI. Aerosol Equipment
A. Define the terms related to aerosol equipment.
1. Aerosol
2. Atomizer
3. Nebulizer
4. Baffle
5. Output
6. Total flow
7. Bernoulli effect
8. Venturi principle
9. Babbington principle
10. Piezoelectric
B. Describe the aerosol generation including particle size, output and
total flow for frequently used aerosol generators.
1. Jet capillary nebulizers
a. Large reservoir airway hydration nebulizers
b. Small reservoir medication nebulizers (mainstream/sidestream)
c. Large reservoir medication nebulizers
d. Tents
2. Ultrasonic nebulizers
3. Hydronamic nebulizers
4. SPAG nebulizers
C. Compute air entrainment ratios and total patient flow from large
reservoir nebulizers.
D. List factors which determine aerosol deposition, stability and
particle size production.
E. Demonstrate the ability to set up, check for function and
troubleshoot aerosol generators.
F. Identify oxygen and gas mixture administration devices that can be
used with the nebulizers discussed.
VII. Analyzers, Pulse Oximeters and Blenders
A. Discuss the rationale for the use of analyzers.
B. Identify the types of analyzers and describe their operation.
1. Paramagnetic/physical
2. Thermoconductive/electrical
3. Galvanic/chemical
4. Polarographic/electrochemical
C. Identify the analyzers which represent each operational type and
compare and contrast their function.
1. Sampling technique
2. Accuracy in the pressure of other gases
3. Response time
4. Safety with flammable gases
5. Oxygen consumption
6. Response to partial pressure
D. Demonstrate the ability to set up, calibrate and troubleshoot
analyzers.
E. Describe the appropriate use of oxygen analyzers.
1. Placement of analyzers in patient circuits
2. Effect of humidity on analyzer accuracy
3. Appropriate alarm settings (adults/children)
F. Identify indications for the use of a blender and describe the
blender operation.
G. Identify pulse oximeters and state the principles of operation.
H. Demonstrate the ability to set up and troubleshoot pulse oximeters.
VIII. Titration
A. Describe and set up the appropriate equipment to obtain required
FiO2.
B. Calculate the liter flow requirements needed of air and of oxygen to
guarantee a given FiO2 delivery with adequate patient flow.
C. Describe and set up equipment at a specified FiO2 and ensure
adequate patient flow.
IX. Hyperinflation Equipment
A. Incentive spirometers (IS)
1. Distinguish between and describe the function of flow and volume
oriented IS devices.
B. Positive airway pressure (PAP)
1. Identify the parts of a basic continuous PAP and Bilevel PAP
setup.
2. List the components of CPAP and Bilevel PAP to be checked when
oxygen administration devices are checked.
3. Demonstrate the ability to set up, check for function and
troubleshoot CPAP and Bilevel PAP device.
C. Intermittent positive pressure breathing (IPPB)
1. Classify the Bennett PR I and PR II using a prescribed system.
2. Discuss the function of the parts and controls of the PR II.
a. Bennett valve
b. Pressure diluter knob
c. Sensitivity control
d. Terminal flow control
e. Timing accumulators
f. Peak flow control
g. Air mix venturi
h. Rate control
i. Expiration time control
j. Air dilution knob
3. Discuss flow characteristics of the Bennett PR units.
4. Compare the features of the PR I, PR II and AP 5 and 4.
5. Identify the modifications required to increase or decrease the
volume delivered by the Bennett IPPB units.
6. Classify the Bird Mark series ventilators using a prescribed
system.
7. Discuss the function of the parts and controls of the Bird Mark
7.
a. Venturi gate
b. Clutch plates
c. Ceramic switch
d. Apnea control (expiratory time control)
e. Air-mix venturi
f. Flow control
g. Pressure control
h. Sensitivity control
8. Compare the features of the Mark 7, 7A, 8A and 10.
9. Discuss flow characteristics of the Bird Mark series
ventilators.
10. Compare and contrast pressure and flow characteristics of the
Bennett PR units and the Bird Mark series ventilators.
11. Identify modifications required to increase and decrease the
volume delivery with the Bird IPPB machine.
12. Describe the function of the exhalation valve on the patient
circuit of IPPB machines.
13. Demonstrate the ability to set up, check for function and
troubleshoot IPPB machines.
X. Cleaning and Sterilization
A. Describe physical and chemical methods of disinfection or
sterilization.
B. Identify procedures and describe agents used for sterilization and
disinfection.
1. Mode of action
2. Time requirements
3. Temperature requirements
4. Organisms disinfected or sterilized
5. Concentrations
6. Advantages and disadvantages of use
7. Precautions of use
C. Outline equipment cleaning, disinfecting and sterilizing
procedures.
D. Compare and contrast the sampling techniques used to determine
equipment cleanliness or sterility.
E. Describe the appropriate cleaning, disinfecting and sterilization
procedures that would be appropriate for the following commonly used
respiratory care equipment:
1. Flowmeters
2. Pulse oximeters
3. Resuscitation bags
4. Main flow filters
5. Peak flow meters
6. Large bore tubing
7. Respirometers/pneumotachs
8. Bronchoscopes
XI. Hospital Safety Measures for Quality Improvement and Equipment
Performance
A. Discuss consideration for the selection and purchase of respiratory
care equipment.
B. Identify the Respiratory Care Services’ responsibility for
preventive maintenance and quality control of equipment.
C. List the current agencies monitoring equipment defects.
D. List the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) standards for equipment safety.
E. Discuss evaluation methods for assessing respiratory care
practitioner competencies and the JCAHO requirements for recordkeeping of
the same.
Method of Evaluation and Competencies:
Written examinations = 60% of total grade Practicum examination = 20% of total grade Comprehensive final exam and practicum = 20% of total grade Grading Criteria: A = 92-100% B = 83- 91% C = 75- 82% D = 67- 74% F = 0- 66% W = withdrawal initiated by college deadline
Caveats:
- Students are expected to comply with JCCC Student Code of Conduct detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students are expected to comply with the attendance and other program policies and procedures described in the Program Administrative Guideline Handbook.
- A grade of “C” or better is required for the course for program promotion to subsequent respiratory course work.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.
RC 135
- Title: Cardiopulmonary Medicine I*
- Number: RC 135
- Effective Term: Spring/Summer 2014
- Credit Hours: 1
- Contact Hours: 16
- Lecture Hours: 16
Requirements:
Prerequisites: Admission to the respiratory care program
Description:
This is the first of three courses that provide a detailed review of the respiratory and cardiac system anatomy and physiology and the clinical implications of normal and abnormal function. 2 hrs./wk. Summer.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
- Describe respiratory system anatomy, physiology and basic clinical implications of normal and abnormal function.
- Describe cardiac system anatomy, physiology and basic clinical implications of normal and abnormal function.
- Describe tracheobronchial secretions in terms of composition, properties, affecting agents and collection techniques.
Content Outline and Competencies:
I. Respiratory System
A. Describe the divisions of the upper and lower airway.
B. For each of the following structures, describe the anatomy,
histology, blood and nerve supply, physiology and clinical implications of
normal and abnormal function:
1. Nose
2. Sinuses
3. Pharynx
4. Larynx
5. Airways--trachea, bronchi and distal
6. Pleura
7. Alveoli
C. Identify thoracic skeletal anatomy and apply appropriate terminology
to structure, contents and outlets.
D. Identify the respiratory muscles used in ventilation, their role in
breathing, and the clinical implications of normal and abnormal function.
E. Identify the contents of the mediastinum and the clinical
implications of normal and abnormal function.
II. Circulatory System
A. Describe, in detail, the following elements of the circulatory
system:
1. The anatomy, histology and characteristics of the heart.
2. The pathway of blood flow from the vena cava to the aorta.
3. The normal electrical pathway starting at the sino-atrial node.
4. The vessels that make up the vascular tree.
B. Describe the function and role of each of the following on heart
action:
1. Heart sounds
2. Cardiac cycle
3. Cardiac volume
4. Heart beat
5. Sympathetic/parasympathetic CNS control
6. Cardiac reflexes
7. Vasomotor control
C. Define and give normals for blood pressure, stroke volume,
circulation time, cardiac output and cardiac index.
D. Describe the following factors that maintain blood pressure and
circulation:
1. Heart action
2. Blood volume
3. Peripheral resistance
4. Blood vessel action
5. Blood viscosity
E. Describe the role of the lymphatic system.
F. Identify normal pressures found in the right atrium, right
ventricle, pulmonary artery, left atrium, left ventricle and aorta.
III. Tracheobronchial Secretions
A. Describe the sources and constituents of sputum.
B. Describe the various methods of collecting sputum and the advantages
and disadvantages of each method.
C. Describe the physical characteristics of sputum.
D. Describe the role of hydration states, environmental factors,
irritants, hormones, etc., on sputum production and characteristics.
E. Relate sputum characteristics as they apply to common respiratory
disorders, such as COPD, asthma, cystic fibrosis, atelectasis, etc.
Method of Evaluation and Competencies:
Written examinations and quizzes = 100% of total grade A minimum of two tests will be given. Each test may contain questions from previous material. Quizzes may be given at the discretion of the instructor. Grading scale: A = 92 - 100% B = 83 - 91% C = 75 - 82% D = 67 - 74% F = 0 - 66% W = Withdrawal initiated by college deadline
Caveats:
- Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students are expected to comply with the attendance and other program policies described in the Program Administrative Guideline Handbook.
- A grade of “C” or better is required for the course for program promotion to subsequent respiratory care work.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.
RC 220
- Title: Cardiopulmonary Physiology*
- Number: RC 220
- Effective Term: Spring/Summer 2014
- Credit Hours: 2
- Contact Hours: 30
- Lecture Hours: 30
Requirements:
Prerequisites: Successful completion of the summer sequence of respiratory care courses
Description:
This is a comprehensive study of the physiology and pathophysiology of the pulmonary, cardiovascular and renal systems as they relate to respiratory care. 2 hrs./wk. Fall.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
- Describe the major concepts and mechanisms of respiratory physiology, to include: a) Lung structure and function, b) Ventilation and gas diffusion, c) Lung mechanics, d) Introduction to pulmonary function testing.
- Describe the major concepts and mechanisms of cardiovascular physiology, to include: a) Cardiac conduction system and blood components, b) Blood flow and hemodynamics, c) Ventilation and perfusion relationships, d) Oxygen transport, e) Carbon dioxide transport and acid base balance.
- Describe the major concepts and mechanisms of renal physiology to include the kidney’s role in maintaining acid base balance.
- Describe the neural and chemical control of ventilation to include factors that influence the function of normal breathing regulation.
- Describe the cardiopulmonary response to abnormal environmental exposures, to include: a) Hyperbaric and hypobaric conditions, b) Increased FiO2, c) Air pollution, d) Tobacco smoke.
Content Outline and Competencies:
I. Lung Structure and Function
A. Review terms and symbols pertinent to respiratory physiology.
B. Describe lung development in utero and identify the fetal
developmental stage when lungs are first viable.
C. Review specific facts about the anatomy of the tracheal/bronchial
tree to include:
1. Tracheal length
2 Tracheal structure
3. Tracheal bifurcation
D. Describe the anatomy and physiology of the alveolocapillary region
to include:
1. Pores of Kohn
2. Alveolar cells
3. Canals of Lambert
4. Sphingomyelin
5. DCCP
6. Alveolar cells
- Type I
- Type II
- Macrophages
E. Describe physiologic humidification of inspired gas.
F. Describe internal and external gas exchange.
G. Explain how the lung clears itself of foreign particles.
H. Define metabolism, including Basal Metabolic Rate.
I. Identify metabolic functions of the lung.
J. Define respiratory quotient and recall its normal value.
II. Ventilation and Diffusion
A. Describe diffusion of gas across the alveolar capillary(ac)
membrane.
B. Identify factors which affect diffusion to include:
1. Time of exposure
2. Membrane integrity
3. Solubility of the gas
4. Temperature
5. Pressure gradients
C. Compare and contrast the rate of diffusion across the ac membrane
for CO2 and O2.
D. Describe the measurement of lung diffusion (DL).
E. Interpret lung diffusion measurements as they relate to lung
disease.
F. Define respiratory quotient (RQ).
G. Identify normal values for O2 consumption (VO2) and CO2 production
(VCO2).
H. Define internal and external respiration.
I. Identify the factors used to determine normal lung volumes and
capacities.
J. Define capacity as it relates to lung volumes and identify the lung
volumes included in each lung capacity.
K. Explain the significance of functional residual capacity (FRC) and
describe the impact of an increased or decreased FRC.
L. Describe the changes in lung volumes and capacities with restrictive
or obstructive lung disease.
M. Define anatomic and physiologic deadspace.
N. Calculate minute ventilation, alveolar tidal volume and alveolar
minute ventilation.
O. Describe normal and abnormal breathing patterns.
III. Lung Mechanics
A. Describe the mechanics of normal inspiration and expiration which
result in gas flow into and out of the thorax.
B. Describe the maximal inspiratory pressure created with the Mueller
maneuver (NIF, MIP or PNP) and the maximal expiratory pressure created
with the Valsalva maneuver (MEP).
C. Define lung compliance and elastance and identify normal values.
D. Calculate lung compliance given changes in pressure and volume.
E. Define airway resistance and identify normal values.
F. Define time constants.
G. Describe the relationship of surfactant and surface tension to lung
compliance.
H. Describe the changes in lung compliance seen in respiratory
diseases.
I. Define Laplace’s law.
J. Define and discuss the following factors as they relate to airway
pressure:
1. Transairway pressure
2. Transpulmonary pressure
3. Time constants
4. CL and Raw
K. Describe the work of breathing and the significance of the increased
work of breathing in disease states.
L. Compare CL and Raw in the adult and infant lungs.
M. Apply each of the following gas laws to ventilation and lung
mechanics.
1. Graham’s law
2. Boyle’s law
3. Henry’s law
4. Dalton’s law
5. Avogadro’s law
6. Poiseuille’s law
7. Fick’s law
IV. Introduction to Pulmonary Functions
A. Define respiratory obstruction and restriction and relate them to
pulmonary disease states.
B. Identify the criteria used to establish patient normal values for
pulmonary function testing.
C. Identify the pulmonary function tests available to assist in the
diagnosis of pulmonary disorders to include:
1. Spirometry (lung mechanics)
2. Lung volumes
3. Diffusing capacity
D. Define the following expiratory flow rate measurements:
1. Forced vital capacity (FVC)
2. Forced expiratory volume 1 second (FEV1)
3. Forced expiratory flow 25%-75% (FEF25-75)
4. Peak expiratory flow rate (PEFR)
5. Maximum voluntary ventilation (MVV)
E. Identify abbreviations used for pulmonary function testing to
include:
FVC FEF 25-75 FEV1/FVC
FEV1 PEFR
F. Convert ATPS pulmonary function values to BTPS results.
G. Interpret pulmonary function spirometry and lung volumes for
restrictive or obstructive changes.
V. Blood Flow and Hemodynamics
A. Blood flow
1. Trace blood flow through the heart.
2. Identify pressure at various points in the systemic and pulmonary
circulation to include:
a. Right Atrium Pressure
b. Right Ventricle Pressure
c. PAP
d. PCWP
3. Define systolic, diastolic and pulse pressure.
4. Define CVP and state the normal value.
5. Describe the balance of forces affecting fluid volume within
blood capillaries (hydrostatic pressure and oncotic pressures).
6. Describe causes of edema (systemic and pulmonary).
7. Identify the effect of O2 and CO2 on pulmonary and systemic
vasculature.
B. Hemodynamics
1. Describe values obtained with a pulmonary artery catheter and
relate the clinical significance of increases or decreases in their values
to include:
a. CVP
b. PAP
c. PCWP
d. C.O.
2. Review the appearance of a pulmonary artery pressure tracing as
it floats to the pulmonary artery and when the balloon is inflated to
wedge.
3. Identify three (3) methods for determining cardiac output.
4. Identify factors which influence cardiac output to include:
a. Preload/afterload
b. Intrathoracic pressure
c. Inotropism
5. Describe the pressure differences between pulmonary vessels in
the apex of the lung versus the base of the lung in an upright individual
(zones 1-3).
6. Identify relationship between alveolar pressure and pulmonary
blood flow.
7. Identify the effect of variations in mean intrathoracic pressure
on systemic and pulmonary blood flow.
8. Identify the Fick Principle.
VI. Ventilation Perfusion Relationships
A. Define shunt and deadspace.
B. Review the normal distribution of blood in the upright lung.
C. Review the normal distribution of ventilation in the upright lung.
D. Review and explain pathologic causes for uneven distribution of
ventilation or perfusion within the lung.
E. Define normal ventilation/perfusion ratios and state the normal
value.
F. Review tests used to identify regional ventilation and perfusion in
the lung.
G. Review bronchiolar and vascular response to mismatch.
H. Review the effect of inequality on arterial and alveolar
oxygenation.
I. Describe the effects of a inequality on arterial and alveolar CO2
levels.
J. Describe pulmonary and systemic responses to hypoxia, hypocapnia and
hypercapnia.
K. Describe the factors that can affect oxygen uptake by the tissues.
L. Describe how a shunt study would be performed.
VII. Oxygen Transport
A. Identify and explain causes of hypoxemia.
B. Review the four types of hypoxia.
C. Describe normal binding of oxygen to hemoglobin.
D. List the two components of oxygen transport.
E. List abnormal types of hemoglobin.
F. Calculate oxygen content and state normal value.
G. Describe cyanosis in terms of oxygen content.
H. Define a–v content difference and discuss its significance.
I. State normal value for PvO2.
J. Calculate predicted alveolar oxygen levels.
K. Differentiate between PaO2 and CaO2 and discuss their respective
roles in oxygen delivery.
L. Identify points on the oxyhemoglobin dissociation curve (OHDC) to
include: loading, unloading, 90, 60 and 75 and 50 percent saturation.
M. List factors causing OHDC to shift left or right.
N. Identify the changes in O2 and Hb affinity that occur with an OHDC
shift to the left or right.
O. Describe the effect of 2,3–DPG on the OHDC.
P. Describe the effect of CO on the OHDC.
Q. Define P50 and state its clinical significance.
R. Describe the Bohr effect.
VIII. Carbon Dioxide Transport
A. Identify the ways CO2 is transported from the cells to the lungs.
B. Describe the events occurring with CO2 uptake at the cell level and
CO2 release at the lungs.
C. Describe in detail the conversion of CO2 to HCO3 to include chloride
shift, carbonic anhydrase, isohydric shift.
D. Describe the Haldane effect.
E. Describe the Bohr effect.
F. Compare the CO2 and O2 dissociation curves.
G. Define and calculate total CO2.
IX. Acid-Base Balance
A. Define “acid” and “base.”
B. Define “buffers” and state their physiologic role.
C. Recall the four body buffers.
D. Define pH and recall its relationship to hydrogen ion concentration
measured in nanomoles.
E. Define acidosis and alkalosis.
F. Compare forms of the Henderson-Hasselbalch equation and be able to
perform computations with the clinic form of the equation.
G. Review basic kidney function.
H. Describe how H+ and HCO3 are regulated by the kidney in acid-base
states.
I. Identify the four types of acid-base disturbance and state
representative causes for each type.
J. Describe how each system (lungs and kidneys) compensates for
imbalance in pH.
K. Interpret arterial blood gas studies for acid-base balance and
oxygenation status.
L. Define “buffer base” and “base excess.”
M. Calculate anion gap and total CO2.
X. Control of Ventilation
A. Neural regulation of ventilation
1. Describe the Gamma-efferent system and its role in modifying
breathing patterns.
a. Obstructive disease pattern
b. Restrictive disease pattern
2. Define the following and state their effect on breathing:
a. Hering-Breuer reflex
b. Paradoxic reflex of head
c. Deflation reflex
d. J receptors
e. Irritant receptors
3. Identify the physiologic responses to hyperventilation.
4. Define Biot’s Breathing and Cheyne-Stokes Breathing.
B. Chemical regulation of ventilation
1. Identify the chemoreceptor area of the medulla.
2. Describe the effect of carbon dioxide on the central
chemoreceptors – including conversion of blood CO2 to CSF H+ as the
mechanism of stimulation.
3. Explain the role of the blood–brain barrier in delaying return
to normal from chronic hyperventilation.
4. State peripheral chemoreceptor response to carbon dioxide.
5. State the effect of free H+ on respiration.
6. Identify the locations of the peripheral chemoreceptors.
7. Describe the effect of low oxygen levels on peripheral
chemoreceptors.
8. Describe and explain the mechanisms involved with oxygen-induced
hypoventilation.
9. Review the calculation of PIO2 and PAO2 under various barometric
conditions.
XI. Cardiac Conduction and Blood Components
A. Describe the function of the following specialized cells of plasma:
1. Erythrocytes
2. Leukocytes
3. Thrombocytes
B. Identify chemical components of the plasma.
C. Describe how blood volume affects blood pressure, stroke volume,
heart rate, and cardiac output.
D. Describe the components of the pulmonary and systemic vascular
systems.
E. Trace blood flow beginning at the superior and inferior vena cavae
through the valves and chambers of the heart.
F. Explain the relationship of systole and diastole to the cardiac
cycle.
G. Describe sympathetic and parasympathetic effects as they relate to
the heart.
H. Explain the relationship between coronary circulation and the events
of the cardiac cycle.
I. Briefly describe the electrical forces involved in membrane
potentials of the heart.
J. Describe the electrical conduction within the heart and relate this
conduction to the resultant EKG impulses.
K. Determine heart rate from an EKG strip.
L. Describe the placement of electrodes for 12 lead EKG, and for
monitoring leads.
M. Describe classic EKG changes in COPD patients or MI changes.
XII. Unusual Atmospheres and Environments
A. Calculate expected PAO2 and PAO2 at different altitudes.
B. Describe the following physiologic responses to living at high
altitude:
1. Hyperventilation
2. Pulmonary hypertension
3. Increased RBC’s
4. Increased 2,3–DPG
5. Increase in pulmonary vascularity
6. Right axis deviation (cardiac)
C. Review the pressure changes and physiologic events involved with
hyperbaric conditions:
1. Quantity of gas in the lung under pressure
2. Increase in gas dissolved in tissue
3. Explanation of “the bends”
4. Explanation of nitrogen narcosis
D. Review the pathophysiologic effects of oxygen toxicity.
E. Describe the normal ventilatory response to increased inspired
concentrations of CO2.
F. Describe the effects of tobacco smoke and pollution on the
respiratory system.
G. Explain absorption atelectasis.
Method of Evaluation and Competencies:
Written examination = 100% of total grade Grading Scale: A = 92-100% B = 83- 91% C = 75- 82% D = 67- 74% F = 0- 73% W = withdrawal initiated by college deadline 1. Each exam may contain questions from previous material. 2. Each exam will be scaled to 100 points.
Caveats:
- Students are expected to comply with JCCC Student Code of Conduct detailed in the JCCC College Catalog. Failure to comply may result in faculty decision regarding program promotion and constitute a reason to fail the course.
- A grade of “C” or better is required for the course for program promotion to subsequent respiratory course work.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.
RC 230
- Title: Clinical Topics and Procedures I*
- Number: RC 230
- Effective Term: Spring/Summer 2014
- Credit Hours: 4
- Contact Hours: 100
- Lecture Hours: 70
- Lab Hours: 30
Requirements:
Prerequisites: Successful completion of the summer sequence of respiratory care courses
Description:
This course supplements the fall clinical experiences. Concepts, techniques and procedures learned in the summer semester are reinforced. The student will develop new understandings and skills in the acute care, basic emergency care and introductory-level critical care settings. Emphasis will be on arterial blood gas procurement and analysis, cardiac rhythm assessment and management, airway equipment and management procedures, patient management of obstructive lung disorders, perioperative care and chest trauma. In addition, basic mechanical ventilation concepts and techniques will be addressed as they relate to physiologic effects, ventilator commitment, management and basic troubleshooting. 3 hrs. lecture, 3 hrs. lab/wk. Fall.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
- Describe the etiology, pathophysiology, signs, symptoms and clinical findings for the following cardipulmonary disorders: a) Obstructive lung diseases, b) Respiratory failure, c) Perioperative care, d) Chest trauma and emergency care.
- Develop and/or modify a respiratory care plan for the cardipulmonary disorders identified.
- Analyze the available clinical data to determine the disease or pathophysiologic states identified.
- Describe the technique and equipment necessary to perform safe and accurate arterial blood gas procurement and analysis.
- Interpret results and make appropriate calculation determinations of arterial blood gas analysis.
- Relate arterial blood gas results and calculations to patient clinical situations and/or provide impressions concluded from the interpretation.
- Describe the technique, equipment characteristics and patient applications necessary to: a) Establish and maintain a patent airway, b) Manually resuscitate a patient, c) Remove bronchopulmonary secretions, d) Extubate the patient.
- Recognize, assess and manage normal and abnormal electrocardiographic (EKG) data and life-threatening situations according to BCLS and ACLS protocols.
- Describe the physiologic effects of mechanical ventilators and contrast to normal ventilatory mechanics.
- Describe the basic characteristics of mechanical ventilators.
- Initiate and adjust basic mechanical ventilator parameters.
Content Outline and Competencies:
I. Arterial Blood Gas Procurement, Analysis and Interpretation
A. Identify anatomy of the wrist, groin and antecubital fossa in terms
of nerve, artery and vein location.
B. Describe a detailed procedure for obtaining arterial blood samples
from the following sites:
1. Radial/femoral/brachial artery puncture
2. Heel stick
3. Arterial and umbilical arterial lines
C. State the indications, contraindications and hazards associated with
arterial blood gas acquisition.
D. Discuss the importance of extracting data re: diagnosis, clinical
lab tests, medications, etc., from a patient’s chart prior to obtaining
arterial blood samples.
E. Briefly describe how each of the following function in the analysis
of blood samples:
1. PO2 electrode
2. PCO2 electrode
3. pH electroce
4. Co-oximeter
F. Identify or recognize normal values for arterial and venous blood
gases for adults and children.
G. State the mechanisms that cause the following conditions:
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
H. Interpret and provide clinical impressions, as indicated, for blood
gas values provided. (Note: Interpretation means acid/base and oxygenation
status by the numbers; clinical impression is based on clinical data or
suspicion relating to patient conditions.)
I. Describe levels and methods of compensation that occur with
respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic
alkalosis, and combined states of respiratory and metabolic acidosis and
alkalosis.
J. Recognize erroneous blood gas results and identify possible causes
for the errors.
K. Estimate the HCO3 value when given the pH and PCO2.
L. Estimate the HCO3 that might be administered in severe metabolic
acidotic conditions.
M. Estimate the O2 saturation on the hemoglobin when given the PO2 and
OHDC and vice versa (the PO2, if given HbO2).
N. Identify the following abbreviations, normal values, units of
measure and what is needed to calculate each:
1. P(A-a)O2 4. CvO2 7. Ve
2. CcO2 5. Qs/Qt 8. Vt
3. CaO2 6. Vd 9. Vd/Vt
O. Calculate the above parameters and discuss the possible causes and
significance of abnormal values.
II. Airway Care
A. Identify the following types of manual resuscitators:
1. Spring loaded 4. Gas powered (demand valve)
2. Duckbill/diaphragm 5. NRPR
3. Diaphragm/leaf 6. Mouth/valve/mask
B. Determine the average minute volume delivered to the patient with a
manual resuscitator and relate it to the patient ventilatory needs during
resuscitation situations.
C. Identify factors that affect FIO2 delivery when using manual
resuscitators.
D. Describe and demonstrate effective techniques of mouth/valve/mask,
bag/mask and bag/tube ventilation.
E. Describe and demonstrate corrective action for potential problems
that may arise with manual resuscitators.
F. Discuss the advantages and disadvantages that may be encountered
with different types of manual resuscitators.
G. Review the anatomy of the airway.
H. Identify the features, indications, applications, advantages,
disadvantages and possible complications of each of the following:
1. Oropharyngeal airways
2. Nasopharyngeal airways
3. Orotracheal airways
4. Nasotracheal airways
5. Double lumen ET tubes
6. Trach tubes and buttons
7. Cricothyroidotomy
8. Laryngeal mask airway
9. Esophageal/tracheal Combitube
10. Esophageal obturator
11. High volume/low pressure cuffs
12. Low volume/high pressure cuffs
I. Describe the features and applications of each of the following that
may be used in inserting and assessing artificial airways:
1. Laryngoscope blades
2. Laryngoscope handles
3. Stylets
4. Fiber optic laryngoscopes
5. Exhaled CO2 detection devices
6. Cuff pressure manometers
J. Determine appropriate techniques for disinfection and/or
sterilization of non-disposable airway care items to include:
1. Resuscitation bags
2. Laryngoscope blades
3. Laryngoscope handles
4. Stylets
K. Describe and demonstrate for each of the airways identified above:
1. Proper head position
2. Appropriate type and size of airway
3. Proper artificial airway insertion
4. Assessment techniques verifying airway placement
5. Stabilization of the artificial airway, as indicated
6. Removal of the artificial airway
L. Describe and demonstrate the proper procedure for trach care.
M. Describe and demonstrate the appropriate application of oxygen,
aerosol and humidity to the patient with the artificial airways identified
above.
N. Describe and demonstrate proper airway cuff assessments and
maintenance.
O. Convert endotracheal tube sizes between mm ID, mm OD and French, and
determine the most appropriate suction catheter size that should be used.
P. Review and recognize the indications and complications of suctioning
the airway.
Q. Describe and recognize design characteristics and application of
different types of suction catheters.
R. Review and demonstrate proper equipment selection and preparation,
patient preparation and procedure for suctioning the patient using oro and
naso open suctioning techniques and in-line catheters.
III. Obstructive Lung Diseases
A. Discuss the etiology, pathophysiology and stages of the following
obstructive lung diseases:
1. COPD
2. Asthma
3. Bronchiectasis
4. Cystic fibrosis
B. Analyze patient assessment, radiologic, pulmonary function and/or
laboratory findings associated with each of the identified obstructive
lung diseases to determine pathophysiologic stage.
C. Discuss cor pulmonale as it relates to COPD.
D. Develop and/or modify a treatment plan for obstructive lung diseases
to include:
1. Oxygen therapy
2. Therapeutic procedures
3. Rehabiliation
4. Sub-acute/home care
IV. Respiratory Failure
A. Define respiratory failure.
B. Describe and/or determine the etiologies of respiratory failure.
C. Differentiate between acute hypoxemic respiratory failure, acute
hypercapnic respiratory failure and chronic respiratory failure.
D. Analyze patient assessment, radiologic, pulmonary function and/or
laboratory findings associated with respiratory failure.
E. Develop and/or modify a treatment plan for acute or chronic
respiratory failure, to include:
1. Oxygen therapy
2. Therapeutic procedures
3. Need for mechanical ventilation
V. Perioperative Care
A. Describe pulmonary considerations for the surgical patient.
B. Discuss the pre-operative and post-operative conditions and/or
complications of the surgical patient.
C. Analyze patient assessment, radiologic, pulmonary function and/or
laboratory findings associated with respiratory failure.
D. Develop and/or modify a treatment plan for the perioperative period
of the surgical patient.
VI. Chest Trauma and Emergency Care
A. Recall appropriate priority action and BCLS techniques for
management of the emergency situation.
B. Review airway management techniques to include:
1. Patient positioning
2. Foreign body removal
3. Artificial oral airways
4. Artificial endotracheal airways
5. Artificial tracheal airways
6. Oropharyngeal, endotracheal and tracheal suctioning
7. Endotracheal intubation/extubation
8. Laryngeal mask airways
9. Combitube airways
10. Esophageal obturator
11. Mouth-to-mouth, mouth-to-mask, bag/mask, bag/tube resuscitation
C. Relate approximate FECO2 and FEO2 values delivered with
mouth-to-mouth resuscitation to the patient’s ventilation needs.
D. Discuss hazards associated with cardiac compressions and ventilation
during CPR and measures that may be taken to minimize the hazards.
E. Discuss methods to achieve maximum FIO2 delivered with a manual
resuscitator and maintain adequate ventilation.
F. Describe the indications, effectiveness factors and techniques of:
1. Closed chest massage
2. Open chest massage
3. Defibrillation
4. Cardioversion
G. Discuss the initial and secondary assessment of the trauma patient
and be able to apply them to real and simulated patient scenarios.
H. Identify abnormal findings associated with each of the following
using physical exam and topographical and anatomical landmarks:
1. Simple rib fractures/flail chest
2. Pulmonary contusion
3. Pleural effusion
4. Fat emboli
5. Sucking chest wounds
6. Simple pneumothorax
7. Tension pneumothorax
8. Hemothorax
9. Cardiac contusion
10. Cardiac tamponade
11. Rupture/laceration of:
a. Airways
b. Aorta/major vessels
c. Diaphragm
I. Determine the etiology, pathology, clinical findings and management
for the identified conditions above.
J. Determine causes for respiratory failure after resuscitation or
chest trauma.
K. Compare the etiology, pathology, clinical findings and management
for three types of shock:
1. Hypovolemic
2. Cardiogenic
3. Distributive
L. Describe the indication and appropriate placement of chest tubes for
air and/or fluid evacuation.
M. Compare and contrast the features, function and precautions
associated with the following chest drainage systems:
1. One-bottle
2. Two-bottle (with and without suction)
3. Three-bottle
4. Pleur-evac or other disposable system
N. Recognize improper function of chest drainage systems and identify
appropriate troubleshooting measures to correct the improper function.
VII. Electrocardiography Recognition and Management
A. Relate the cardiac conduction system to the EKG tracing.
B. Describe the proper lead placement for monitoring and 12 lead EKG
evaluation.
C. Determine the cardiac rate and recognize the following cardiac
rhythms:
1. Normal sinus rhythm (NSR)
2. Sinus bradycardia
3. Sinus tachycardia
4. Sinus arrhythmia
5. Premature atrial contraction (PAC)
6. Atrial tachycardia/paroxysmal atrial tachycardia/supraventricular
tachycardia/paroxysmal supraventricular tachycardia (AT/PAT/SVT/PSVT)
7. Atrial flutter
8. Atrial fibrillation
9. Premature junctional contraction (PJC)
10. Junctional (aka nodal) rhythm
11. First degree heart block
12. Second degree heart block, Type I (Wenckebach)
13. Second degree heart block, Type II
14. Third degree heart block
15. Ventricular tachycardia (VT/V-Tach)
16. Ventricular fibrillation (V-fib)
17. Pulseless electrical activity (PEA)/electromechanical
dissociation (EMD)
18. Asystole
19. Pacemaker
20. Changes associated with the following conditions:
a. Pulmonary disease
b. Heart hypertrophy
c. K+ or Ca++ electrolyte changes
d. Myocardial ischemia
e. Myocardial injury
f. Myocardial infarction
D. Determine the appropriate therapeutic action(s) (BCLS, electrical
and pharmacological) given a clinical situation and rhythm.
VIII. Introduction to Mechanical Ventilation
A. Differentiate between different types of ventilators using a
classification system.
B. Describe ventilator breathing circuits and related adjunct
equipment.
C. Determine the implications of compliance and resistance of the
patient/ventilator system.
D. Describe the mechanics of normal breathing.
E. Describe the modes of ventilation that may be available on
mechanical ventilators.
F. Determine the clinical indications for mechanical ventilation.
G. Describe clinical conditions that may require mechanical
ventilation.
H. Describe the physiologic effects of positive and negative pressure
ventilation.
I. Discuss potential complications or hazards associated with
mechanical ventilation.
J. Perform serial compliance curves and apply to patient condition.
K. Set up a ventilator and establish initial parameters.
L. Establish initial alarm settings and make appropriate adjustments
upon patient application.
M. Troubleshoot ventilator alarms and identify corrective actions.
N. Adjust the ventilator parameters as indicated by ABG’s and other
clinical data.
O. Describe methods to maintain adequate humidification of the airway
for mechanically ventilated patients.
P. Describe methods to deliver respiratory pharmacological agents to
the mechanically ventilated patient.
Q. Identify and set up additional adjunct equipment that may be
associated with the mechanically ventilated patient.
Method of Evaluation and Competencies:
Written examinations = 80-100% of total grade
Final examination = Pass/Fail based on NBRC Entry-Level Exam Matrix
Projects and quizzes = 0-20% of total grade
Lab competencies = “Satisfactory” on Satisfactory/Needing Improvement
evaluation by instructor
Grading Criteria:
92 - 100% = A
83 - 91% = B
75 - 82% = C
67 - 74% = D
0 - 66% = F
W= withdrawal initiated by college deadline
Caveats:
- Students are expected to comply with the program policies and procedures as outlined in the Program Administrative Handbook. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.
RC 231
- Title: Clinical Topics and Procedures II*
- Number: RC 231
- Effective Term: Spring/Summer 2014
- Credit Hours: 4
- Contact Hours: 88.5
- Lecture Hours: 78
- Lab Hours: 10.5
Requirements:
Prerequisites: Successful completion of the fall sequence of respiratory care courses
Description:
This course supplements the spring clinical experiences. Concepts, techniques and procedures learned in the fall semester are reinforced. The student will refine understandings of and skills in the acute care, basic emergency care and critical care settings. Emphasis will be on ventilator management of patients with specific lung insults, neurological compromise and cardiac problems. Advanced mechanical ventilation concepts and techniques will be addressed as they relate to physiologic effects, management and troubleshooting. Home care, pulmonary rehabilitation, physician-assisted procedures, cardiopulmonary stress testing, patient case management and department management will be addressed. 3 hrs. lecture, 3 hrs. lab/wk. Spring.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
- Describe the therapy applications and the role of the home care agency and respiratory care practitioner in the delivery of pulmonary home care.
- Describe the goals, implementation factors, and patient/family counseling and instruction for pulmonary rehabilitation.
- Describe the impact of current health care delivery trends and reimbursement measures on respiratory care practice.
- Develop personal strategies to meet the expectations identified by employers for successful hiring and retention upon graduation.
- Describe the role of the respiratory care practitioner in disease management programs and the relationships that need to be established with case managers to provide quality patient care.
- Describe the role of the respiratory care practitioner in assisting the physician performing special procedures.
- Describe the indications and measured parameters of a cardiopulmonary exercise test, evaluate the data to determine exercise limitations, and recommend an exercise prescription.
- Adapt concepts of conventional mechanical ventilation to specific patient situations, to include initiation, monitoring, adjustment and removal of ventilatory support.
- Describe nonconventional ventilation techniques, to include: a) Differential lung ventilation, b) High frequency ventilation, c) High frequency jet ventilation, d) High frequency oscillatory ventilation, e) Permissive hypercapnia, f) Inverse I:E ratio ventilation, g) Prone position ventilation, h) Pressure release ventilation.
- Describe the indications, equipment, normal parameters and make patient applications for the following: a) Central venous lines, b) Pulmonary artery catheters, c) Arterial lines, d) Oximeters, e) Capnography, f) ECG, g) Transcutaneous measurements.
- Describe the etiology, pathophysiology, signs, symptoms and clinical findings for the following: a) Lung insults, b) Cardiac conditions, c) Neurological, neurosurgical and neuromuscular conditions.
- Develop and/or modify a respiratory care plan for the disease or pathophysiologic states identified.
- Analyze the available clinical data to determine the disease or pathophysiologic states identified.
- Develop and/or modify a respiratory care plan for the disease or pathophysiologic states identified.
- Analyze the available clinical data to determine the disease or pathophysiologic states identified.
Content Outline and Competencies:
I. Pulmonary Home Care
A. Identify the different types of oxygen therapy systems available for
home use: liquid, cylinders, concentrators.
B. Identify the variables considered when choosing home O2 equipment
for a patient.
C. Describe the role of the respiratory practitioner in home care.
D. Describe the effect of various living conditions on the patient’s
home care and the patient and family acceptance of home care.
E. Describe ventilator selection and management as it applies to the
home setting.
F. Describe function, set-up and maintenance of apnea monitors.
G. Describe the role of the home provider company in providing
equipment and service:
1. Proper set-up procedures
2. Verbal and written instructions to patient/family
3. Visual demonstration and practice of equipment
4. Provision of round-the-clock service
5. Assisting the patient in handling the billing process
II. Pulmonary Rehabilitation
A. Identify the goals of a rehab program for a pulmonary patient.
B. Describe the guidelines and basic designs of a rehab program.
C. Describe the implementation of plans (e.g., staffing, medical
direction, patient evaluation and instruction, documentation, equipment
choice, follow-up).
D. Identify the factors considered in patient selection for a pulmonary
rehab plan.
E. Describe the type of patient instruction given and the aids used for
increased patient understanding and participation.
F. State specific patient instruction for:
1. Graded exercise breathing pattern
2. Home respiratory equipment cleaning procedures
3. Breathing patterns to accommodate activities of daily living
(ADL) (e.g., climbing stairs, bending and stooping)
G. Describe the role of exercise and breathing exercises in pulmonary
rehab.
H. Evaluate a patient care plan in terms of the patient’s physical
and psychosocial needs.
I. Describe the concept of multidisciplinary care to rehab of the total
patient.
J. Describe and demonstrate patient ambulation with consideration for
patient safety and good body mechanics for the care giver.
K. Describe range of motion exercises.
L. Describe the role of the respiratory care practitioner in
respiratory disease management.
III. Respiratory Care Management
A. Describe the manager’s concerns and responsibility to the employee
regarding institutional mission statements.
B. Identify the influences on reimbursement and coverage to include:
1. Medicare
2. Medicaid
3. Fee for Service
4. DRGs
5. HMOs
6. Managed Care
7. Prospective Payment
C. Describe the impact of current health care delivery trends on
respiratory care practice to include:
1. Specialty work teams
2. Consensus teams
3. Patient focused care
4. Protocols
5. Disease management
6. Reengineering
7. Collaborative care
8. Clinical care pathways
9. SNF, rehab units, etc.
10. Multi-skilling
D. Identify the impact of JCAHO and other regulatory bodies on the
everyday RCP to include:
1. Competency profiles
2. License/registration requirements
E. Identify the procedures and expectations of the respiratory care
graduate hiring process to include:
1. The employer’s desired applicant qualities
2. Procedures for applicant position inquiries
3. The interview process
4. The orientation process
5. One and five year goal setting
IV. Physician Assisted Procedures
A. Identify the indications for bronchoscopy.
B. Describe the potential complications/hazards of bronchoscopy.
C. Identify the need for rigid scope bronchoscopy.
D. List the steps for preparing a patient for a bronchoscopy.
E. List the steps for preparing a bronchoscope and specimen acquiring
tools for a bronchoscopy.
F. Describe the therapist’s responsibilities during a bronchoscopy to
include:
1. Bronchial washings, bronchial lavage
2. Bronchial tissue biopsy
3. Transbronchial biopsy
4. Brush biopsy
5. Needle biopsy
6. Patient monitoring and comfort
G. Discuss bronchoscopy sample preparation for laboratory analysis.
H. Describe the procedure for cleanup after a bronchoscopy.
I. List typical post bronchoscopy physician orders to include:
1. RT orders
2. Nursing orders
3. Miscellaneous
J. Identify reasons for performing a thoracentesis.
K. Define transudate and exudate as they apply to thoracentesis
fluids.
L. Identify when a chest tube is indicated in the treatment of a
pleural effusion.
V. Cardiopulmonary Stress Testing
A. Identify the indication for a pulmonary exercise stress test.
B. Describe the parameters measured during a pulmonary exercise test
and when a test should be stopped.
C. Define terminology or equations associated with pulmonary exercise
testing:
1. Aerobic and anaerobic metabolism
2. Anaerobic threshold
3. Carbon dioxide production
4. Minute ventilation
5. Ergometer
6. Workload expressions of kpm, watts, MET
7. Oxygen consumption
8. Oxygen pulse
9. Respiratory exchange ratio
10. Respiratory quotient
11. Heart and breathing reserves
D. Identify normal cardiac (heart rate) and respiratory response (O2
consumption) to exercise.
E. Identify the pulmonary response to exercise with regard to
ventilation and O2 consumption.
F. Identify cardiac response to exercise in heart disease in terms of
heart rate and O2 consumption.
G. Describe the use of ear oximetry as an adjunct in pulmonary exercise
testing.
H. Identify the use of pulmonary exercise testing in a pulmonary
rehabilitation program.
VI. Mechanical Ventilation
A. Describe hemodynamic changes with Positive Pressure Ventilation
(PPV) to include estimation of PCWP with PPV.
B. Review pharmacological therapy for patients on mechanical
ventilation.
C. State guidelines for initial ventilator parameters.
D. Calculate volume delivered for alveolar exchange for a patient being
mechanically ventilated based on tubing and anatomical deadspace loss.
E. Review monitoring techniques and devices used when ventilating a
patient to include:
1. ABGs
2. Vital signs
3. Lab values
4. Urine output
5. Pulmonary artery catheter values
6. Routine ventilator checks
7. Compliance curves
8. External alarms
9. Cuff pressure manometers
F. Describe the performance of pressure/volume/time curves.
G. Correlate changes in pressure/volume/time curves to clinical
conditions.
H. Indicate the ventilator adjustments indicated for specific patient
findings.
I. Calculate FIO2 needed for a desired PaO2 and/or the PaO2 that will
result from a given FIO2.
J. Identify total ventilatory and partial ventilatory support modes.
K. In SIMV calculate the following:
1. Spontaneous tidal volume
2. Spontaneous minute volume
3. Spontaneous respiratory rate
4. Machine minute volume
L. Calculate minute volume needs to change a given PaCO2.
M. Define Optimal PEEP using hemodynamic and compliance curve
information.
N. Define and measure AUTO-PEEP.
O. Discuss application of NIPPV.
P. Troubleshoot a ventilator to include:
1. Correction of ventilator alarm conditions
2. Systematic approach to identifying a leak
3. Performance of preapplication safety checks
Q. Describe the evaluation of ventilator patients for weaning to
include:
1. ABGs
2. Vital signs
3. Weaning parameters
R. Describe artificial airways to include the advantages, disadvantages
and complications of endotracheal tubes and tracheostomy tubes in the
management of the ventilator patient.
S. Describe criteria for selection and the technique for weaning a
patient using the following:
1. SIMV
2. T-tube trials
3. Flow-by
4. Talking trachs
5. Buttons/passey-muirs
6. CPAP
T. Describe the nutritional implications of ventilation and weaning.
U. Define and describe the nontraditional ventilator modes, adjuncts
and techniques to include:
1. Pressure release ventilation
2. Inverse I:E ratio ventilation
3. Permissive hypercapnia
4. Negative pressure ventilation
5. High frequency positive pressure ventilation
6. High frequency jet ventilation
7. High frequency oscillation
8. Differential lung ventilation
9. Prone position ventilation
V. Suggest initial settings for the nontraditional ventilator
techniques identified.
VII. Critical Care Monitoring
A. State the indications and possible complications associated with
pulmonary artery catheters, CVP catheters, and arterial catheters.
B. Describe the insertion procedure and anatomic placement of each of
the above.
C. Describe the information that may be obtained from the blood samples
and pressure tracings from pulmonary artery, CVP, and arterial catheters.
D. Define PAP, PCWP, CVP, CO, and state the normal values for each.
E. Describe the set-up and transducer calibration for arterial lines,
pulmonary artery catheters and CVP lines.
F. Identify pressure tracings for each of the above monitoring lines.
G. Describe the different methods of obtaining cardiac output.
H. Describe the use of pulmonary artery, CVP, and arterial catheters in
patient/ventilator management.
I. Describe the use and function of the ear/pulse oximeters, TcPO2,
TcPCO2, TcpH, and end-tidal CO2 monitors.
J. Describe the procedures and anatomic placement of each item listed
above.
K. Identify abnormal capnography tracings and list potential causes.
L. State advantages and disadvantages for each of the above monitoring
techniques.
M. Describe factors that may cause errors in the information from each
of these monitoring devices and make recommendations for correcting
malfunctions.
N. Identify patient conditions including the need for, and response to,
treatment based on information from these and other routine assessment
sources.
VIII. Lung Insults
A. Review adult and pediatric CPR to include management of the
obstructed airway.
B. Describe the pathogenesis and pathophysiology for the following lung
insults:
1. Status asthmaticus
2. Smoke inhalation
3. Pulmonary burn
4. Aspiration foreign body - gastric contents
5. Near drowned
6. Pulmonary emboli and infarcts
7. Cardiac vs. non-cardiac pulmonary edema (ARDS)
8. Surgery
9. AIDS and infectious diseases
10. Misc.: DIC, etc.
C. Describe for the above insults patient signs and symptoms, clinical
laboratory and X-ray findings.
D. Develop for the above insults a prioritized general and respiratory
management care plan.
E. Define and describe ARDS with regard to pathogenesis and
pathophysiology.
IX. Cardiac Patients
A. Define and differentiate between HDL & LDL.
B. Define angina and be able to differentiate between the three types
of angina.
C. Identify diagnostic tests performed to detect myocardial
infarction.
D. Describe the treatment for angina.
E. Identify diagnostic tests for chest pain.
F. List signs and symptoms of a myocardial infarction.
G. Classify cardiac disease.
H. Name cardiac enzymes and be able to discuss their significance.
I. Identify the coronary arteries.
J. Describe the pathophysiology and signs and symptoms of the following
disease states:
1. Congestive heart failure
a. Right heart failure
b. Left heart failure
2. Cardiomyopathy
a. Hypertrophic
b. Congestive
c. Restrictive
3. Pulmonary edema
4. Valvular disease
a. Mitral
b. Tricuspid
5. Shock
a. Cardiogenic
b. Hemorrhage
c. Hypovolemic
d. Neurogenic
e. Anaphylactic
f. Traumatic
g. Septic
K. Identify the indications for coronary angioplasty.
L. Identify the indications for coronary artery bypass surgery.
M. Describe the use of cardioplesia solution.
N. Describe pulmonary risk of thoracic surgery to include:
1. Phrenic nerve injury
2. Impaired PFTs
3. Hemodilution
4. Respiratory depression
O. Describe ventilation and bronchial hygiene management of the cardiac
patient.
P. Identify adjunct interventions for the failing heart to include:
1. Heart transplant
2. Pacemakers
3. AICD
4. Intra-aortic balloon pump
5. Ventricular assist device
X. Neurological, Neurosurgical and Neuromuscular Management
A. Identify the abnormal breathing patterns associated with
neurological conditions.
B. Describe the effects of intracranial pressure changes and cerebral
edema.
C. Develop a comprehensive respiratory management plan of care for the
neuro patient, especially as it applies to each of the following neuro
conditions:
1. Cerebral edema/head trauma
2. Hyperventilation states:
a. Reyes Syndrome
b. Neurogenic Pulmonary Edema
c. CNS Lesion
d. Viral/Bacterial Meningitis
e. Salicylate Intoxication
3. Neurologic and neuromuscular disorders resulting in
hypoventilation:
a. Landry-Guillian-Barré Syndrome (polyneuritis)
b. Poliomyelitis (neural infections)
c. Surgery/Trauma of Spinal Cord
d. Myasthenia Gravis
e. Multiple Sclerosis (demyelinating disease)
f. Tetanus and Botulism (neural infections)
4. Abnormal respiratory center drive resulting in hypoventilation:
a. Drug overdose
b. Sleep related hypoventilation
5. Respiratory muscle disorders and related conditions:
a. Polymyositis
b. Huntington’s Chorea (hereditary degeneration)
c. Amyotrophic Lateral Sclerosis (degeneration)
d. Muscular Dystrophy (voluntary muscle)
e. Seizures
f. Coma
g. Cardiovascular Accidents (CVA)
D. Describe the etiology and diagnosis of each of the above
conditions.
Method of Evaluation and Competencies:
Written Examinations = 80 - 100% of total grade Clinic Simulation with each written exam = Pass/Fail based on minimal pass requirements per simulation Case Study Presentation = 0 - 20% of total grade Final Examination = Pass/Fail based on NBRC Registry Level Written and Clinical Simulation Exam matrix Grading Criteria: A = 92 - 100% B = 83 - 91% C = 75 - 82% D = 67 - 74% F = 0 - 73% W = Withdrawal initiated by college deadline.
Caveats:
- Students are expected to comply with the program policies and procedures as outlined in the Program Administrative Handbook. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.
RC 233
- Title: Respiratory Care of Children*
- Number: RC 233
- Effective Term: Spring/Summer 2014
- Credit Hours: 2
- Contact Hours: 30
- Lecture Hours: 30
Requirements:
Prerequisites: RC 230
Description:
The focus will be on the respiratory care of neonatal and pediatric patients, with emphasis on the management of cardiopulmonary disease states unique to children. Information will be based on developmental anatomy and physiology, pathology, diagnostic/laboratory assessments, and associated patient management in the acute, critical, emergency care, transport and home care settings. 2 hrs./wk. Spring.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
- Describe the development stages of the human embryo and fetus particularly as it applies to the cardiac and pulmonary systems.
- Describe and analyze findings of maternal and fetal assessment during the prenatal, labor and delivery and postnatal periods.
- Describe the etiology, pathophysiology, signs, symptoms and clinical findings for the following: a) Premature and perinatal lung disorders, b) Persistent perinatal lung disorders, c) Congenital defects, d) Pediatric lung disorders
- Develop and/or modify a respiratory care plan for the cardiopulmonary disorders identified.
- Analyze the available clinical data to determine the disease or pathophysiologic states identified.
- Describe the technique(s), equipment selection and characteristics and neonatal/pediatric patient applications necessary to: a) Conduct neonatal and pediatric resuscitation efforts according to established protocols, b) Prepare and implement patient transport, c) Prepare and implement home care.
- Describe and analyze findings of assessment of the neonatal/pediatric patient oxygenation and ventilation status.
- Describe the basic concepts related to the application of conventional and non-conventional mechanical ventilation and special procedures for the neonatal and pediatric patient to achieve adequate oxygenation and/or ventilation.
- Initiate and adjust conventional and non-conventional mechanical ventilation parameters for the neonatal and pediatric patient to achieve adequate oxygenation and/or ventilation.
Content Outline and Competencies:
I. Embryology and Fetal/Neonatal Transition
A. Compare the blood gas values of umbilical arteries and the umbilical
veins.
B. Describe the development of the lung and determine when the
development is compatible with maintaining life outside the uterus.
C. Describe the development of the heart and determine when the heart
is fully formed.
D. Describe the development of lung fluids and surfactant in
relationship to the following:
1. Sources
2. Composition
3. Time appearance in the developmental stage
4. Physiologic importance
E. Describe the methods that may be used to stimulate surfactant
development in utero.
F. Describe fetal circulation in relationship to the following:
1. Placental role in fetal blood flow and gas exchange
2. Pathway of blood flow and why there is limited circulation to the
lungs in utero
3. Oxygen levels
4. Anatomic differences between fetal and adult circulation
5. Physiologic changes of the cardiovascular system at birth
6. Anatomical changes of the cardiovascular system at birth
G. Interpret arterial blood gas levels at the following stages:
1. Fetal
2. At birth
3. 24 hours after birth
H. Describe the physiologic events that must occur with the first
breath, to include:
1. Inflation pressures
2. Stimulus to breathe
3. Role of the lung fluids
I. Describe the compliance and resistance of the newborn lung.
J. Compare the OHDC relationship of the newborn with that of the
adult.
K. Compare fetal hemoglobin to adult hemoglobin and the implications
for oxygenation.
II. Maternal and Fetal Assessment
A. Describe factors relating to high-risk pregnancies and deliveries
that may result in an increased potential for respiratory distress of the
neonate.
B. Describe the following assessment techniques used to determine fetal
status:
1. Amniocentesis
2. Ultrasound
3. Fetal heart monitoring
C. Compare and contrast studies that determine lung maturity.
D. Describe early, late and variable decelerations and the implications
for delivery.
E. Apply the APGAR scoring system to clinical descriptions of a
newborn.
F. Describe the methods used to determine gestational age.
G. Analyze the respiratory rate, heart rate and blood pressure for
presented scenarios.
H. Differentiate between periodic breathing and apnea.
I. Describe thermoregulation for newborns and the implications of heat
loss or cold stress of the newborn.
J. Identify factors that will contribute to newborn heat loss or cold
stress, given presented scenarios.
K. Describe the causes and basic management of hyperbilirubinemia.
L. Analyze clinical lab findings and radiologic findings for presented
scenarios.
M. Describe why and how aseptic conditions are maintained in the
nursery.
N. Differentiate between Level I, Level II and Level III nurseries.
III. Neonatology
A. Describe the assessments made in the physical and neurological exam
of the neonate.
B. Describe the etiology, pathophysiology, signs, symptoms and clinical
findings for the following neonatal disorders:
1. Respiratory distress syndrome (RDS)/Hyaline Membrane Disease
(HMD)
2. Transient Tachypnea of Newborn (TTN or TTNB)
3. Bronchopulmonary Dysplasia (BPD)/Chronic Lung Disease (CLD)
4. Meconium Aspiration Syndrome (MAS)
5. Air leaks (pneumothorax, pneumomediastinum and PIE)
6. Pneumonia/Infection/Sepsis
7. Asphyxia
8. Intraventricular Hemorrhage (IVH)
9. Apnea of prematurity
10. Persistent Pulmonary Hypertension (PPHN)/Persistent Fetal
Circulation (PFC)
11. Retinopathy of Prematurity (ROP)
C. Analyze the available clinical data to determine the disease or
pathophysiologic state for presented neonatal scenarios.
D. Develop and/or modify a respiratory care plan for the neonatal
disorders identified in presented neonatal disorders.
E. Describe and apply the technique(s), equipment selection and
characteristics, and patient applications necessary to conduct pediatric
resuscitation efforts according to established protocols.
F. Describe the potential developmental outcomes that are associated
with the care of infants with early respiratory difficulites.
IV. Congenital Defects
A. Describe the defect, the primary means of diagnosis and general and
respiratory treatment management for the following defects:
1. Congenital pulmonary anomalies
a. Choanal atresia
b. Tracheo-esophageal anomalies
c. Pierre Robin Syndrome
d. Congenital Diaphragmatic Hernia (CDH)
2. Congenital cardiac anomalies
a. Transposition of the great vessels (TGV)
b. Tetralogy of Fallot (TOF or TET)
c. Atrial Septal Defect (ASD)
d. Ventricular Septal Defect (VSD)
e. Patent Ductus Arteriosus (PDA)
f. Coarctation of the aorta (Coarc)
g. Tricuspid/pulmonary atresia
h. Total Anomalous Pulmonary Venous Return (TAPVR)
i. Truncus Arteriosus
j. Hypoplastic left heart
k. Subaortic stenosis
3. Miscellaneous conditions
a. Necrotizing enterocolitis (NEC)
b. Gastroschisis
c. Omphalocele
d. Myelomeningocele
B. Analyze the available clinical data to determine the disease or
pathophysiologic state for presented congenital defect scenarios.
C. Develop and/or modify a respiratory care plan for the neonatal
disorders identified in presented congenital defect scenarios.
V. Care of the Pediatric Patient
A. Determine normal physical characteristics, psychosocial skills and
motor development for infants, toddlers, preschool, school age and
adolescent patients.
B. Describe and apply appropriate communication and teaching techniques
for the five age groups.
C. Describe the etiology, pathophysiology, signs, symptoms and clinical
findings for the following pediatric disorders:
1. Asthma
2. Bronchiolitis/Respiratory Syncytial Virus (RSV)
3. Croup/Laryngotracheobronchitis (LTB)
4. Epiglottis
5. Cystic Fibrosis
6. SIDS
7. Aspiration/Inhalation
8. Near drowning
9. Head trauma
10. Neuromuscular disorders
11. ARDS
12. Reyes Syndrome
D. Analyze the available clinical data to determine the disease or
pathophysiologic state for presented neonatal scenarios.
E. Develop and/or modify a respiratory care plan for the neonatal
disorders identified in presented neonatal disorders.
F. Describe and apply the technique(s), equipment selection and
characteristics and patient applications necessary to conduct pediatric
resuscitation efforts according to established protocols.
VI. Transport
A. Compare and contrast the modes of transport.
B. Relate the effects of altitude with air transport to include patient
problems, equipment problems and the effects on transport team members.
C. Describe and apply stabilization techniques that may be performed by
the transport therapist and compare with normal routine responsibilities.
D. Determine the appropriate support measures for a patient with
marginally acceptable blood gas values that should be taken prior to
transport.
E. Describe and apply the considerations that should be made when
selecting equipment for transport.
F. Describe and apply the considerations that should be made when
determining if a patient should be transported to a major care center.
G. Calculate length of gas service for given patient transport
scenarios.
VII. Home Care
A. Describe the roles and responsibilities of a discharge planning team
member.
B. Determine and apply the considerations that should be made when
selecting equipment for home care.
C. Describe and apply tracheostomy home care for patients.
D. Compare and contrast gas systems used for home care to include gas
cylinders, liquid systems and concentrators and determine the most
appropriate system for selected home care situations.
E. Compare and contrast patient oxygen delivery devices and/or
respiratory therapy equipment used for home care and determine the most
appropriate device/equipment for selected home care situations.
F. Describe the patient/family/caregiver education that should be
provided for respiratory home care situations.
VIII. Assessment and Management of Oxygenation and Ventilation
A. Describe the assessment and monitoring techniques that are used for
the neonatal/pediatric patient and apply to given patient scenarios.
B. Describe and apply the principles and goals of neonatal/pediatric
mechanical ventilation.
C. Describe the indications and complications/hazards associated with
neonatal/pediatric mechanical ventilation.
D. Describe the relationships that exist between the following
ventilatory parameters for both time-cycled/pressure limited and
volume-cycled ventilators and appropriately apply them to
neonatal/pediatric scenarios and specified ventilators:
1. Tidal volume
2. Peak inspiratory pressure
3. Flow rate
4. Inspiratory time
5. Mean airway pressure
6. Respiratory rate
7. I:E ratio
8. Time constants
9. Positive and expiratory pressure
E. Determine the appropriate airway type and size for given
neonatal/pediatric patients.
F. Determine the appropriate humidification device for
neonatal/pediatric mechanical ventilation.
G. Select the appropriate ventilator and initiate appropriate patient
parameters and alarms for given clinical data and/or neonatal/pediatric
disorders.
H. Modify parameters as indicated by ABG’s and other clinical data.
I. Apply weaning criteria to given patient scenarios.
J. Describe weaning methods that may be used and apply an appropriate
method to given patient scenarios.
K. Describe methods of assessing and monitoring the ventilated patient
and apply appropriate methods to given patient scenarios.
L. Describe clinical indications and delivery techniques for surfactant
replacement therapy.
M. Describe extubation criteria and procedure and apply to given
patient scenarios.
N. Describe the indications, initiation of and adjustments made for
oscillating and high-frequency ventilation and contrast with conventional
ventilation techniques.
O. Describe the indications and application of extracorporeal membrane
oxygenation, liquid ventilation, nitric oxide therapy and other
non-conventional techniques to address oxygenation and ventilation
difficulties.
P. Describe the effects of CPAP therapy on the following:
1. FRC 5. Cardiac output
2. Lung compliance 6. Pulmonary blood flow
3. Airway resistance 7. Cerebral blood flow
4. Respiratory rate 8. Arterial blood gases
Q. Describe the indications, equipment and delivery techniques,
potential complications and adverse effects relating to CPAP therapy and
apply to given patient scenarios.
R. Compare and contrast the various CPAP system set-ups for advantages
and disadvantages.
Method of Evaluation and Competencies:
Written examinations = 80-100% of total grade Projects and quizzes = 0-20% of total grade Grading Criteria: A = 92 - 100% B = 83 - 91% C = 75 - 82% D = 67 - 74% F = 0 - 66% W = withdrawal initiated by college deadline
Caveats:
- Students are expected to comply with the program policies and procedures as outlined in the Program Administrative Handbook. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.
RC 235
- Title: Cardiopulmonary Medicine II*
- Number: RC 235
- Effective Term: Spring/Summer 2014
- Credit Hours: 2
- Contact Hours: 30
- Lecture Hours: 30
Requirements:
Prerequisites: Successful completion of the summer sequence of respiratory care courses
Description:
This is the second in a series of three courses that provide a detailed review of the physical and diagnostic assessments of the cardiopulmonary patient and the related clinical implications of the assessment finding. 2 hrs. lecture/wk. Fall.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
- Describe clinical laboratory tests in the assessment of blood, urine, sputum and other fluid samples and apply assessment findings to determine normal and abnormal body organ functions and clinical implications.
- Compare and contrast normal radiologic findings and be able to interpret chest X-ray findings.
- Interpret normal cardiac rhythm and common atrial, ventricular and pacemaker rhythm patterns and determine the appropriate management for identified rhythms.
- Determine what additional clinical data and diagnostic procedures should be recommended based on patient history and physical assessment findings to assist in providing a differential diagnosis.
Content Outline and Competencies:
I. Introduction to Clinical Laboratory Medicine
A. Describe and determine clinical implications for each of the
following hematologic assessments:
1. Hb
2. RBC
3. Hct
4. Indices (MCV, MCH, MCHC)
5. Reticulocyte count
6. WBC differential
7. Platelet count
8. Bleeding time assessments (PT, PTT, Lee-White)
9. Blood groups
B. Describe and determine clinical implications for each of the
following tests used to evaluate renal, liver, endocrine, cardiac and/or
cerebral function:
1. Renal
a. Urea and Creatinine clearance
b. BUN
c. Urinalysis (appearance, pH, specific gravity, protein,
glucose, cell count)
2. Liver
a. Bilirubin d. SGOT
b. Alkaline phosphate e. SGPT
c. Cholesterol f. LDH
3. Endocrine
a. Glucose d. Parathyroid
b. GTT e. Adrenal
c. Thyroid
4. Cardiac
a. SGOT d. ESR
b. LDH e. Triponin
c. CPK
5. Cerebral fluid
a. Pressures
b. Appearance
c. Analysis (sugar, protein, cell count)
C. Describe and determine clinical implications of the following
analysis of serum electrolytes and proteins:
1. Electrolytes
a. Na+ d. Cl-
b. K+ e. CO2
c. Ca++ f. PO4
2. Proteins
a. Albumin
b. Alpha 1 and alpha 2
c. Gammaglobulins
d. Immunoglobulins
II. Introduction to Radiology
A. Locate the following on normal and abnormal chest X-rays:
1. Position
2. Translucency
3. Soft tissue and thoracic cage
4. Diaphragm
5. Lung fields
6. Mediastinum
7. Hilum
8. Tracheal bifurcation
9. Heart and vasculature
10. Shadows
11. Fissures
12. Costophrenic angle
B. Describe and relate the purpose of the following radiologic
procedures:
1. Lordotic/oblique views 7. Angiograms
2. Inspiratory/expiratory views 8. Lung scans
3. Decubitus views 9. V/Q scans
4. Tomograms 10. MRI
5. Fluoroscopy 11. CT scan
6. Bronchograms
C. Compare and contrast normal radiologic findings and be able to
interpret chest x-ray findings for the following disorders or conditions:
1. Atelectasis
2. Pneumonia/Infectious diseases
3. COPD
4. Pleural effusion
5. Pneumothorax
6. Pneumonectomy
7. Pulmonary edema
8. Pulmonary embolism
9. Tumors
10. Tuberculosis
11. Chest tube placement
12. Endotracheal tube placement
13. Flail chest/fractured ribs
D. Describe the impact of acute and chronic radiation exposures.
III. Introduction to Electrocardiography
A. Review the anatomy and physiology of the heart and
electrophysiology.
B. Identify the normal components of an EKG tracing.
C. Determine the heart rate when provided an EKG tracing.
D. Identify the following EKG rhythms:
1. Normal sinus rhythm
2. Sinus arrhythmia
3. Sinus tachycardia
4. Sinus bradycardia
5. Pacemaker
6. Premature ventricular contractions
7. Ventricular tachycardia
8. Ventricular fibrillation
9. Paroxysmal atrial tachycardia
10. Premature atrial contractions
11. Atrial flutter
12. Atrial fibrillation
13. 1, 2, 3 degree heart blocks
14. Bundle branch blocks
15. Asystole
E. Identify EKG changes seen in an acute myocardial infarction.
F. Relate appropriate drug(s) and/or emergency management to a
recognized arrhythmia.
IV. Patient Assessment
A. Describe the appropriate interactions expected between and among the
respiratory care practitioner, the patient, the physician and other health
care team members.
B. Describe and relate the normal values and clinical implications for
the vital signs of temperature, respirations, pulse and blood pressure.
C. Describe measures to prevent respiratory complications for
hospitalized patients.
D. Describe the component parts of the patient history and clinical
implications for pulmonary diagnosis and patient management.
E. Describe major pulmonary signs and symptoms and relate their
significance to possible respiratory disorders.
F. Describe the component parts of the patient physical examination and
clinical implications for pulmonary diagnosis and patient management.
G. Describe and relate indications, normals and clinical implications
for abnormal clinical findings of the following diagnostic procedures:
1. Clinical lab work 7. Lung biopsy
2. Bronchoscopy 8. Thoracoscopy
3. Scalene node biopsy 9. Thoracotomy
4. Mediastinoscopy 10. Thoracentesis
5. Bronchogram 11. Percutaneous needle biopsy
6. Pleural biopsy 12. CP stress testing
H. Describe the role of the respiratory care practitioner in assisting
the physician with the identified diagnostic procedures.
Method of Evaluation and Competencies:
Written examinations and quizzes = 100% of total grade A minimum of three tests will be given. Each test may contain questions from previous material. Quizzes may given at the discretion of the instructor. Grading scale: A = 92 - 100% B = 83 - 91% C = 75 - 82% D = 67 - 74% F = 0 - 66% W = Withdrawal initiated by college deadline
Caveats:
- Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students are expected to comply with the attendance and other program policies described in the Program Administrative Guideline Handbook.
- A grade of “C” or better is required for the course for program promotion to subsequent Respiratory Care work.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.
RC 236
- Title: Cardiopulmonary Medicine III*
- Number: RC 236
- Effective Term: Spring/Summer 2014
- Credit Hours: 2
- Contact Hours: 30
- Lecture Hours: 30
Requirements:
Prerequisites: Successful completion of the fall sequence of respiratory care courses
Description:
This is the third in a series of three courses that provide a detailed review of pulmonary disorders, their pathology and their management. 2 hrs. lecture/wk. Spring.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
- Describe the physiologic responses that may occur with injuries, infection and disease.
- Describe the etiology, pathology, diagnosis, management and prognosis of pulmonary diseases and other disorders with respiratory implications: a) Chronic Obstructive Pulmonary Disease (COPD), b) Allergic disorders, c) Respiratory failure, d) Respiratory diseases due to infection, e) Occupational/environmental pulmonary disorders, f) Tumors of the lung, g) Chest trauma, h) Heredity and congenital disorders, I) Pleural disorders, j) Other system disorders with respiratory implications including cardiovascular, collagen, central nervous system and drug induced pulmonary disorders.
- Develop interpretation skills of chest X-rays.
Content Outline and Competencies:
I. Introduction to Disease
A. Describe the potential contributing factors in developing disease.
B. Describe the physiologic response to disease to include:
1. Inflammation
2. Repair and healing process
3. Retrograde changes
4. Circulation changes
5. Growth disturbances
C. Describe the infective process to include:
1. Host-parasite relationship
2. Defense mechanisms
3. Infectivity of organisms
4. Natural and acquired immunity
5. Immunizations
6. Use of antibiotics
7. Role of bacteria, viruses, fungi and parasites in the infective
process
II. Pulmonary Diseases and Other Disorders with Respiratory Implications
A. Describe the etiology, pathology, diagnosis, management and
prognosis for the following pulmonary diseases and other disorders with
respiratory implications.
1. Chronic Obstructive Pulmonary Disease (COPD)
a. Bronchitis
b. Emphysema
c. Asthma
d. Other obstructive disorders
2. Allergic disorders
a. Asthma
b. Hay fever
c. Hypersensitivity lung disease
d. Status Asthmaticus
3. Respiratory failure
a. Acute respiratory failure
b. Chronic respiratory failure
4. Respiratory diseases due to infection
a. Common cold/other viral infections
b. Influenza
c. Pneumonia
d. Bronchiectasis
e. Tuberculosis
f. Fungal infections
g. Abscess
h. Parasital infections
i. Granulomatous disease
j. HIV/AIDS
5. Occupational/environmental pulmonary disorders
a. Pneumoconiosis
b. Organic lung disease
c. Noxious gases
d. Interstitial lung disease
6. Tumors of the lung
a. Neoplasia
b. Role of tobacco products
c. Benign and malignant pulmonary disorders
7. Chest trauma
a. Upper airway
b. Lower airway
c. Chest cage
d. Muscle
e. Hemothorax
f. Pneumothorax
g. Cardiac/circulatory
h. Contusion
i. Fat emboli
j. ARDS
8. Heredity and congenital disorders
a. Alpha 1 antitrypsin
b. Cystic fibrosis
c. Immunoglobulin deficiencies
d. Cysts
9. Pleural disorders
a. Effusion
b. Pleurisy
c. Pneumothorax
10. Other system disorders with respiratory implications
a. Cardiac
1) Pulmonary edema
2) Embolic disorders
3) Hypertension
4) Cor pulmonale
b. Collagen
c. Central nervous system
d. Drug induced pulmonary disorders
III. Chest X-Ray Interpretation
A. Interpret presented chest X-rays using a systematic
examination.
Method of Evaluation and Competencies:
Written examinations and quizzes = 100% of total grade A minimum of three tests will be given. Each test may contain questions from previous material. Quizzes may given at the discretion of the instructor. Grading scale: A = 92 - 100% B = 83 - 91% C = 75 - 82% D = 67 - 74% F = 0 - 66% W = Withdrawal initiated by college deadline
Caveats:
- Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students are expected to comply with the attendance and other program policies described in the Program Administrative Guideline Handbook.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.
RC 240
- Title: Cardiopulmonary Pharmacology*
- Number: RC 240
- Effective Term: Spring/Summer 2014
- Credit Hours: 2
- Contact Hours: 30
- Lecture Hours: 30
Requirements:
Prerequisites: Successful completion of the summer sequence of respiratory care courses
Description:
This course acquaints the student with general principles of pharmacology and provides a comprehensive review of all drugs and drug groups that are either administered by respiratory-care practitioners or play an integral part in the management of patients they may encounter. Emphasis is on the clinical application of pharmacological agents, their therapeutic effects, mechanism of action and adverse effects, rather than the biochemistry involved. 2 hrs. lecture/wk. Fall.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
- Describe the mechanisms of action, indication, therapeutic and adverse effects, strengths and dosage and clinical application for pharmacological agents administered by the respiratory care practitioner.
- Recognize common generic and product names, as well as their clinical applications, for drug groups that play an integral part in care of the cardiorespiratory patient but not necessarily administered by the respiratory practitioner.
- Determine the appropriate pharmacologic applications and/or modify current pharmacologic applications of the respiratory care plan given real and simulated patient situations.
Content Outline and Competencies:
I. General Principles of Pharmacology
A. Define the following terms:
1. Drug
2. Pharmacology
3. Therapeutic index
4. Tachyphylaxis
5. Side effect
6. Agonist
7. Antagonist
8. Synergism
9. Placebo
10. Affinity
11. Efficacy
12. Median lethal dose (LD50)
13. Principal effect
14. Half-life
B. Define and appropriately use the following abbreviations:
1. a.c. and p.c. 13. IM
2. bid, qid, tid, etc. 14. IV
4. gtt 15. I & O
3. g or gm 16. DPI
5. p.o. 17. mg
6. prn 18. NPO
7. stat 19. q2, q3, q4, etc.
8. MDI 20. OTC
9. noc 21. SQ and SC
10. cc 22. WA
11. ml 23. SPAG
12. hs 24. SVN and HHN
C. Identify and differentiate between a generic and trade name.
D. Use the following resources to gain drug information:
1. PDR
2. Hospital formulary
3. Product or package inserts
4. Pharmacy
E. Describe the pharmaceutical phase of drug action in terms of drug
dosage forms and the various routes of administration.
F. Briefly describe the pharmacokinetic phase of drug action to
include:
1. Mechanisms of absorption
2. Distribution
3. Metabolism
4. Elimination
5. Application to inhaled aerosols
G. Explain the drug receptor model relating to the pharmacodynamic
phase of drug action leading to a drug effect.
H. Review metric to English measurement conversion.
I. Calculate doses from prepared-strength liquids, tablets and
capsules.
J. Calculate doses from percentage-strength solutions.
K. Calculate intravenous infusion rates.
L. Determine why the use of Young’s Rule, Fried’s Rule and
Clark’s Rule may not be appropriate for actual respiratory clinical
application.
II. Administration of Aerosolized Agents
A. Select the equipment appropriate to the respiratory care plan in
delivering pharmacological agents.
1. Small- and large-volume medication nebulizers
2. Metered dose inhaler with and without spacers and holding
chambers
3. Dry powder inhaler
4. Large-volume bland nebulizers
5. Ultrasonic nebulizers
B. Describe proper aerosolized medication administration to include:
1. Assembly, check of proper function and identification/correction
of malfunctions for equipment selected
2. Drawing up medication and diluent, as indicated, with a syringe
and/or dropper
3. Patient instruction for the selected equipment
4. In-line therapy administration for the ventilated patient
5. Documentation
C. Compare and contrast the devices used for aerosol delivery and
factors that affect medication delivery to the targeted areas of the
airways and lung periphery.
III. Sympathomimetic (Adrenergic) Agents
A. Review the sympathetic branch of the autonomic nervous system to
include:
1. Anatomy
2. Preganglionic and postganglionic neurotransmitters
3. Receptors
B. Describe the sympathetic response on the following organs/sites:
1. Heart
2. Bronchi smooth muscle
3. Bronchial mucus glands
4. Vascular smooth muscle
C. Describe the effects of alpha, beta 1 and beta 2 receptor
stimulation.
D. Differentiate between sympathomimetic and sympatholytic agents.
E. Explain how the chemical structure of a drug may affect
bronchodilation.
F. Describe and evaluate clinical scenarios to determine the following
for sympathomimetic bronchodilators:
1. Mode of action
2. Indication for use
3. Routes of administration
4. Associated adverse effects
5. Assessment of expected outcomes
G. Determine the most appropriate sympathomimetic bronchodilator for a
patient respiratory care plan considering the following factors:
1. Onset and duration of action
2. Dosage form
3. Dosage amounts
4. Recommended frequency of administration
5. Signs and symptoms of the patient
H. Recognize the drug class and either the generic name and/or trade
name for the following agents:
1. Racemic epinephrine 6. Albuterol
2. Isoproterenol 7. Bitolterol
3. Isoetharine 8. Pirbuterol
4. Terbutaline 9. Salmeterol
5. Metaproterenol
I. Review the pathophysiology of COPD and asthma and relate this drug
class to the management of COPD and asthma.
IV. Cholinergic and Anticholinergic
A. Review the parasympathetic branch of the autonomic nervous system to
include:
1. Anatomy
2. Preganglionic and postganglionic neurotransmitters
3. Receptors
B. Describe the parasympathetic response on the following
organs/sites:
1. Heart
2. Bronchi smooth muscle
3. Bronchial mucus glands
4. Vascular smooth muscle
C. Describe the effects of muscarinic receptor stimulation.
D. Differentiate between parasympathomimetic and parasympatholytic
agents.
E. Describe and evaluate clinical scenarios to determine the following
for parasympathomimetic (i.e. methacholine) and parasympatholytic (i.e.
atropine and ipratropium) agents:
1. Mode of action
2. Indication for use
3. Routes of administration
4. Associated adverse effects
5. Assessment of expected outcomes
F. Determine the most appropriate parasympatholytic bronchodilator for
a patient respiratory care plan considering the following factors:
1. Onset and duration of action
2. Dosage form
3. Dosage amounts
4. Recommended frequency of administration
5. Signs and symptoms of the patient
G. Recognize the drug class and either the generic name and/or trade
name for the following agents:
1. Atropine
2. Ipratropium bromide
3. Ipratropium + albuterol
4. Methacholine
H. Review the pathophysiology of COPD and asthma and relate this drug
class to the management of COPD and asthma.
V. Methylxanthine Agents
A. Describe and evaluate clinical scenarios to determine the following
for xanthine agents:
1. Mode of action
2. Indication for use
3. Routes of administration
4. Associated adverse effects and other physiologic effects
5. Assessment of expected outcomes
B. Determine the most appropriate xanthine agent for a patient
respiratory care plan considering the following factors:
1. Onset and duration of action
2. Dosage form
3. Dosage amounts
4. Recommended frequency of administration
5. Signs and symptoms of the patient
C. Recognize the drug class and either the generic name and/or trade
name for the following agents:
1. Theophylline
2. Oxtriphylline
3. Aminophylline
D. Discuss the use and role of caffeine in respiratory care practice.
E. Evaluate serum theophylline levels and determine the anticipated
effects of these levels.
F. Recognize and describe factors that affect theophylline
effectiveness and clearance and discuss therapeutic dosing/frequency
adjustments that may need to be made.
G. Review the pathophysiology of COPD and asthma and relate this drug
class to the management of COPD and asthma.
VI. Mediator Antagonists (Anti-Asthmatic) Agents
A. Describe and evaluate clinical scenarios to determine the following
for mediator antagonist agents:
1. Mode of action
2. Indication for use
3. Routes of administration
4. Associated adverse effects and other physiologic effects
5. Assessment of expected outcomes
B. Determine the most appropriate mediator antagonist agent for a
patient respiratory care plan considering the following factors:
1. Onset and duration of action
2. Dosage form
3. Dosage amounts
4. Recommended frequency of administration
5. Signs and symptoms of the patient
C. Recognize the drug class and either the generic name and/or trade
name for the following agents:
1. Cromolyn sodium
2. Nedocromil sodium
3. Zafirlukast
4. Zileuton
5. Montelukast
D. Review the pathophysiology of COPD and asthma and relate this drug
class to the management of COPD and asthma.
VII. Corticosteroids
A. Describe and evaluate clinical scenarios to determine the following
for steroidal agents:
1. Mode of action
2. Indication for use
3. Routes of administration
4. Associated adverse effects and other physiologic effects
5. Assessment of expected outcomes
B. Determine the most appropriate steroidal agent for a patient
respiratory care plan considering the following factors:
1. Onset and duration of action
2. Dosage form
3. Dosage amounts
4. Recommended frequency of administration
5. Signs and symptoms of the patient
C. Recognize the drug class and either the generic name and/or trade
name for the following agents:
Inhaled Systemic
1. Dexamethasone 6. Prednisone
2. Beclomethasone 7. Methylprednisolone
3. Triamcinolone 8. Hydrocortisone
4. Flunisolide 9. Budesonide
5. Fluticasone
D. Review the pathophysiology of COPD and asthma and relate this drug
class to the management of COPD and asthma.
VIII. Mucokinetic, Surface Active and Cough-and-Cold Agents
A. Describe mucociliary transport in the lung and factors that affect
this transport.
B. Describe the nature and physical properties of mucus.
C. Describe and evaluate clinical scenarios to determine the following
for mucokinetic, surface active and cough-and-cold agents:
1. Mode of action
2. Indication for use
3. Routes of administration
4. Associated adverse effects and other physiologic effects
5. Assessment of expected outcomes
D. Determine the most appropriate mucokinetic, surface active and
cough-and-cold agent for a patient respiratory care plan considering the
following factors:
1. Onset and duration of action
2. Dosage form
3. Dosage amounts
4. Recommended frequency of administration
5. Signs and symptoms of the patient
E. Recognize the drug class and either the generic name and/or trade
name for the following agents:
1. Acetylcysteine 9. Astemizole
2. Dornase alfa 10. Loratadine
3. Phenylephrine 11. Fexofenadine
4. Pseudoephedrine 12. Cetirizine
5. Ephedrine 13. Guaifenesin
6. Diphenhydramine 14. Dextromethorphan
7. Chlorpheniramine 15. Natural surfactant
8. Terfenadine 16. Synthetic surfactant
F. Discuss the role of bland aerosols and other mucolytic and
expectorant agents that may be used in mucus control.
G. Relate these drug classes to respiratory clinical applications.
IX. Anti-Infective Agents
A. Define the following terms:
1. Antibiotic 7. Anti-tuberculosis
2. Broad spectrum 8. Anti-viral
3. Narrow spectrum 9. VRE
4. Bacteriocidal 10. MRSA
5. Bacteriostatic 11. PCP
6. Anti-fungal
B. Describe and evaluate clinical scenarios to determine the following
anti-infective agents:
1. Mode of action
2. Indication for use
3. Routes of administration
4. Associated adverse effects and other physiologic effects
5. Assessment of expected outcomes
C. Determine the most appropriate inhaled anti-infective agent for a
patient respiratory care plan considering the following factors:
1. Dosage form
2. Dosage amounts
3. Recommended frequency of administration
4. Signs and symptoms of the patient
5. Infective organism
D. Recognize the drug class and either the generic name and/or trade
name for the following inhaled agents:
1. Pentamidine
2. Ribavirin
3. Tobramycin
4. Amphotericin B
5. Gentamicin
E. Provide examples, mode of action, clinical indication, general
contraindications, precautions and adverse reactions associated with
following classes of antibiotics:
1. Penicillins 8. Erythromycins
2. Cephalosporins 9. Sulfonamides
3. Carbapenems 10. Misc. antibiotics
4. Aminoglycosides 11. Anti-tuberculosis
5. Tetracyclines 12. Anti-fungal
6. Quinolones 13. Anti-viral
7. Polymixins 14. Interferons
X. Cardiovascular and Diuretic Agents
A. Define the following terms:
1. Chronotropic
2. Inotropic
3. Cardiotonic
4. Preload
5. Afterload
B. Describe factors that effect blood pressure and cardiac function.
C. Provide examples, drug class, mode of action and general clinical
indications for the following agents:
1. Cardiac glycosides
2. Phosphodiesterase inhibitors
3. Beta adrenergic stimulants
4. Anti-arrythmics
5. Vasodilators/anti-hypertensive agents
6. Antianginal agents
7. Vasopressors
8. Antithrombotics
9. Diuretics
D. Manage common cardiac emergencies according to ACLS protocol.
E. Apply the appropriate class of agent to the cardiac patient scenario
and make recommendation of a drug or drugs in each class.
XI. Skeletal Muscle Relaxants
A. Describe the physiology of the neuromuscular junction and the
application of nondepolarizing and depolarizing neuromuscular blocking
agents.
B. Provide examples, mode of action, clinical indication, general
contraindications, precautions, adverse reactions and possible reversal
agents associated with the use of nondepolarizing and depolarizing
neuromuscular blocking agents.
C. Relate these agents to respiratory clinical applications.
XII. Agents Affecting the Central Nervous System
A. Describe the clinical uses, principal effects and adverse effects
associated with the following drug classes:
1. Sedatives and hypnotics
2. Barbiturates
3. Nonbarbiturate hypnotics
4. General anesthetics
5. Local anesthetics
6. Psychotherapeutic agents
7. Narcotic and non-narcotic analgesics
8. Respiratory stimulants
B. Provide examples, mode of action, clinical indication, precautions,
adverse reactions and possible reversal agents associated with the drug
classes identified.
C. Relate these agents to respiratory clinical applications.
D. Describe the clinical manifestations and management of barbiturate
and narcotic overdoses.
E. Briefly describe malignant hyperthermia.
F. Briefly describe conscious sedation and the respiratory clinical
applications.
Method of Evaluation and Competencies:
Written examinations = 80-100% of total grade Projects, quizzes, etc. = 0-20% of total grade Grading Criteria: A = 92-100% B = 83- 91% C = 75- 82% D = 67- 74% F = 0- 66% W= withdrawal initiated by college deadline
Caveats:
- Students are expected to comply with the program policies and procedures as outlined in the Program Administrative Handbook. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.
RC 271
- Title: Clinical Practice I*
- Number: RC 271
- Effective Term: Spring/Summer 2014
- Credit Hours: 6
- Contact Hours: 372
- Lecture Hours:
- Other Hours: 372
Requirements:
Prerequisites: Successful completion of the summer sequence of respiratory care courses
Description:
This course is the clinical application of respiratory care therapeutic and diagnostic procedures. Students will have the opportunity to work with patients under close supervision to further develop their skill and understanding of basic respiratory care procedures for adults and children. The course objectives progress throughout the semester to involve the student initially in basic care of the less critically ill patient. As their comfort level and exposures progress, students are allowed to work with the more critically ill patients. Enrollment in this course requires that you be current in payment of a professional liability fee of $16.00. This fee is required once per calendar year based on enrollment in selected courses and must be in place prior to the start of classes. Students will be notified via their JCCC student email account if they are required to pay a $16 fee. 24 hrs./wk. Fall.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
- Gather and analyze the appropriate patient care data to develop or determine the appropriateness of the respiratory care plan.
- Describe the clinical indications, function and application of equipment and potential risks associated with the following respiratory care modalities: a) Oxygen administration, b) Humidifiers, c) Aerosol generators, d) Gas delivery/metering/analyzing devices, e) Hyperinflation therapies, f) Secretion clearance therapies, g) Breathing circuits, h) Monitoring devices, i) Resuscitation devices, j) Artificial airways.
- Demonstrate the ability to properly administer each of the above-mentioned modalities to adult and pediatric patients according to established procedures and/or protocols, demonstrating appropriate levels of safety, dexterity and timing.
- Determine the appropriateness of the respiratory care plan and recommend modifications as indicated.
- Describe the clinical indications, function and techniques of arterial blood gas acquisition and analysis.
- Develop skills necessary to perform safe arterial blood gas acquisition and analysis.
- Demonstrate the ability to safely and efficiently change ventilator patient breathing circuits.
- Develop skills necessary to initiate, conduct or modify respiratory care techniques in the emergency setting according to BCLS, ACLS and PALS protocols, as indicated.
- Discuss the indications and applications for specialty procedures and the role of the respiratory care practitioners, to include: a) Bronchoscopy, b) EKG, c) Polysomnography, d) HBO.
- Discuss and observe, as available, specific diseases, diagnostic tests and management for cardiac patient care.
- Maintain appropriate patient care and department/institution records
- Develop appropriate communication with the patient, family, peers, instructor, health care staff and physicians.
- Begin to acclimate to the subacute and critical care arena.
- Demonstrate personal behaviors consistent with professional and employer expectations, to include dependable attendance and punctuality, appropriate professional appearance and preparedness, positive interaction skills, adaptability to interruptions and participation in continuing education activities.
- Identify and integrate logistical approaches to improve timing, efficiency and decision making without compromise to patient care in completing assigned therapies and activities.
Content Outline and Competencies:
I. General Respiratory Care Implementation Objectives
A. Demonstrate the ability to gather appropriate data from existing
patient record in a timely fashion.
B. Gather additional data, as indicated, from other resources than the
existing patient record.
C. Perform/measure, interpret and analyze results, as indicated to
include:
1. Vital signs
2. Pulse oximetry
3. ABG’s, co-oximetry and other oxygenation/ventilation
assessments
4. ECG
5. Artificial airway pressure/volume
6. Other diagnostic tests (nutrition, sleep, stress, metabolic)
D. Determine the appropriateness of the respiratory care plan and
recommend changes, as indicated.
E. Analyze available data to determine the disease or pathophysiologic
state and/or describe disease or pathophysiologic state if it is already
identified.
F. Administer assigned therapeutic procedures according to established
procedure or protocol, demonstrating appropriate safety, dexterity and
timing.
1. Select and obtain equipment appropriate to the respiratory care
plan.
2. Assemble and check for proper function of equipment, including
quality control, as indicated, before patient use, demonstrating
appropriate dexterity and/or timing.
3. Identify and correct malfunctions of equipment identified,
demonstrating appropriate dexterity, timing and/or attention to patient
well-being and safety.
4. Ensure selected equipment cleanliness by using proper package and
equipment handling techniques and/or ensuring appropriate disinfection
and/or sterilization techniques have been utilized.
5. Adhere to infection control policies and procedures and practice
proper body kinetic and patient safety and comfort measures.
6. Explain planned therapy and goals to the patient/family in
understandable terms to achieve optimal therapeutic outcome.
7. Evaluate and monitor, as indicated, the patient response to
respiratory care by establishing a baseline prior to therapy, evaluating
and monitoring during therapy
and re-evaluating the patient and therapeutic outcomes after therapy
administration.
8. Recommend/make necessary modifications in therapeutic procedures
based on patient response and/or established protocols.
9. Record complete, accurate and legible entries for therapy and
procedure or diagnostic test results in patient and/or department records
using conventional terminology as required in the health care setting
and/or by regulating agencies.
G. Recognize indications, contraindications and possible adverse
effects related to administered therapies and/or pharmacologic agents.
H. Assist the physician in performing special procedures, as
indicated.
I. Demonstrate the ability to work well with peers in sharing
opportunities, offering assistance and appropriately interacting in
discussions in a positive and timely manner.
J. Collaborate with the clinical instructor in a tactful and timely way
for assistance, to clarify confusion and/or to get answers to questions.
K. Practice appropriate (professional, concise and timely)
communication that should occur between the respiratory care practitioner
and the physician and other health care team with regards to:
1. Patient assessment
2. Benefits/response of therapy
3. Continuing clinical indications for therapy
4. Recommendations for modification or diagnostic testing
5. Clarification of orders/protocols
L. Apply computer technology to patient management, as available.
M. Adhere to program and professional standards for appearance and
readiness to perform the assigned responsibilities.
N. Listen and follow directions with appropriate clarifications and
action.
O. Perform in a safe manner so as to avoid any risk to patient, self or
other staff members.
P. Demonstrate an appropriate level of confidence, minimizing
instructional need at the patient bedside and exercising appropriate
professional discretion in all patient areas.
Q. Identify and integrate logistical approaches to improve timing,
efficiency and decision making without compromise to patient care in
completing assigned therapies and activities.
R. Demonstrate the ability to handle interruptions or abrupt changes in
assignments with composure and professionalism.
II. Airway Care
A. Apply general respiratory care implementation objectives to all
assigned therapies and activities.
B. Adhere and discuss infection control policies and procedures
specifically as it relates to airway care.
C. Review X-ray for ET/trach tube position and presence of supra and/or
subglottic edema or airway narrowing.
D. Perform and/or measure and interpret results of ET/trach tube cuff
pressure/volume.
E. Describe the function, principle(s) of operation, characteristics,
advantages/ disadvantages of the equipment used in airway care and
secretion clearance:
1. Vacuum systems
2. Open and in-line catheters
3. Specimen collectors/traps
4. Oral (Yankaur) suction devices
5. Oro/nasal pharyngeal airways
6. Trach tubes and buttons
F. Discuss therapeutic procedures to maintain a patent airway,
specifically:
1. Proper patient position
2. Adequate humidification
3. Proper cuff inflation
4. Proper tube placement
5. Trach insertion and care
6. Insertion of oro/nasal pharyngeal airways
7. Proper tube stabilization
G. Discuss therapeutic procedures assigned to remove bronchopulmonary
secretions, specifically:
1. Nasotracheal suctioning
2. Open and closed system ET suctioning
3. Open and closed system tracheal suctioning
H. Evaluate, monitor and make recommendations, as indicated, based on
the patient’s response specifically as it applies to airway care and
removal of bronchopulmonary secretion:
1. Review/recommend chest X-ray
2. Perform/interpret ABG and/or pulse-ox
3. Observe changes in sputum production/consistency
4. Note patient’s subjective response
5. Measure/monitor/record VS & cardiac rhythm
6. Measure/determine FIO2 and/or liter flow requirements
7. Auscultate/interpret breath sounds
8. Monitor cuff pressures
I. Recognize indications, contraindications and possible adverse
effects related to airway care procedures.
1. Therapy induced hypoxemia
2. Therapy induced vagal response
3. Mucus plugging from inadequate humidification
4. Improper artificial airway placement
III. Acclimation to the Subacute Area
A. Apply the general respiratory care implementation objectives to all
assigned therapies and activities with specific applications in the
subacute area.
B. Select and obtain appropriate equipment to change humidification,
breathing circuit and related adjuncts for ventilators encountered.
C. Assemble, check for proper function and identify/correct
malfunctions of equipment selected.
IV. Hyperinflation Therapy
A. Apply general respiratory care implementation objectives to all
assigned therapies and activities.
B. Review X-ray for presence/change of air, consolidation and/or fluid
in chest fields.
C. Review planned hyperinflation therapy to establish therapeutic goals
and/or appropriateness of prescribed therapy and recommend changes in
therapeutic plan, as indicated.
D. Describe the function, principle(s) of operation, characteristics,
advantages/disadvantages of the equipment used for hyperinflation
therapy.
1. IPPB
2. CPAP/BiLevel PAP
3. Incentive spirometry
4. IPV, PEP and other multi-purpose procedures
E. Discuss therapeutic procedures to achieve adequate hyperinflation.
1. Instruct in proper breathing techniques
2. Instruct and monitor incentive spirometry
3. Initiate and adjust IPPB, CPAP or BiLevel PAP
F. Evaluate, monitor and make recommendations, as indicated, based on
the patient’s response specifically as it applies to hyperinflation
therapy.
1. Review/recommend chest X-ray
2. Perform/interpret ABG and/or pulse-ox
3. Observe changes in sputum production/consistency
4. Note patient’s subjective response
5. Measure/monitor/record VS & cardiac rhythm
6. Measure/determine FIO2 and/or liter flow requirements
7. Auscultate/interpret breath sounds
8. Patient volumes
G. Recognize indications, contraindications and possible adverse
effects related to hyperinflation procedures.
V. Acclimation to the Critical Care Area
A. Apply the general respiratory care implementation objectives to all
assigned therapies and activities with specific applications in the
critical care area.
B. Identify the differences in the sights, smells, pace/activity,
communication and acuity of care that occurs in the critical care area and
discuss/practice techniques to effectively function in this environment.
C. Select and obtain appropriate equipment to change humidification,
breathing circuit and related adjuncts for ventilation.
D. Assemble, check for proper function and identify/correct
malfunctions of equipment selected.
VI. Aerosol and Bronchial Hygiene Therapies
A. Apply general respiratory care implementation objectives to all
assigned therapies and activities.
B. Review X-ray for presence/change of air, consolidation and/or fluid
in chest fields.
C. Review planned aerosol therapy to establish therapeutic goals and/or
appropriateness of prescribed therapy and recommend changes in therapeutic
plan, as indicated.
D. Review planned bronchial hygiene therapy to establish therapeutic
goals and/or appropriateness of prescribed therapy and recommend changes
in therapeutic plan, as indicated.
E. Describe the function, principle(s) of operation, characteristics,
advantages/disadvantages of the equipment used to deliver aerosol
therapies:
1. Medication nebulizers
2. MDI, MDI w/spacers
3. Large reservoir nebulizers
4. Ultrasonic nebulizers
E. Describe the function, principle(s) of operation, characteristics,
advantages/disadvantages of the equipment used to deliver bronchial
hygiene therapies:
1. Vibrators and percussors
2. Kinetic or similar beds
3. Flutter valves
4. HFCWO (i.e. therapy vest)
5. IPV, PEP and other multi-purpose therapies
F. Discuss therapeutic procedures specific to aerosol therapy:
1. Prescribed pharmacological agents delivery via medication
nebulizers, MDI and MDI w/spacer.
2. Large reservoir nebulizers
3. Ultrasonic nebulizers
G. Discuss therapeutic procedures specific to bronchial hygiene
therapy:
1. Postural drainage, including proper positioning per areas of
involvement
2. Vibration and/or percussion
3. Flutter valve
4. HFCWO (i.e., therapy vest)
5. IPV, PEP and other multi-purpose therapies
6. Autogenic drainage
H. Evaluate, monitor and make recommendations, as indicated, based on
patient’s response specifically as it applies to aerosol and/or
bronchial hygiene therapies.
1. Review/recommend chest X-ray
2. Perform/interpret ABG and/or pulse-ox
3. Observe changes in sputum production/consistency
4. Note patient’s subjective response
5. Measure/monitor/record VS & cardiac rhythm
6. Measure/determine FIO2 and/or liter flow requirements
7. Auscultate/interpret breath sounds
8. Fluid balance (I/O)
I. Recognize indications, contraindications and possible adverse
effects related to aerosol and/or bronchial hygiene therapy.
VII. Clinic Time Management
A. Apply the general respiratory care implementation objectives to all
assigned therapies and activities with specific applications in the
critical care area.
B. Demonstrate the ability to organize, prioritize and safely
administer a workload that would be at least 50% of that assigned to a
staff member.
(Note: The instructor will need to establish/verify student comfort, skill
levels and decision-making skills prior to making this assignment.)
C. Demonstrate the ability to identify, organize, prioritize and
complete other responsibilities of a staff member in the course of a
shift, to include:
1. Stat oxygen set-ups
2. Stat blood gas and/or oximetry
3. Code blue or emergency calls
4. Stat therapies
5. Physician assistance
6. Patient transport
VIII. Cardiac Patient Care
A. Apply general respiratory care implementation objectives to all
assigned therapies and activities.
B. Identify the differences in the sights, smells, pace/activity,
communication and acuity of care that occur in the critical care area and
discuss/practice techniques to effectively function in this environment.
C. Select and obtain appropriate equipment to change humidification,
breathing circuit and related adjuncts for mechanical ventilation.
D. Review the blood flow through the heart and cardiac circulation to
the heart.
E. State the pathophysiology and describe the appropriate care plan for
each of the following disease processes:
1. Hypertension
2. Myocardial infarction
3. Cardiac valve disorders
4. Congestive heart failure
5. Cardiomyopathy
F. Assess overall patient cardiopulmonary status by:
1. Inspection for venous distention, peripheral edema, etc., that
may be significant for the cardiac patient.
2. Palpation for heart rate, rhythm and force.
3. Auscultation, as indicated, for verification of heart sounds,
dysrhythmias, murmurs, bruits.
G. Discuss and observe, as available, diagnostic testing procedures for
cardiac disease, to include:
1. Cardiac catheterization
2. Exercise stress testing
3. Thallium stress testing
4. Echocardiograms
5. Holter monitoring
6. Lab data
H. Discuss and observe, as available, therapy interventions for cardiac
abnormalities, to include:
1. Pacemakers
2. Cardiac rehab
3. Thrombolitic therapy
4. Cardioversion
5. Defibrillation
6. Fluid balance
I. Recognize and discuss indications, contraindications and possible
adverse effects related to interventions and/or pharmacologic agents used
in cardiac patient care:
1. Ace inhibitors
2. Beta blockers
3. Calcium antagonists
4. Diuretics
5. Anti-arrythmics
6. Oxygen
7. Anti-thrombolytics
8. Items in the above objective
J. Practice basic EKG interpretations and describe therapeutic
interventions for identified rhythms, including the application of BCLS
and ACLS for cardiopulmonary collapse.
K. Participate in patient transport as available, including determining
cylinder length of service for patients being transported for various
procedures.
IX. Pediatric Management
A. Apply general respiratory care implementation objectives to the
pediatric population.
B. Assess and discuss overall cardiopulmonary status by assessing
patient learning needs, vital signs and clinical signs and symptoms that
are manifested in a child in respiratory distress.
C. Describe the function, principle(s) of operation, characteristics,
advantages/disadvantages and applications to the pediatric population of
the following equipment:
1. Oxygen administration devices, including oxygen tents and hoods
2. Humidifiers
3. Aerosol generators, including oxygen tents
4. Hyperinflation devices
5. Secretion clearance devices
6. Resuscitation devices
7. Artificial airways
D. Explain planned therapy and goals to patient/family in
understandable terms to achieve optimal therapeutic outcomes.
E. Discuss therapeutic procedure applications for the pediatric
population:
1. Maintenance of a patent airway
2. Removal of bronchopulmonary secretions
3. Achievement of adequate ventilation
4. Achievement of adequate oxygenation
F. Describe the pathophysiology and the appropriate care plan for each
of the following disease processes:
1. Croup
2. Epiglottitis
3. Cystic fibrosis
4. Asthma
5. Bronchiolitis
6. RSV
G. Discuss treatment of pediatric cardiopulmonary collapse according to
PALS protocols.
X. Blood Gas Procurement, Analysis and Interpretation
A. Demonstrate the ability to appropriately contact the instructor,
staff and others for assistance.
B. Safely perform arterial puncture for blood gas analysis.
C. Review existing data in the patient record and recommend procedures
to obtain additional data, as indicated, to perform a safe arterial
puncture and to correlate interpretation.
1. Pulse oximetry, as indicated
2. Clinical lab data
3. Previous ABG’s
4. Medications
D. Perform, measure and/or calculate and interpret results, as
indicated:
1. ABG’s for acid base and oxygenation status
2. Co-oximetry
3. P(A-a)O2
4. Oxygen content
5. HCO3 estimation
6. HCO3 administration
7. H+ ion content
8. Venous results
9. Mixed venous results
10. p50
E. Identify potential causes for a given acid/base state and recommend
changes in therapeutic plan, as indicated.
F. Perform blood gas quality control procedures on analyzing equipment
and discuss implications of results.
G. Describe the function, principle(s) of operation, characteristics,
advantages/disadvantages of the equipment used for obtaining and analyzing
the sample.
1. PO2 electrode
2. PCO2 electrode
3. pH electrode
4. Co-oximeter
5. Specialty gas mixtures
6. Arterial line equipment
7. Pulm. artery equipment
H. Compare/contrast the use of tonometry for quality control of
analyzing equipment with other quality control measures.
I. Handle blood samples to avoid erroneous results.
J. Describe the changes imposed on the blood sample if:
1. Not iced
2. Large air bubble is present
3. Diluted with liquid heparin
4. Patient is hyper/hypothermic
5. Patient has abnormal electrolytes
6. Patient has leukocytosis
K. Recognize indications, contraindications and possible adverse
effects related to arterial puncture or line draw.
L. Record results in patient and/or department records using
conventional terminology as required in the health care setting and/or by
regulatory agencies.
1. Specify sample site, date, time
2. Patient’s adverse or subjective response
3. Correlating oxygen and/or ventilator management
4. Verify computations and note erroneous data
M. Apply computer technology to patient management.
N. Communicate information regarding patient’s clinical status to
appropriate members of the health care team.
XI. Fluid and Electrolyte Balance
A. Identify the four most common and two other electrolytes measured,
noting the accepted normal ranges and usual units of measurement.
B. Identify the appropriate cations and anions and determine the anion
gap and its implications.
C. Describe the following:
1. Where electrolytes are stored
2. Mechanisms for fluid loss by the body
3. How overhydration or dehydration may occur
4. Possible implications of overhydration or dehydration
5. Possible implications of electrolyte imbalance (hyper or hypo
conditions)
XII. Specialty Practicum
A. Ensure selected equipment cleanliness.
1. Select/determine appropriate agent and technique for disinfection
and/or sterilization.
2. Perform/discuss procedures for disinfection and/or
sterilization.
3. Monitor/discuss effectiveness of sterilization procedures.
B. Review X-ray to determine proper ET/trach tube position.
C. Perform and/or measure and interpret results of ET/trach tube cuff
pressure and volume.
D. Select and obtain the equipment appropriate for achieving a patent
airway and resuscitation.
1. Vacuum systems
2. Open and in-line suction catheters
3. Oral (Yankaur) suction devices
4. Bag/valve mask
5. Demand valve
6. Mouth/valve/mask
7. Oro/naso pharyngeal airways
8. Oro/naso ET tubes
9. Intubation equipment
10. LMA
11. ETC
12. Exhaled CO2 detection devices
E. Conduct therapeutic procedures to maintain a patent airway and
resuscitation.
1. Insertion of oro/naso pharyngeal airways
2. Oro/naso Intubation/extubation
3. Proper tube placement and stabilization
4. Proper cuff inflation
5. Proper patient position
F. Recognize indications, contraindications and possible hazards
relating to maintaining a patient airway and resuscitation.
G. Interpret results of ECG.
H. Discuss and treat cardiopulmonary collapse according to BCLS and
ACLS protocols.
I. Select and obtain equipment appropriate to changing the breathing
circuit and humidification set-up on ventilators with external exhalation
valves, external PEEP valves and/or closed system suction set-ups.
J. Demonstrate efficient breathing circuit and accessory changes on
ventilators with external exhalation valves.
K. Select and obtain equipment appropriate to delivering aerosolized
pharmacologic agents in-line with the ventilator.
L. Demonstrate proper placement of equipment in-line with the
ventilator to deliver aerosolized pharmacologic agents.
XIII. Physician Rounds
A. Review existing data in the patient record and determine additional
data that may be indicated.
B. Assess overall patient cardiopulmonary status by inspection and
auscultation.
C. Assess overall patient cardiopulmonary status by percussion and
palpation, as indicated.
D. Observe and participate, as appropriate, in taking a patient
history.
E. Review findings of X-ray and other diagnostic tests.
F. Review planned therapy to establish therapeutic goals and/or
appropriateness of prescribed therapy and recommend changes in therapeutic
plan, as indicated.
G. Discuss how the respiratory care practitioner may assist the
physician in performing special procedures:
1. Cardioversion
2. Intubation
3. Bronchoscopy
4. Thoracentesis
5. Insertion of chest tubes
6. Conscious sedation
H. Practice appropriate communication that should occur between the
respiratory care practitioner and physician with regards to patient
assessment, benefits/response of therapy, continuing clinical indications
for therapy, recommendations for modification in therapy or diagnostic
testing.
XIV. EKG Rotation
A. Perform routine 12 lead EKG’s.
B. Discuss the indications for performing 12 lead EKG’s.
C. Discuss the indications and procedures for other cardiac testing,
including Holter monitoring and echocardiograms.
D. Observe other cardiac diagnostic testing as available.
XV. Hyperbaric Oxygen Therapy
A. Describe the gas laws applicable to hyperbaric medicine.
B. Describe the physiologic basis for HBO.
C. Identify contraindications and precautions relating to HBO.
D. Define oxygen toxicity and the associated signs and management of
oxygen toxicity.
E. Discuss the indications and rationale for HBO in clinical situations
for which it is described as an approved mode of therapy.
F. Discuss other clinical situations in which HBO might be effective
but not necessarily proven.
XVI. Polysomnography
A. Differentiate between active (REM) and quiet (NREM) sleep stages.
B. Differentiate between obstructive, central and mixed apneas.
C. Review the technical aspects of performing a sleep study:
1. Equipment used
2. Patient preparation
3. Patient history and physical
4. Study procedures
5. Cleaning and calibration
D. Discuss the methods of treating sleep disorders and determining the
appropriateness of each method for specific patients and/or conditions:
1. Surgical interventions (tracheostomy, pharyngoplasty, etc.)
2. Weight loss
3. Drug therapy
4. Nocturnal oxygen therapy (NOT)
5. CPAP or BiLevel PAP
6. Diaphragmatic pacing
E. Discuss the scoring of polysomnography.
F. Discuss how the respiratory care practitioner may assist the
physician in sleep studies.
XVII. Diagnostic Bronchoscopy
A. Discuss the indications for a diagnostic bronchoscopy.
B. Discuss the potential complications for a bronchoscopy (both during
the procedure and post procedure) and strategies for minimizing
complications.
C. Observe and identify the role of the respiratory care practitioner
in assisting the physician with diagnostic bronchoscopy, to include:
1. Procedure set-up
2. Patient preparation
3. Biopsy and specimen sample procurement and preparation
a) Wang needle
b) Retrieval baskets
c) Forceps
d) Blind & fluoroscopy assisted techniques
e) Brushings, washings
f) Specimen preparation for lab
D. Observe and participate, as available, in the set-up for
bronchoscopy.
E. Observe and participate, as available, in the patient prep for
bronchoscopy.
F. Observe and participate, as available, in cleaning/disinfection of a
bronchoscope, adhering to standard precautions.
G. Observe physician technique for insertion and use of a
bronchoscope.
XVIII. Metabolic Cart Testing
A. Identify the indications for use of the metabolic cart.
B. Identify the parts of the metabolic cart and the function of each.
C. Discuss and observe and participate, as available, in the equipment
and patient preparation for a metabolic cart test for:
1. Intubated/trached patients with and without oxygen needs
2. Non-intubated patients with and without oxygen needs
3. Mechanically ventilated patients
D. Discuss the use of the metabolic cart for determining basal
metabolic rates (BMR) and nutritional assessments.
E. Discuss the use of the metabolic cart for cardiopulmonary stress
testing, including the parameters measured.
F. Discuss the evaluation of the cardiopulmonary stress test and the
determination of an exercise prescription.
Method of Evaluation and Competencies:
Written Performance Evaluation (first half of semester) = Satisfactory on Satisfactory/ Needing Improvement evaluation by instructor Written Performance Evaluation (second half of semester) = 70% of total grade Rotation Quizzes, Projects, Reports, etc. = 20% of total grade Student Clinic Book = 10% of total grade Clinic Practicum = Pass on Pass/Fail evaluation Grading Criteria: A = 92 - 100% B = 83 - 91% C = 75 - 82% D = 67 - 74% F = 0 - 66% W = withdrawal initiated by college deadline
Caveats:
- Students will have provided proof of health conducive to being in a health care environment. In addition, drug screening and other requirements may be imposed by clinical agencies. Students are responsible for any and all costs related to their health care or other imposed requirements. Students will also need to provide their own transportation to and from scheduled clinical activities. They will also need to be dressed and prepared appropriately as outlined in the Program Administrative Handbook.
- Students are responsible for providing their own transportation to and from the assigned clinical agencies and activities.
- Students are expected to comply with the program policies and procedures as outlined in the Program Administrative Handbook. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students must have maintained current clinical liability insurance.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.
RC 272
- Title: Clinical Practice II*
- Number: RC 272
- Effective Term: Spring/Summer 2014
- Credit Hours: 6
- Contact Hours: 372
- Lecture Hours:
- Other Hours: 372
Requirements:
Prerequisites: Successful completion of the fall sequence of respiratory care courses
Description:
This course is the clinical application of respiratory care therapeutic and diagnostic procedures. Students will have the opportunity to work with patients under close supervision to further develop their skill and understanding of critical respiratory care procedures for adults and children. Students will also be involved in specialty activities to include physician rounds, pulmonary rehabilitation, home care, and pulmonary function. Enrollment in this course requires that you be current in payment of a professional liability fee of $16.00. This fee is required once per calendar year based on enrollment in selected courses and must be in place prior to the start of classes. Students will be notified via their JCCC student email account if they are required to pay a $16 fee. 24 hrs./wk. Spring.
Course Fees:
NoneTextbooks:
http://bookstore.jccc.edu/Supplies:
Refer to the instructor's course syllabus for details about any supplies that may be required.Objectives
- Demonstrate personal behaviors consistent with professional and employer expectations, to include dependable attendance and punctuality, appropriate professional appearance and preparedness, positive interactions skills, adaptability to interruptions and participation in continuing education activities.
- Demonstrate appropriate communication with the patient, family, peers, instructor, health care staff and physicians.
- Gather and analyze the appropriate patient care data to develop or determine the appropriateness of the respiratory care plan.
- Discuss the clinical indications, function and application to the critically ill patient and potential risks associated with the following respiratory care modalities: a) Ventilator initiation, b) Ventilator management, c) Ventilator weaning, d) Hemodynamic monitoring, e) Basic respiratory care procedures (oxygen administration, hyperinflation procedures, bronchial hygiene procedures, airway care, etc.), f) Cardiopulmonary monitoring (EKG, pulse ox, ABG, respiratory mechanics, capnography, etc.).
- Demonstrate the ability to properly administer each of the above mentioned modalities to adult and pediatric patients according to established procedures and/or protocols demonstrating appropriate levels of safety, dexterity and timing.
- Discuss and observe, as available, management of the open heart patient.
- Identify and integrate logistical approaches to improve timing, efficiency and decision making without compromise to patient care in completing assigned therapies and activities.
- Develop and practice, as feasible, skills necessary to initiate, conduct or modify respiratory care techniques in the emergency setting according to BCLS, ACLS, PALS or NRP protocols, as indicated
- Discuss the indications and applications for post acute respiratory care and the role of the respiratory care practitioners, to include pulmonary rehabilitation and pulmonary home care.
- Demonstrate the ability to perform and interpret pulmonary function tests.
- Analyze the available pulmonary function data to determine pathophysiologic changes.
- Discuss and practice, as feasible, the role of the respiratory care practitioner in assisting the physician performing special procedures.
Content Outline and Competencies:
I. General Respiratory Care Implementation Objectives
A. Demonstrate the ability to gather appropriate data from existing
patient record in a timely fashion.
B. Gather additional data, as indicated, from other resources than the
existing patient record.
C. Perform/measure, interpret and analyze results, as indicated to
include:
1. Vital signs
2. Pulse oximetry
3. ABG’s, co-oximetry and other oxygenation/ventilation
assessments
4. ECG
5. Artificial airway pressure/volume
6. Respiratory mechanics and critical care indices
7. Other diagnostic tests (nutrition, sleep, stress, metabolic)
D. Determine the appropriateness of the respiratory care plan and
recommend changes as indicated.
E. Analyze available data to determine the disease or pathophysiologic
state and/or describe disease or pathophysiologic state if it is already
identified.
F. Administer assigned therapeutic procedures according to established
procedure or protocol, demonstrating appropriate safety, dexterity and
timing.
1. Select and obtain equipment appropriate to the respiratory care
plan.
2. Assemble and check for proper function of equipment, including
quality control as indicated, before patient use, demonstrating
appropriate dexterity and/or timing.
3. Identify and correct malfunctions of equipment identified,
demonstrating appropriate dexterity, timing an/or attention to patient
well-being and safety.
4. Ensure selected equipment cleanliness by using proper package and
equipment handling techniques and/or ensuring appropriate disinfection
and/or sterilization techniques have been utilized.
5. Adhere to infection control policies and procedures and practice
proper body kinetic and patient safety and comfort measures.
6. Explain planned therapy and goals to the patient/family in
understandable terms to achieve optimal therapeutic outcome.
7. Evaluate and monitor, as indicated, the patient response to
respiratory care by establishing a baseline prior to therapy, evaluating
and monitoring during therapy and re-evaluating the patient and
therapeutic outcomes after therapy administration.
8. Recommend/make necessary modifications in therapeutic procedures
based on patient response and/or established protocols.
9. Record complete, accurate and legible entries for therapy and
procedure or diagnostic test results in patient and/or department records
using conventional terminology as required in the health care setting
and/or by regulating agencies.
G. Recognize indications, contraindications and possible adverse
effects related to administered therapies and/or pharmacologic agents.
H. Participate in patient transport (in house and between care sites),
as available.
I. Assist the physician in performing special procedures, as
indicated.
J. Demonstrate the ability to work well with peers in sharing
opportunities, offering assistance and appropriately interacting in
discussions in a positive and timely manner.
K. Collaborate with the clinical instructor in a tactful and timely way
for assistance, to clarify confusion and/or to get answers to questions.
L. Practice appropriate (professional, concise and timely)
communication that should occur between the respiratory care practitioner
and the physician and other health care team with regards to:
1. Patient assessment
2. Benefits/response of therapy
3. Continuing clinical indications for therapy
4. Recommendations for modification or diagnostic testing
5. Clarification of orders/protocols
M. Apply computer technology to patient management, as available.
N. Adhere to program and professional standards for appearance and
readiness to perform the assigned responsibilities.
O. Listen and follow directions with appropriate clarifications and
action.
P. Perform in a safe manner so as to avoid any risk to patient, self or
other staff members.
Q. Demonstrate an appropriate level of confidence, minimizing
instructional need at the patient bedside and exercising appropriate
professional discretion in all patient areas.
R. Identify and integrate logistical approaches to improve timing,
efficiency and decision making without compromise to patient care in
completing assigned therapies and activities.
S. Demonstrate the ability to handle interruptions or abrupt changes in
assignments with composure and professionalism.
II. Open Heart Surgical Management and Critical Care Monitoring
A. Apply general respiratory care implementation objectives to all
assigned therapies and activities.
B. Demonstrate the ability to conduct therapeutic procedures to achieve
adequate ventilation and oxygenation, to include:
1. Selecting the appropriate ventilator and adjunct equipment
2. Initiating and adjusting A/C, SIMV, PSV, PCV and flow-by
3. Initiating and modifying weaning procedures
4. Initiating and adjusting CPAP and PEEP
5. Positioning the patient to minimize hypoxemia
6. Preventing procedure associated hypoxemia
C. Demonstrate the ability to evaluate and monitor patient’s response
to respiratory care, to include:
1. Lung compliance and airway resistance
2. Ventilator waveforms
3. Ventilator mean airway pressure
4. Ventilator alarms
5. Ventilator parameters
6. Hemodynamic measurements/calculation
7. Critical care indices
8. Clinical indicators of oxygenation and ventilation
9. Other patient evaluation/monitoring measures (chest X-ray,
clinical lab, EKG, etc.)
D. Review existing data in the patient record and recommend procedures
to obtain additional data, as indicated, for open heart surgical
management and critical care monitoring:
1. Vital signs
2. Fluid balance (I/O)
3. Respiratory monitoring
4. Hemodynamic monitoring
5. Other diagnostic studies (VO2 and VCO2; Nutrition assessment; V/Q
scan; Pulmonary angiography)
E. Assess overall patient cardiopulmonary status by:
1. Auscultation
a) As indicated, for verification of heart sounds, dysrhythmias,
murmurs, bruits
2. Bedside cardiopulmonary monitoring and weaning procedures
3. Review of X-ray
a) ET/trach tube position
b) Position of chest tubes and hemodynamic catheters
4. Recognition of clinical signs of hypoxia and hypercapnia
F. Perform and/or monitor and interpret results, as indicated:
1. Hemodynamic monitoring
a) CVP
b) Cardiac output/cardiac index
c) PCWP
d) PAP
e) Mixed venous sampling
f) C(a-v) O2
g) Qs/Qt
h) PVR
i) SVR
j) SV/SVI
2. Critical care indices
a) ABG profile
b) CaO2
c) SvO2
d) Weaning parameters
e) PaO2/FIO2
f) P(A-a)O2
g) RSI (f/Vt)
G. Review planned therapy to establish therapeutic goals and/or
appropriateness of prescribed therapy and recommend changes in therapeutic
plan, as indicated.
1. Pre op evaluation and clinical indications for surgery
2. Surgical management or alternatives
3. Post op clinical lab, ECG, ABG, other monitoring and management
H. Discuss the function, principle(s) of operation, characteristics,
advantages/disadvantages of the equipment and methods used to manage and
monitor the open heart surgical or other critical patient.
1. Blood pressure monitoring via sphygmomanometer, doppler and
arterial catheter
2. Pulmonary artery catheter equipment
3. Chest tubes
4. Intra-aortic balloon pump
5. Left ventricular assist device
6. Ventilator and respiratory adjuncts
I. Recommend/make necessary modifications in therapeutic procedures
based on patient response.
J. Apply computer technology to patient management.
1. Charting
2. Ventilator waveform analysis
3. Patient care protocols/algorithms
III. Ventilator Management and Weaning
A. Apply general respiratory care implementation objectives to all
assigned therapies and activities.
B. Demonstrate the ability to conduct therapeutic procedures to achieve
adequate ventilation and oxygenation, to include:
1. Selecting the appropriate ventilator and adjunct equipment
2. Initiating and adjusting A/C, SIMV, PSV, PCV and flow-by
3. Initiating and modifying weaning procedures
4. Initiating and adjusting CPAP and PEEP
5. Positioning the patient to minimize hypoxemia
6. Preventing procedure associated hypoxemia
C. Demonstrate the ability to evaluate and monitor patient’s response
to respiratory care, to include:
1. Lung compliance and airway resistance
2. Ventilator waveforms
3. Ventilator mean airway pressure
4. Ventilator alarms
5. Ventilator parameters
6. Hemodynamic measurements/calculation
7. Critical care indices
8. Clinical indicators of oxygenation and ventilation
9. Other patient evaluation/monitoring measures (chest X-ray,
clinical lab, EKG, etc.)
D. Review planned therapy to establish therapeutic goals and/or
appropriateness of prescribed therapy and recommend changes in therapeutic
plan, as indicated.
1. Compare and contrast the following weaning methods:
a) T-tube trials
b) SIMV
c) CPAP
d) Pressure support
e) Flow-by
2. Discuss the following parameters in determining if the patient is
a candidate for weaning:
a) Ventilation and FIO2 requirements
b) ABG’s and pulse oximetry
c) Weaning parameters (MIP, VC, VE, VT, RR, RSBI)
d) Vital signs
e) Capnography; VD/VT
f) Sensorium and mentation
g) Other (sputum production, clinical lab, X-ray, etc.)
E. Discuss the function, principle(s) of operation, characteristics,
advantages/disadvantages, indications of the equipment and methods used to
manage and monitor the weaning process.
1. Oxygen administration devices (t-pieces, face tents, face masks,
etc.)
2. Aerosol generators (large volume nebulizers)
3. Monitoring devices (manometers and respirometer)
F. Demonstrate the ability to appropriately measure parameters of the
weaning process:
1. Respiratory monitoring
a) Frequency
b) VT
c) VE
d) I:E ratio
e) I/E pressures
f) VC
g) Flow/volume/pressure waveforms
h) Lung compliance
i) Airway resistance
j) Work of breathing indices (RSBI)
k) MIP
G. Evaluate and monitor patient’s response to the weaning process.
IV. Airway Management
A. Apply general respiratory care implementation objectives to all
assigned therapies and activities.
B. Demonstrate the ability to conduct therapeutic procedures to achieve
adequate ventilation and oxygenation, to include:
1. Selecting the appropriate ventilator and adjunct equipment
2. Initiating and adjusting A/C, SIMV, PSV, PCV and flow-by
3. Initiating and modifying weaning procedures
4. Initiating and adjusting CPAP and PEEP
5. Positioning the patient to minimize hypoxemia
6. Preventing procedure associated hypoxemia
C. Demonstrate the ability to evaluate and monitor patient’s response
to respiratory care, to include:
1. Lung compliance and airway resistance
2. Ventilator waveforms
3. Ventilator mean airway pressure
4. Ventilator alarms
5. Ventilator parameters
6. Hemodynamic measurements/calculation
7. Critical care indices
8. Clinical indicators of oxygenation and ventilation
9. Other patient evaluation/monitoring measures (chest X-ray,
clinical lab, EKG, etc.)
D. Describe/perform the correct procedures to insert, secure and/or
remove the following airways:
1. Oro and nasopharyngeal
2. Oro and nasotracheal
3. Tracheostomy
4. Trach button
E. Demonstrate, as indicated, the correct procedure for:
1. Minimum leak technique
2. Cuff pressure monitoring
3. Trach dressing changes
4. Trach inner cannula replacement
F. Demonstrate appropriate suctioning technique of the patient airway,
including demonstration of appropriate use of demand valves,
self-inflating resuscitation bags and the NRPR bag.
G. Describe indications and possible complications or hazards
associated with the use of airway adjuncts.
H. Discuss the concerns for maintaining a stable airway and ventilation
during patient transport.
I. Compare the role of respiratory care in a subacute health care
environment with that of the acute care environment.
V. Adult Critical Care Management and Capnography
A. Apply general respiratory care implementation objectives to all
assigned therapies and activities.
B. Demonstrate the ability to conduct therapeutic procedures to achieve
adequate ventilation and oxygenation, to include:
1. Selecting the appropriate ventilator and adjunct equipment
2. Initiating and adjusting A/C, SIMV, PSV, PCV and flow-by
3. Initiating and modifying weaning procedures
4. Initiating and adjusting CPAP and PEEP
5. Positioning the patient to minimize hypoxemia
6. Preventing procedure associated hypoxemia
C. Demonstrate the ability to evaluate and monitor patient’s response
to respiratory care, to include:
1. Lung compliance and airway resistance
2. Ventilator waveforms
3. Ventilator mean airway pressure
4. Ventilator alarms
5. Ventilator parameters
6. Hemodynamic measurements/calculation
7. Critical care indices
8. Clinical indicators of oxygenation and ventilation
9. Other patient evaluation/monitoring measures (chest X-ray,
clinical lab, EKG, etc.)
D. Perform and/or measure and interpret results of capnography.
E. Discuss the function, principle(s) of operation, characteristics,
advantages/disadvantages of the capnography.
F. Determine the amount of autoPEEP present and discuss the
significance and alternatives for relieving it.
VI. Neonatal/Pediatric Critical Care
A. Apply general respiratory care implementation objectives to all
assigned therapies and activities of the neonatal and pediatric patient.
B. Review existing data in the patient record and recommend procedures
to obtain additional data, as indicated.
1. Physical exam/VS
2. Pulse oximetry and/or TcCO2 and TcO2 and/or ABG’s
3. Lab data
4. Chest/upper airway X-ray
5. ECG and echocardiography
6. Fluid balance
7. Respiratory monitoring
8. Hemodynamic monitoring
9. Medications
10. Maternal and perinatal/neonatal history and data
C. Review the differences between the child and an adult anatomy and
physiology and describe how the following may influence therapy
administration:
1. Size/position/characteristics of the tongue, larynx, epiglottis
and trachea
2. Tidal volume and respiratory rate
3. Alveolar size and number
4. Rib cage shape and structure
D. Assess overall patient cardiopulmonary status by:
1. Inspection, to include discussion of transillumination of infant
chest, Apgar scoring and gestational age assessment
2. Auscultation
3. Assessment of family/patient learning needs and age appropriate
interactions
4. Review of X-ray
E. Perform and/or measure and interpret results, as indicated:
1. Basic vital signs
2. Pulse oximetry
3. Transcutaneous monitoring for O2 and CO2
4. Apnea monitoring
F. Analyze available data and/or discuss factors that determine
pathophysiologic state of neonatal and pediatric disorders.
Neonatal Pediatric
1. HMD/RDS 1. RSV
2. TTN 2. PRDS/ARDS
3. BPD/CLD 3. Sepsis
4. MAS 4. Neuromuscular disorders
5. PIE 5. Head injury
6. Congenital heart anomalies 6. Asthma
7. Bronchiolitis
8. Croup
9. Epiglottitis
G. Select and obtain equipment appropriate to the respiratory care plan
and discuss specific applications and considerations for the neonatal and
pediatric population.
1. O2 therapy (isolette, cannula, mask, oxyhood, croup tent, CPAP)
2. Aerosol and humidity therapy
3. Bronchial hygiene procedures
4. Suction and airway care
5. Ventilation, including HFV
6. Monitoring (TcCO2, TcO2, pre/post ductal oxygenation studies,
UAC/UVC catheters, temperature probes, oxygen analyzers, oxygen saturation
monitors, EKG)
H. Recognize indications, contraindications and possible adverse
effects relating to respiratory therapy and management of the neonatal and
pediatric patient.
I. Recognize indications, contraindications, possible adverse effects
and discuss delivery methods for respiratory related pharmacologic agents
as they apply to the neonatal and pediatric patient:
1. Sympathomimetics
2. Anti-asthmatics
3. Mucolytics
4. Aerosolized anti-viral agents
5. Aerosolized corticosteroids
6. Aerosolized antibiotics
7. Methylxanthines
8. Benzodiazepines
9. Neuromuscular blocking agents
10. Morphine
11. Corticosteroids
12. Indomethacin
13. Resuscitation drugs
14. Magnesium Sulfate
15. Surfactant replacement
J. Discuss PALS and NRP protocols for treatment of cardiopulmonary
collapse, including necessary equipment and techniques.
K. Discuss factors implicating a high risk delivery and observe a
high-risk delivery, as available.
L. Discuss neonatal/pediatric transport needs to include necessary
equipment and technique considerations.
M. Discuss modification of neonatal respiratory care procedures for use
in the home, ensuring safety and infection control.
VII. Physician Rounds
A. Review existing data in the patient record and determine additional
data that may be indicated.
B. Assess overall patient cardiopulmonary status by inspection and
auscultation.
C. Assess overall patient cardiopulmonary status by percussion and
palpation, as indicated.
D. Observe and participate, as appropriate in taking a patient
history.
E. Review findings of X-ray and other diagnostic tests.
F. Review planned therapy to establish therapeutic goals and/or
appropriateness of prescribed therapy and recommend changes in therapeutic
plan, as indicated.
G. Discuss how the respiratory care practitioner may assist the
physician in performing special procedures:
1. Cardioversion
2. Intubation
3. Bronchoscopy
4. Thoracentesis
5. Insertion of chest tubes
6. Conscious sedation
7. Transtracheal aspiration
8. Percutaneous needle biopsy
9. Insertion of monitoring lines
10. CP Stress Testing
11. Sleep studies
12. Tracheostomy
H. Practice appropriate communication that should occur between the
respiratory care practitioner and physician with regards to patient
assessment, benefits/response of therapy, continuing clinical indications
for therapy, recommendations for modification in therapy or diagnostic
testing.
VIII. Alternative Care Site
A. Differentiate between the levels of care in the acute care setting
versus that in the alternative care setting.
B. Discuss the implications of the various health care reimbursement
plans for the level of care and reimbursement for services in the
alternative care setting.
1. Medicare
2. Medicaid
3. PPS
4. POS
5. HMO
C. Participate in a general patient assessment and make recommendations
for care.
D. Review interdisciplinary care plans and recommend changes, as
indicated.
E. Practice appropriate communication to explain the respiratory care
plan and goals in understandable terms to the patient and family.
F. Practice appropriate communication of relevant information regarding
a patient’s clinical status and coordination of patient care.
G. Practice recording of patient assessment, respiratory care plan and
evaluation of results, using conventional terminology as required in the
alternative care setting and/or by regulatory agencies.
IX. Pulmonary Rehab
A. Review existing data in the patient record and recommend procedures
to obtain additional data, as indicated.
B. Assess overall patient cardiopulmonary status, including exercise
tolerance, ADL, physical environment, social support systems, nutrition
status and patient learning needs.
C. Review interdisciplinary patient family care plan.
D. Identify the goals of a rehab program for a pulmonary patient.
E. Discuss the guidelines, basic components and implementation of a
pulmonary rehab program (i.e. resources, staffing, medical direction,
patient selection and evaluation, patient instruction, equipment
selection, follow-up, reimbursement, etc.).
F. Practice explaining planned therapy and goals to patient/family in
understandable terms to achieve optimal therapeutic outcome.
1. Describe the type of general patient education given and the aids
used for increased patient understanding and participation.
2. Provide specific patient instruction for:
a) Graded exercise breathing pattern
b) Home respiratory equipment cleaning procedures
c) Breathing patterns to accommodate activities of daily living
(i.e., climbing stairs, bending and stooping)
3. Describe the role of exercise and breathing exercises in
pulmonary rehab.
G. Discuss the elements of a smoking cessation program and practice, as
appropriate, how to counsel patient and family concerning smoking
cessation.
H. Discuss the elements of a disease management education program and
practice, as appropriate, how to counsel patient and family concerning
disease management education.
I. Communicate information relevant to coordinating patient care and
discharge planning such as it might relate to scheduling and sequence of
program implementation.
J. Participate in development of respiratory care plan.
K. Discuss the implementation and monitoring of graded exercise program
and cardiopulmonary stress testing.
X. Pulmonary Home Care
A. Review existing data in the patient record and recommend procedures
to obtain additional data, as indicated.
B. Discuss the selection of equipment appropriate to the home
respiratory care plan:
1. Oxygen administration devices, to include transtracheal oxygen
therapy and oxygen conserving device considerations.
2. Humidifiers.
3. Gas delivery/metering/analyzing devices, to include selection
considerations for cylinders; concentrators; compressors; and/or liquid
systems and pulsed dosed oxygen delivery systems.
C. Explain planned therapy and goals, as appropriate, to patient/family
in understandable terms to achieve optimal therapeutic outcome.
1. Describe the type of general patient education given and the aids
used for increased patient understanding and participation.
2. Provide specific patient instruction for home respiratory
equipment cleaning procedures.
D. Describe the role of the respiratory care practitioner in home care,
to include:
1. Patient selection/referral
2. Record keeping
3. Follow-up: clinical, physician, audits
4. Scheduling and routing
5. Supply/equipment selection and set-up
6. Assisting the patient and company in the billing/reimbursement
process
E. Discuss the implications of the various health care reimbursement
plans for the level of care and reimbursement for services in the home
care setting.
1. Medicare
2. Medicaid
3. PPS
4. POS
5. HMO
F. Discuss disease management programs.
1. Patient selection/referral
2. Program educational components and length
3. Goals and outcome measures
4. Follow-up: clinical, physician, audits
5. Scheduling
XI. Pulmonary Function Rotation
A. Demonstrate the ability to appropriately contact the instructor,
staff and others for assistance.
B. Review existing data in the patient record and recommend procedures
to obtain additional data, as indicated.
C. Perform and/or measure and interpret results, as indicated:
1. Pulmonary function testing
a) Spirometry a/p bronchodilator
b) MVV
c) DLCO
d) FRC
e) Flow-volume loops
f) Body box
g) N2 washout
h) CO2 response curve
i) TLC
j) Closing volume
k) Airway resistance
l) Bronchoprovocation
m) MIP
n) MEP
D. Analyze available data to determine pathophysiologic state.
1. Spirometry
2. Flow-volume loop
3. Volume of iso flow
4. FRC, RV, TLC determinations
5. Body plethysmography
6. Single breath nitrogen test
7. Closing volume
8. DLCO
E. Select and obtain the following equipment appropriate performing
PFT’s:
1. Spirometers
2. Plethysmography
3. Pneumotachometers
4. CO, He, N2 and other specialty gas analyzers
5. Respirometer
6. Manometers
F. Describe the function, principle(s) of operation, characteristics,
advantages/disadvantages of the selected equipment and procedures, to
include:
1. Applicable gas laws
2. Available measurements
G. Assemble, check for proper function and identify/correct
malfunctions for equipment identified.
H. Perform QC procedures for pulmonary function equipment.
I. Practice coaching and explain planned procedures to the patient in
understandable terms to achieve optimal results.
J. Interpret pulmonary function test reports using conventional
terminology as required in the healthcare setting and/or by regulatory
agencies.
1. Differentiate and obstructive versus restrictive process using
FEV1% (FEV1/FVC) and/or flow volume tracing
2. Bronchial provocation tests
3. Pre and post bronchodilator studies
4. Identify the lung volume and capacities measured/calculated
5. Specialty evaluations:
a) Volume of iso flow
b) Closing volume
c) Single breath nitrogen test
d) Bedside PFT assessments
K. Practice appropriate communication that should occur between the
respiratory care practitioner and physician with regards to patient
assessment, benefits/response of therapy, continuing clinical indications
for therapy, recommendations for modification in therapy or diagnostic
testing.
XII. Specialty Practicum--ACLS Emphasis
A. Review data and recommend procedures to obtain additional
information, specifically as it applies to BCLS/ACLS.
B. Interpret results of patient assessment, specifically as it applies
to BCLS/ACLS.
C. Analyze available data and determine pathophysiologic state.
D. Select and obtain equipment appropriate to the respiratory care
plan, specifically as it applies to BCLS/ACLS.
1. Oxygen administration
2. Gas delivery systems
3. Secretion clearance
4. Resuscitation devices
5. Artificial airways
6. Monitoring devices
E. Assemble, check for proper function and identify/correct
malfunctions for equipment identified.
F. Conduct therapeutic procedures to maintain a patent airway and
remove secretions.
1. Oro/nasal pharyngeal airways
2. Intubation/extubation procedures
3. Proper tube placement
4. Proper cuff inflation
5. Proper patient position
6. Suction
G. Conduct therapeutic procedures to achieve adequate ventilation and
oxygenation.
1. Oxygen administration
2. Prevention of procedure associated hypoxemia
3. Resuscitation efforts
H. Evaluate and monitor patient’s response to care and recommend/make
necessary modifications in procedures or plan, as indicated.
I. Treat cardiopulmonary collapse according to BCLS/ACLS protocols.
J. Practice troubleshooting of mechanical ventilators.
K. Demonstrate efficient changes on ventilators with external
exhalation valves.
Method of Evaluation and Competencies:
Written Performance Evaluations = 70% of total grade Rotation Quizzes, Projects, Reports, etc. = 20% of total grade Student Clinic Book = 10% of total grade Grading Criteria: A = 92 - 100% B = 83 - 91% C = 75 - 82% D = 67 - 74% F = 0 - 66% W = withdrawal initiated by college deadline
Caveats:
- Students will have provided proof of health conducive to being in a health care environment. In addition, drug screening and other requirements may be imposed by clinical agencies. Students are responsible for any and all costs related to their health care or other imposed requirements.
- Students are responsible for providing their own transportation to and from the assigned clinical agencies and activities.
- Students are expected to comply with the program policies and procedures as outlined in the Program Administrative Handbook. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
- Students must have maintained current clinical liability insurance.
Student Responsibilites:
Disabilities:
If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.
JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.