Miami Dade College
Medical Campus
School of Health Sciences
Respiratory Care Program
RET 2833 Respiratory Care Clinic 2
(Revised: May 2015)
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MIAMI DADE COLLEGE
MEDICAL CAMPUS
SCHOOL OF HEALTH SCIENCES
RESPIRATORY CARE PROGRAM
RET 2833 RESPIRATORY CARE CLINIC 2
COURSE OUTLINE
COURSE OVERVIEW:
RET 2833 is designed to allow the student to develop psychomotor skills related to Respiratory Care.
During the course, the student is provided with the opportunity to apply and discuss the theory and
techniques as learned in pre-requisite and co-requisite courses. The student is also responsible for
all objectives in pre-requisite and co-requisite courses.
Clinic Days: _____________________ Clinic Location: ________________________
Clinic Location: ______________________
Instructor: ______________________
Office #: ______________________________
Phone #: ______________________
E-mail: _____________________________
Office Hours: __________________________________________________________
EVALUATIONS:
1st Clinic Evaluation
35%
2nd Clinic Evaluation
45%
Written Exams
20%
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RET 2833
TABLE OF CONTENTS
MODULE 1.0
PATIENT DATA EVALUATION
MODULE 2.0
PHYSICAL ASSESSMENT
MODULE 3.0
PERFORM PROCEDURES TO COLLECT CLINICAL INFORMATION
MODULE 4.0
AIRWAY MANAGEMENT
MODULE 5.0
AEROSOL DRUG THERAPY
MODULE 6.0
LUNG EXPANSION THERAPY
MODULE 7.0
BRONCHIAL HYGIENE THERAPY
MODULE 8.0
PATHOPHYSIOLOGY
SKILLS LAB – TASKS COMPLETION RECORD
TASKS
CLINIC - TASKS COMPLETION RECORD
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MODULE 1.0 - PATIENT DATA EVALUATION
General Objective:
Upon completion of the module, the student will demonstrate an ability to review data in the patient
record as integral part of the overall patient assessment.
Specific Objectives:
1.0
Collect, evaluate and discuss pertinent clinical information derived from the patient’s medical
record:
1.1
Patient history e.g.,

Present illness

Progress notes

Admission notes

Diagnoses

Respiratory care orders

DNR status

Medication history

Patient education
(previous)
1.2
Physical examination relative to the cardiopulmonary system e.g., vital
signs, physical findings
1.3
Laboratory data e.g.,

CBC

Culture and sensitivities

Electrolytes

Sputum Gram stain

Coagulation studies
1.4
Pulmonary function results
1.5
Blood gas results
1.6
Imaging studies e.g., Radiograph, CT, MRI
1.7
Monitoring data, e.g., Pulse oximetry, ECG
1.8
Sleep study results e.g., diagnosis, treatment
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MODULE 2.0 – PHYSICAL ASSESSMENT
General Objective:
Upon completion of the module, the student will demonstrate the ability to perform a physical
assessment.
Specific Objectives:
2.0
Collect, evaluate and discuss pertinent clinical information derived from a physical examination
of the patient:
2.1
Interview the patient to determine:
a. Level of consciousness and orientation, emotional state, and ability to cooperate
b. Level of pain
c. Presence of dyspnea, sputum production, and exercise tolerance
d. Social history, e.g., smoking, substance abuse
e. Learning needs
2.2
Assess patient’s overall cardiopulmonary status by inspection to determine:
a. General appearance e.g.,
 Venous distention
 Edema
 Accessory muscle activity
 Chest wall movement
 Diaphoresis
 Cyanosis
 Breathing pattern
b. Airway assessment e.g., macroglossia, neck range of motion
c. Cough, sputum amount and character
d. Apgar score, gestational age, transillumination of the chest
2.3
Assess patient’s overall cardiopulmonary status by palpation
a. Pulse, rhythm, force
b. Asymmetrical chest movements, tactile fremitus, crepitus, tenderness, secretions in
the airway, and tracheal deviation
2.4
Assess a patient’s overall cardiopulmonary status by percussion
2.5
Assess patient’s overall cardiopulmonary status by auscultation
a. Breath sounds
b. Heart sounds and rhythm
c. Blood pressure
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MODULE 3.0 PERFORM PROCEDURES TO COLLECT CLINICAL INFORMATION
General Objective:
Upon completion of the module, the student will demonstrate the ability to perform procedure to
collect pertinent clinical information.
Specific Objectives:
3.0
Perform procedure and interpret results for:
3.1
Pulse oximetry
3.2
Bedside spirometry e.g., FVC, FEV1
3.3
Tidal volume, minute volume, vital capacity, and peak flow
3.4
Arterial blood sampling
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MODULE 4.0 - AIRWAY MANAGEMENT
General Objective:
Upon completion of the module, the student will be able to perform various procedures related to
airway management for the adult and pediatric patient.
Specific Objectives:
4.1
Establish the need for and safely insert an oropharyngeal airway
4.2
Establish the need for and safely insert a nasopharyngeal airway
4.3
Establish the need for and aseptically perform nasotracheal suctioning
4.4
Establish the need for and aseptically perform endotracheal suctioning
4.5
Aseptically collect a sputum sample during nasotracheal or endotracheal suctioning
4.6
Establish the need for and perform or assist with oral endotracheal intubation; inclusive of
assessment and confirmation of endotracheal tube (ETT) placement, and securing the ETT
4.7
Measure and adjust ETT or tracheostomy tube (TT) cuff pressure
4.8
Establish the need for and perform ETT extubation or TT decannulation
4.9
Aseptically perform TT and stoma care
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MODULE 5.0 – AEROSOL DRUG THERAPY
General Objective:
Upon completion of the module, the student will be able to perform various procedure related to the
delivery of aerosolized medications to the adult and pediatric patient.
Specific Objectives:
5.1
Select the best aerosol delivery system for a given patient
5.2
Procure the correct type and dosage of ordered medication via unit dose or multi-dose vial
using a syringe
5.3
Safely and effectively administer medication via a metered dose inhaler (MDI); with and
without a reservoir device
5.4
Safely and effectively administer medication via a dry powdered inhaler (DPI)
5.5
Safely and effectively administer medication via a small volume nebulizer (SVN)
5.6
Safely and effectively administer medication via a continuous nebulizer
5.7
Evaluate and monitor patient’s objective and subjective responses to aerosol drug therapy
5.8
Independently modify therapeutic procedures bases on the patient’s response, e.g., terminate
treatment, modify techniques, etc.
5.9
Record/Communicate therapy and results using conventional terminology as required in the
health care setting and/or regulatory agencies
a. Specify therapy administered, date, time, frequency or therapy, medication, and
ventilatory data
b. Note and interpret patient’s response to therapy
i.
Effects of therapy, adverse reactions, patient’s subjective and objective response
to therapy
ii.
Ausculatory findings, cough and sputum production and characteristics
iii.
Vital signs
iv.
Pulse oximetry, heart rhythm, capnography
c. Communicate information regarding patient’s clinical status to appropriate members of
the heath care team
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MODULE 6.0 LUNG EXPANSION THERAPY
General Objective:
Upon completion of the module, the student will perform the various procedures involved in lung
expansion therapy for the adult and pediatric patient.
Specific Objectives:
6.1
Establish the need for and correctly administer incentive spirometry (IS)
6.2
Establish the need for and correctly administer intermittent positive airway pressure
(IPPB) using the most effective adjunct (mouth piece, mouth seal, mask, etc.)
6.3
Establish the need for and correctly administer positive airway pressure (PEP, CPAP)
6.4
Evaluate and monitor patient’s objective and subjective responses to lung expansion
therapy
6.5
Independently modify therapeutic procedures bases on the patient’s response, e.g.,
terminate treatment, modify techniques, etc.
6.6
Record therapy and results using conventional terminology as required in t he health
care setting and/or regulatory agencies
a. Specify therapy administered, date, time, frequency or therapy, medication, and
ventilatory data
b. Note and interpret patient’s response to therapy
i.
Effects of therapy, adverse reactions, patient’s subjective and objective
response to therapy
ii.
Ausculatory findings, cough and sputum production and characteristics
iii.
Vital signs
iv.
Pulse oximetry, heart rhythm, capnography
c. Communicate information regarding patient’s clinical status to appropriate
members of the heath care team
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MODULE 7.0 BRONCHIAL HYGIENE THERAPY
General Objective:
Upon completion of the module, the student will be able to perform procedures related to bronchial
hygiene for the adult and pediatric patient.
Specific Objectives:
7.1
Establish the need for and correctly administer EZPAP, PEP, or Vibratory PEP (Acapella, or
Flutter Valve)
7.2
Establish the need for and correctly administer postural drainage, making modifications as
needed
7.3
Establish the need for and correctly administer chest percussion and vibration, making
modifications as needed
7.4
Establish the need for and correctly administer High-Frequency Chest Wall Oscillation
(HFCWO)
7.5
Effectively instructs, demonstrates, and assists patient in various directed cough techniques
7.6
Evaluate and monitor patient’s objective and subjective responses to bronchial hygiene
7.7
Independently modify therapeutic procedures bases on the patient’s response, e.g., terminate
treatment, modify techniques, etc.
7.8
Record therapy and results using conventional terminology as required in t he health care
setting and/or regulatory agencies
a. Specify therapy administered, date, time, frequency or therapy, medication, and
ventilatory data
b. Note and interpret patient’s response to therapy
i.
Effects of therapy, adverse reactions, patient’s subjective and objective
response to therapy
ii.
Ausculatory findings, cough and sputum production and characteristics
iii.
Vital signs
iv.
Pulse oximetry, heart rhythm, capnography
c. Communicate information regarding patient’s clinical status to appropriate members
of the heath care team
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MODULE 8.0 PATHOPHYSIOLOGY
General Objective:
Upon completion of the module, the student will be able to discuss the pathophysiology related to the
patient's treated during clinical rotations.
Specific Objectives:
8.1
Analyze available patient data (medical record, physical exam) and determine the
pathophysiologic state of the patient
8.2
Describe the main pathologic features presented by the patient and its relationship to patient's
disease or condition
8.3
Determine appropriateness of prescribed therapy and goals as they relate to the
pathophysiologic state of the patient and adjust therapy as per protocol, or recommend
changes in respiratory care plan when indicated
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Respiratory Care Program
RET 2833 Respiratory Care Clinic 2
SKILLS LAB COMPETENCIES
Student Name: __________________________ Date: ___________
MDC ID: ________________________________
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RET 2833
SKILLS LAB – TASKS COMPLETION RECORD
Student Name: ________________________________________________
TASK DESCRIPTION
DATE
Instructor
Initials
INSERTION OF OROPHARYNGEAL AIRWAY DURING MANUAL RESUSCITATION
OROPHARYNGEAL SUCTIONING USING A TONSIL TIP SUCTION DEVICE
INSERTION OF NASOPHARYNGEAL AIRWAY / NASOTRACHEAL SUCTIONING AND
SPECIMEN COLLECTION
ENDOTRACHEAL TUBE/TRACHEOSTOMY TUBE SUCTIONING WITH:
A.
SUCTION CATHETER
B.
CLOSED SUCTION SYSTEM
DRAWING AND MEASURING MEDICATION USING A SYRINGE
INITIATION OF SMALL VOLUME NEBULIZER (SVN)
ADMINISTRATION OF MEDICATION VIA A MDI / DPI
CHEST PHYSIOTHERAPY - POSTURAL DRAINAGE / PERCUSSION / VIBRATION
BEDSIDE SPIROMETRY
INCENTIVE SPIROMETRY
POSITIVE AIRWAY PRESSURE (PAP) / POSITIVE EXPIRATORY PRESSURE (PEP)
THERAPY
IPPB THERAPY ADMINISTRATION - BIRD SERIES
DCE _______________________________________________________________ DATE ______________
Instructors will date and initial the Task Sheet Completion Record as the student successfully completes each
task. The Task Sheet Completion Record will be collected by the instructor and placed in the student’s record
at the end of Skills Laboratory.
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INSERTION OF OROPHARYNGEAL AIRWAY DURING MANUAL RESUSCITATION
STUDENT NAME: __________________________________________
PROCEDURE
Satisfactory
Unsatisfactory
1.
Selects and gathers the necessary equipment
a. Oropharyngeal airway
b. Resuscitator bag-valve- mask (BVM) with oxygen tubing
c. Oxygen source
i. wall outlet with flow meter and nipple adaptor
ii. O2 tank with appropriate regulator and nipple adaptor


2.
Assembles the equipment and ensures that resuscitator is working and
connected to the oxygen source with the oxygen flowing at 15
liters/minute


3.
Washes hands and applies standard precautions and transmissionbased isolation procedures as appropriate


4.
Assesses and verifies the patient’s need for manual resuscitation
5.
Measures the patient for the appropriate size oropharyngeal airway
(OPA)




6.
Appropriately positions the patient’s airway using the head-tilt, chin-lift or
jaw–thrust maneuver


7.
Inserts the OPA using the appropriate technique
8.
Applies the mask to the patient’s face, repositions the patient’s head /
airway and administers a manual breath




9.
Assesses the adequacy of ventilation by ensuring that the chest is
expanding


10. Manually ventilates the patient at a rate of 12 – 16 breaths per minute
using an I:E ratio of 1:2


11. Demonstrates how to properly hold the mask and position the patient’s
head / airway with 2 hands while another students assists with manual
ventilation


RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: _______________________________________________________
Date: ____________________
Comments/Remedial Action Plan: _______________________________________________________________________
Student Signature: _________________________________________________________
Date: ____________________
17
OROPHARYNGEAL SUCTIONING USING A TONSIL TIP SUCTION DEVICE
STUDENT NAME: ______________________________________________
PROCEDURE
Satisfactory
Unsatisfactory
1.
Collects necessary equipment: PPE, vacuum regulator, vacuum collection jar
suction regulator, tonsil tip suction device, sterile H2O


2.
Verifies physician's order
3.
Introduces self, explains the purpose of the procedure, and confirms patient’s and/or
family’s understanding




4.
Decontaminates hands with an alcohol-based hand rub or performs a 15 second hand
wash and dons the appropriate PPE


5.
Confirms the patient’s identity and assesses the patient’s pulse, respiratory rate, and
breath sounds


6.
Attaches vacuum regulator to vacuum outlet, connects collection jar to vacuum regulator,
connects suction connecting tube to collection jar, and connects tonsil tip suction to
suction connecting tube


7.
Adjusts vacuum regulator to appropriate vacuum level to facilitate the removal of oral
secretions and inserts tonsil tip suction into patient's mouth, avoids gagging the patient
by not advancing the tonsil tip suction too far into the back of the oropharynx


8.
After completing the procedure, rinses tonsil tip with sterile H2O, turns off vacuum
regulator, and stores/disposes of equipment properly


9.
Repositions the patient as comfortable as possible, reassures patient, observes patient's
tolerance of therapy








10. Ensures the safety and comfort of the patient before leaving patient's room
11. Removes and disposes of PPE properly and washes hands
12. Records relevant data in patient chart and appropriate departmental records, and
communicates pertinent information regarding patient’s clinical status to appropriate
members of the heath care team
RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: _____________________________________________
Date: ____________________
Comments/Remedial Action Plan: _____________________________________________________________________
Student Signature: _____________________________________________________
Date: ____________________
18
ENDOTRACHEAL TUBE (ETT) or TRACHEOSTOMY TUBE (TT) SUCTIONING WITH AND
WITHOUT A CLOSED SUCTION CATHETER SYSTEM
STUDENT NAME: ______________________________________________
PROCEDURE
Satisfactory
Unsatisfactory
1.
Selects and gathers the necessary equipment:
a. Resuscitator bag / mask with oxygen tubing
b. Oxygen source
i. wall outlet with flow meter and nipple adaptor
ii. O2 tank with appropriate regulator and nipple adaptor
c. Suction regulator
d. Suction canister with tubing
e. Suction catheter or closed catheter system
f. Sterile and non-sterile gloves
g. Sterile water and sterile container


2.
Introduces self to patient, verifies the patient’s identity, identifies the
patient’s learning needs, and explains the procedure in terms the
patient/family can understand


3.
Washes hands using the appropriate hand-hygiene procedure and
initiates standard and/or transmission based precautions


4.
Assesses the patient’s vital signs and breath sounds and verifies the
patient’s need for suctioning


5.
Assembles and checks equipment:
a. Ensures that BVM is working and connected to the oxygen
source with the oxygen flowing at 15 liters/minute
b. Ensures that the suction system (regulator, canister, tubing)
are connected and functioning properly
c. Adjusts the suction regulator to the appropriate level
d. Pours sterile water into sterile container


6.
Places the patient in a Fowlers position and hyperoxygenates and
hyperinflates the patient for at least 30 seconds using the BVM


19
ENDOTRACHEAL TUBE (ETT) or TRACHEOSTOMY TUBE (TT) SUCTIONING WITH
AND WITHOUT A CLOSED SUCTION CATHETER SYSTEM
PROCEDURE
7.
Dons sterile gloves and connects the suction catheter to suction tubing;
ensuring that the catheter does not become contaminated
Satisfactory
Unsatisfactory




Closed sheath catheters: the catheter is already attached, simply
unlock the thumb port suction valve
8.
Applies suction intermittently and rotates and withdraws catheter for a
maximum of 10 – 15 seconds
Closed sheath catheters: Depress the thumb port suction valve to
apply suction
Hyperoxygenates and hyperinflates the patient using the BVM for at
least 60 seconds


10. Reassesses patient’s vital signs, breath sounds, and pulse oximetry


11. Suctions normal saline solution through the catheter to clear the
catheter of secretions. Repeats the suctioning and clearing processes if
necessary








9.
Closed sheath catheters: upon completion of the procedure, with the
catheter withdrawn into its sheath, inject sterile normal saline solution
through the catheter’s lavage/irrigation port while applying suction in
order to clear the catheter of secretions
12. Disposes of suction catheter and sterile gloves in the appropriate
biohazard container
Closed sheath catheters: Retracts the catheter into its sheath and
locks the thumb port suction valve to prevent accidental suctioning
13. Reassess vital signs, breath sounds, and SPO2 and ensures that the
patient is comfortable
14. Removes non-sterile gloves and decontaminates hands with an alcoholbased hand rub or performs a 15 second hand wash
20
ENDOTRACHEAL TUBE (ETT) or TRACHEOSTOMY TUBE (TT) SUCTIONING WITH
AND WITHOUT A CLOSED SUCTION CATHETER SYSTEM
PROCEDURE
Satisfactory
Unsatisfactory
15. Ensures the safety and comfort of the patient before leaving patient's
room


16. Records relevant data in patient chart and appropriate departmental
records, and communicates pertinent information regarding patient’s
clinical status to appropriate members of the heath care team


RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: _______________________________________________________
Date: ____________________
Comments/Remedial Action Plan: _______________________________________________________________________
___________________________________________________________________________________________________
Student Signature: ________________________________________________________
Date: _____________________
21
NASOTRACHEAL SUCTIONING WITH NASOPHARYNGEAL AIRWAY (NPA)
AND SPECIMEN COLLECTION
STUDENT NAME: ______________________________________________
PROCEDURE
Satisfactory
Unsatisfactory
1.
Selects and gathers the necessary equipment:
a. Nasopharyngeal airway
b. BVM with oxygen tubing
c. Oxygen source
i. wall outlet with flow meter and nipple adaptor
ii. O2 tank with appropriate regulator and nipple adaptor
d. Suction regulator
e. Suction canister with tubing
f. Suction catheter
g. Sterile and non-sterile gloves
h. Water-soluble lubricant
i. Sterile water and sterile container
j. Luken’s trap


2.
Introduces self to patient, verifies the patient’s identity, identifies the
patient’s learning needs, and explains the procedure in terms the
patient/family can understand


3.
Washes hands using the appropriate hand-hygiene procedure and
initiates standard and/or transmission based precautions


4.
Verifies patient’s identity and assesses the patient’s vital signs and
breath sounds and verifies the patient’s need for nasotracheal
suctioning


5.
Assembles and checks equipment:
a. Ensures that BVM is working and connected to the oxygen
source with the oxygen flowing at 15 liters/minute
b. Ensures that the suction system (regulator, canister, tubing) is
connected and functioning properly
c. Adjusts the suction regulator to the appropriate level
d. Places the Lukens trap inline with suction tubing
e. Pours sterile water into sterile container


6.
Places the patient in a Fowlers position and removes any oxygen
adjuncts that might be in use


7.
Measures the patient for the appropriate size NPA and inserts it using
the appropriate technique


8.
With the assistance of a student or instructor, hyperoxygenates and
hyperinflates the patient for at least 30 seconds using the BVM


22
NASOTRACHEAL SUCTIONING WITH NASOPHARYNGEAL AIRWAY (NPA)
AND SPECIMEN COLLECTION
PROCEDURE
Satisfactory
Unsatisfactory


10. Lubricates the catheter and inserts it through the NPA, into the
oropharynx and into the patients trachea


11. Applies suction and rotates and withdraws catheter for a maximum of 10
– 15 seconds


12. Assistant hyperoxygenates and hyperinflates the patient using the
resuscitator bag/mask for at least 60 seconds


13. Reassesses patient’s vital signs, breath sounds, and pulse oximetry
readings by viewing the above-bed monitors, being vigilant of any
untoward reactions


14. Suctions normal saline solution through the catheter to clear the
catheter of secretions. Repeats the suctioning and clearing processes if
necessary


15. Disposes of suction catheter and sterile gloves in the appropriate
biohazard container








19. Removes non-sterile gloves and decontaminates hands with an alcoholbased hand rub or performs a 15 second hand wash


20. Properly labels sputum specimen and places it in a biohazard bag for
transport to laboratory


21. Records relevant data in patient chart and appropriate departmental
records, and communicates pertinent information regarding patient’s
clinical status to appropriate members of the heath care team


9.
Dons sterile gloves and connects the suction catheter to suction tubing;
ensuring that the catheter does not become contaminated
16. Removes the Lukens trap with its specimen from the suction system
and securely closes the container
17. Reassess vital signs, breath sounds, and SPO2
18. Ensures the safety and comfort of the patient and that any oxygen
adjuncts have been replaced, e.g., nasal cannula
RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: _______________________________________________________
Date: ____________________
Comments/Remedial Action Plan: _______________________________________________________________________
Student Signature: _________________________________________________________
Date: ____________________
23
MEASURING MEDICATION USING A SYRINGE
STUDENT NAME: ______________________________________________
PROCEDURE
Satisfactory
Unsatisfactory
1.
Verifies physician’s order


2.
Selects and gathers the necessary equipment:
a. 3 mL syringe or 1 mL TB syringe
b. Medium gauge needle
c. Alcohol swab
d. Medication vial


3.
Examines the medication vial and verifies correct medication, dosage,
and expiration date


4.
Calculates the proper dosage required for the ordered medication


5.
Wipes the rubber cap of the medication vial with alcohol swap, inserts
needle and withdraws the proper amount of medication


6.
Recaps the needle using a one-handed scoop technique


7.
Replaces cap on medication bottle and stores properly


8.
Labels syringe with medication name and dosage


9.
After dispensing medication into nebulizer, disposes of syringes and
needles in the appropriate sharps container


RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: _______________________________________________________
Date: ____________________
Comments/Remedial Action Plan: _______________________________________________________________________
___________________________________________________________________________________________________
Student Signature: ________________________________________________________
Date: _____________________
24
INITIATION OF SMALL VOLUME NEBULIZATION (SVN)
STUDENT NAME: _____________________________________
PROCEDURE
Satisfactory
Unsatisfactory
1.
Verifies physician’s order and reviews chart for pertinent data


2.
Gathers the necessary equipment;
a. Flow meter
b. SVN with oxygen tubing
c. Aerosol mask or mouthpiece
d. Medication


3.
Introduces self to patient, verifies the patient’s identity, identifies the
patient’s learning needs, and explains the procedure in terms the
patient/family can understand


4.
Decontaminates hands with an alcohol-based hand rub or performs
a 15 second hand wash, and then dons non-sterile gloves


5.
Positions the patient sitting upright and assesses the patient’s vital
signs and breath sounds


6.
Assembles the equipment and aseptically places medication into the
SVN


7.
Sets gas flow at 8-10 L/min


8.
Places mask on patient’s face or mouth piece in patient’s mouth and
instructs the patient to breath normally


9.
Periodically assesses the patient’s vital signs and breath sounds
during therapy


10. Asks the patient to cough and evaluates sputum


11. After the medication has been nebulized, rinses the SVN with sterile
water, and allows it to air dry, or discards the unit


12. Reassesses patient


13. Removes gloves and decontaminates hands with an alcohol-based
hand rub or performs a 15 second hand wash


25
14. Records relevant data in patient’s chart and appropriate
departmental records, and communicates pertinent information
regarding patient’s clinical status to appropriate members of the
health care team


INITIATION OF SMALL VOLUME NEBULIZATION (SVN)
RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: _______________________________________________________
Date: ____________________
Comments/Remedial Action Plan: _______________________________________________________________________
___________________________________________________________________________________________________
Student Signature: _________________________________________________________ Date: ____________________
26
ADMINISTRATION OF MEDICATION VIA pMDI & DPI
STUDENT NAME: _____________________________________
PROCEDURE
Satisfactory
Unsatisfactory
1.
Verifies physician’s order and reviews chart for pertinent data


2.
Gathers the necessary equipment:
a. pMDI or DPI
b. Spacer or Holding Chamber using pMDI


3.
Introduces self to patient, verifies the patient’s identity, identifies the
patient’s learning needs, and explains the procedure in terms the
patient/family can understand


4.
Washes hands using the appropriate hand-hygiene procedure and
initiates standard and/or transmission based precautions


5.
Positions the patient sitting upright and assesses vital signs, breath
sounds, and the patient’s ability to perform procedure and follow
directions






pMDI: Respiratory rate less than 25
DPI: Able to inhale rapidly – inspiratory flows >60 LM
6.
pMDI







Warms the pMDI to hand or body temperature
Assembles the apparatus, making sure there are not
objects in the device that could be aspirated or obstruct
outflow
Holds the canister vertically and shakes it vigorously
Actuates one puff into the air if the unit has not been used
for 24 hours of more
Attaches the spacer or holding chamber and positions it in
the patient’s mouth (or places the mask over the patient’s
nose and mouth)
While the patient is breathing normally, actuates the pMDI
and has the patient breath through the device for 3 – 7
breaths, encourages breath-holding when possible
Allows 1 – 2 minutes between actuations
DPI



Assembles the apparatus
Loads medication
Instructs the patients as follows:
i. Exhale normally
ii. Seal lips around the mouthpiece
iii. Inhale deeply and forcefully (a breath hold should
be encouraged but is not essential)
iv. Repeat the process until dosage is complete
27
ADMINISTRATION OF MEDICATION VIA MDI & DPI
PROCEDURE
Satisfactory
Unsatisfactory
7.
Reassesses the patient and monitors the patient for adverse
reactions


9.
Removes gloves and decontaminates hands with an alcohol-based
hand rub or performs a 15 second hand wash


10. Ensures the safety and comfort of the patient before leaving patient's
room


11. Records relevant data in patient’s chart and appropriate
departmental records, and communicates pertinent information
regarding patient’s clinical status to appropriate members of the
health care team


RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: ________________________________________________________________ Date: ____________
Comments/Remedial Action Plan: _______________________________________________________________________
___________________________________________________________________________________________________
Student Signature: _________________________________________________________________
Date: ____________
28
CHEST PHYSIOTHERAPY - POSTURAL DRAINAGE/PERCUSSION/VIBRATION
STUDENT NAME: ___________________________________________
PROCEDURE
Satisfactory
Unsatisfactory
1.
Verifies physician's order and reviews patient chart for significant
findings and data


2.
Identifies and gathers the necessary equipment, e.g., mechanical
percussor


3.
Introduces self to patient, verifies the patient’s identity, identifies
the patient’s learning needs, and explains the procedure in terms
the patient/family can understand


4.
Decontaminates hands with an alcohol-based hand rub or
performs a 15 second hand wash, and then dons non-sterile
gloves


5.
Assesses the patient’s vital signs and breath sounds


6.
Places patient in appropriate postural drainage positions for
targeted segments, modifying position to accommodate patient’s
response


7.
Provides percussion while coaching the patient to take slow deep
breaths during the treatment


8.
Follows percussion with vibration and instructs patient to cough


9.
Repeats sequence 6-8 for additional targeted areas


10. Discontinues treatment is and notifies the proper personnel if any
adverse reactions occur


11. After completing treatment, returns patient to a comfortable position
and instructs and assists the patient to cough, noting any sputum
production; amount, color, viscosity, and odor


29
CHEST PHYSIOTHERAPY - POSTURAL DRAINAGE/PERCUSSION/VIBRATION
PROCEDURE
Satisfactory
Unsatisfactory
12. Reassess the patient


13. Removes gloves and decontaminates hands with an alcohol-based
hand rub or performs a 15 second hand wash


14. Ensures the safety and comfort of the patient before leaving
patient's room


15. Records relevant data in patient chart and appropriate departmental
records, and communicates pertinent information regarding
patient’s clinical status to appropriate members of the heath care
team


RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: _______________________________________________________
Date: ____________________
Comments/Remedial Action Plan: _______________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Student Signature: _________________________________________________________
Date: ____________________
30
BEDSIDE SPIROMETRY – FORCED VITAL CAPACITY (FVC)
STUDENT NAME: _____________________________________
PROCEDURE
Satisfactory
Unsatisfactory
1.
Verifies physician’s order and reviews chart for pertinent data


2.
Gathers the necessary equipment;
a. Portable spirometer
b. Disposable mouth piece
c. Nose clip
d. 3-liter calibration syringe
e. Filter (if applicable)


3.
Introduces self to patient, verifies the patient’s identity, identifies the
patient’s learning needs, and explains the procedure in terms the
patient/family can understand


4.
Washes hands using the appropriate hand-hygiene procedure and
initiates standard and/or transmission based precautions


5.
Assesses the patient’s vital signs and breath sounds


6.
Assembles the equipment and enters patient’s demographic and
other required information into spirometer database


7.
Provides clear patient instruction and demonstration for FVC


8.
Coaches patient to obtain maximum patient effort for each test trial


9.
Properly applies acceptability criteria for each maneuver and selects
the best FVC and FEV1 results out of 3 acceptable trials for reporting


10. Removes gloves and decontaminates hands with an alcohol-based
hand rub or performs a 15 second hand wash


12. Ensures the safety and comfort of the patient before leaving patient's
room


13. Records relevant data in patient’s chart and appropriate
departmental records, and communicates pertinent information
regarding patient’s clinical status to appropriate members of the
health care team


31
BEDSIDE SPIROMETRY – FORCED VITAL CAPACITY (FVC)
RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: ___________________________________________________
Date: ____________________
Comments/Remedial Action Plan: _____________________________________________________________________
_________________________________________________________________________________________________
Student Signature: _____________________________________________________
Date: _____________________
32
INCENTIVE SPIROMETRY
STUDENT NAME: ___________________________________________________
PROCEDURE
Satisfactory
Unsatisfactory
1.
Verifies physician’s order and reviews chart for pertinent data and
reviews patient chart for significant findings and data, i.e., conditions
predisposing to the development of atelectasis, chest x-ray for
presence and location of atelectasis


2.
Identifies and gathers the necessary equipment


a.
Incentive spirometer
3.
Introduces self to patient, verifies the patient’s identity, identifies the
patient’s learning needs, and explains the procedure in terms the
patient/family can understand


4.
Washes hands using the appropriate hand-hygiene procedure and
initiates standard and/or transmission based precautions


5.
Verifies patient’s identity and assesses the patient’s vital signs and
breath sounds


6.
Determines target volume to be achieved according to patient age
and height (see manufacture's insert)


7.
Assembles the device (volume, flow or electronic device, patient
tubing, and mouthpiece)


8.
Instructs patient on how to use the device effectively, taking a slow
deep breath at the appropriate flow rate; attempts to achieve target
volume; performs breath-hold for at least 5-10 seconds


9.
Evaluates patient technique and provides appropriate feedback


33
INCENTIVE SPIROMETRY
PROCEDURE
Satisfactory
Unsatisfactory
10. Re-adjusts volume or flow goals as necessary to challenge the
patient during the procedure.


11. Instructs the patient to perform approximately 6 - 10 breaths every
hour


12. Places device within reach of the patient and reinforces instructions
for patient to perform independently


13. Assess vital signs and breath sounds


14. Removes gloves and decontaminates hands with an alcohol-based
hand rub or performs a 15 second hand wash


15. Ensures the safety and comfort of the patient before leaving patient's
room


16. Records relevant data in patient chart and appropriate departmental
records, and communicates pertinent information regarding patient’s
clinical status to appropriate members of the heath care team


RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: _______________________________________________________
Date: ____________________
Comments/Remedial Action Plan: _______________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Student Signature: _________________________________________________________
Date: ____________________
34
POSITIVE AIRWAY PRESSURE (PAP) / POSITIVE EXPIRATORY PRESSURE (PEP) THERAPY
STUDENT NAME: _____________________________________
PROCEDURE
DATE: _____________
Satisfactory
Unsatisfactory
1.
Verifies physician’s order and reviews chart for pertinent data


2.
Gathers the necessary equipment (EZ-PAP, Flutter Valve, PEP
mask valve, Acapella, etc.)


3.
Introduces self to patient, verifies the patient’s identity, identifies the
patient’s learning needs, and explains the procedure in terms the
patient/family can understand


4.
Washes hands using the appropriate hand-hygiene procedure and
initiates standard and/or transmission based precautions


5.
Assesses vital signs and breath sounds


6.
Positions the patient


7.
Places the mask comfortably over the nose and mouth or places a
nose clip on the patient if using a device with a mouthpiece


8.
Instructs the patient to take a larger than normal breath, but not to
TLC, and to exhale slowly


9.
Observes the pressure on the manometer (if applicable) to ensure
that the patient is receiving the prescribed pressure (if applicable)


10. Instructs the patient to take 10 – 20 breaths followed by 2 – 3 huff
coughs, and to repeat this procedure 4 – 8 times over 10 – 20
minutes


11. Notes the quantity, color, viscosity, and odor of any sputum
expectorated


12. Reassess the patient


13. Correctly removes and disposes of PPE and washes hands


35
POSITIVE AIRWAY PRESSURE (PAP) / POSITIVE EXPIRATORY PRESSURE (PEP) THERAPY
STUDENT NAME: _____________________________________
PROCEDURE
DATE: _____________
Satisfactory
Unsatisfactory
14. Ensures the safety and comfort of the patient before leaving patient's
room


15. Records relevant data in patient chart and appropriate departmental
records, and communicates pertinent information regarding patient’s
clinical status to appropriate members of the heath care team


RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: _______________________________________________________
Date: ____________________
Comments/Remedial Action Plan: _______________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Student Signature: _________________________________________________________
Date: ____________________
36
INTERMITTENT POSITIVE PRESSURE BREATHING (IPPB) THERAPY
STUDENT NAME: __________________________________________________
PROCEDURE
Satisfactory
Unsatisfactory
1.
Verifies physician's order and reviews patient chart for significant
findings and data, i.e., conditions predisposing to the development of
atelectasis, chest x-ray for presence and location of atelectasis


2.
Identifies and gathers the necessary equipment (IPPB machine,
circuit, Wright spirometer, appropriate patient interface, e.g., mouth
piece, IPPB mask, mouth seal, endotracheal/tracheostomy tube
adaptor, nose clip, medications bedside spirometer if FVC is not in
chart,)


3.
Introduces self to patient, verifies the patient’s identity, identifies the
patient’s learning needs, and explains the procedure in terms the
patient/family can understand


4.
Washes hands using the appropriate hand-hygiene procedure and
initiates standard and/or transmission based precautions


5.
Assesses the patient’s vital signs and breath sounds


6.
Establishes base line information from spirometry on one or more of
the following: Peak Flow, VC, FEV1, FVC


7.
Determines appropriate target volume to be achieved (10 – 15 ml/kg
of ideal body weight)


8.
Assembles equipment and ensures its proper function (pressure
check)


9.
Adjusts initial settings: Low pressure 10 – 15 cm H20, moderate flow
15 L/min, moderate sensitivity -1 to -2 cm H2O




10. Aseptically fills nebulizer with prescribed medication
37
INTERMITTENT POSITIVE PRESSURE BREATHING (IPPB) THERAPY
PROCEDURE
Satisfactory
Unsatisfactory
11. Instructs the patient to insert the mouthpiece and inhale slightly until
the machine triggers on (adjust sensitivity if needed) and to maintain
a tight seal around the mouthpiece so that the machine can augment
inspiration (applies nose clip, mouth seal, or mask as appropriate)


12. Notes the volume achieved with a spirometer and adjusts the
pressure and flow until a target volume is achieved during inspiration
without patient discomfort


13. Monitors the patient vital signs throughout the therapy and observes
the patient for adverse outcomes, e.g., hyperventilation, gastric
distention, nausea, etc.


14. After completing therapy reassess the patient vital signs and breath
sounds and performs post-treatment spirometry and notes outcomes


15. Instructs patient to cough and notes any sputum production; amount,
color, viscosity, and odor


16. Disassembles equipment and discards unused medication from the
nebulizer, rinses it with sterile water, and allows to air dry


17. Removes gloves and decontaminates hands with an alcohol-based
hand rub or performs a 15 second hand wash



18. Ensures the safety and comfort of the patient before leaving patient's
room
19. Records relevant data in patient chart and appropriate departmental
records, and communicates pertinent information regarding patient’s
clinical status to appropriate members of the heath care team



38
INTERMITTENT POSITIVE PRESSURE BREATHING (IPPB) THERAPY
RATING


Satisfactory (no critical errors, corrects with some coaching or without supervision)
Unsatisfactory (critical errors, requires remediation)
Evaluator Signature: _______________________________________________________
Date: ____________________
Comments/Remedial Action Plan: _______________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Student Signature: _________________________________________________________
Date: ____________________
39
40
RET 2833
CLINIC – TASKS COMPLETION RECORD
Student Name: ______________________________________________
TASK DESCRIPTION
DATE
Instructor
Initials
INSERTION OF OROPHARYNGEAL AIRWAY DURING MANUAL RESUSCITATION
OROPHARYNGEAL SUCTIONING USING A TONSIL TIP SUCTION DEVICE
INSERTION OF NASOPHARYNGEAL AIRWAY / NASOTRACHEAL SUCTIONING AND
SPECIMEN COLLECTION
ENDOTRACHEAL TUBE/TRACHEOSTOMY TUBE SUCTIONING WITH:
C.
SUCTION CATHETER
D.
CLOSED SUCTION SYSTEM
DRAWING AND MEASURING MEDICATION USING A SYRINGE
INITIATION OF SVN FOR AEROSOLIZATION OF MEDICATION
ADMINISTRATION OF MEDICATION VIA A MDI / DPI
CHEST PHYSIOTHERAPY - POSTURAL DRAINAGE / PERCUSSION / VIBRATION
BEDSIDE SPIROMETRY
INCENTIVE SPIROMETRY
POSITIVE AIRWAY PRESSURE (PAP) / POSITIVE EXPIRATORY PRESSURE (PEP)
THERAPY
IPPB THERAPY ADMINISTRATION - BIRD SERIES
DCE ______________________________________________________________ DATE _______________
Instructors will date and initial the Task Sheet Completion Record as the student successfully completes each
task. The Task Sheet Completion Record will be collected by the instructor at the conclusion of RET
2833 Clinic 2 and placed in the student’s record.
41