Welcome to RT 210:
Introduction to Applied
Respiratory Therapeutics
Instructor: Ms. K. Walker, BS, RRT
Respiratory Therapy Organizations
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Associations
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AARC – American Assn. for Respiratory Care
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Promotes Profession
Respiratory Care and AARC magazines
Clinical Practice Guidelines (CPG’s)
Governmental representation
State Society for Respiratory Care (FSRC)
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Education
Newsletters
Respiratory Therapy Organizations
Associations (cont)
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NBRC – National Board for Respiratory Care
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Testing – National exams accepted by most
states for licensure
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Certified Respiratory Therapist (CRT)
Registered Respiratory Therapist (RRT)
CoARC – Committee on Accreditation for
Respiratory Care
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Accreditation of RT schools
Respiratory Therapy Organizations
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Groups that affect healthcare
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Insurance Companies
Government Medicare
Consumer Groups Ex: AARP
Hospital Organization
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Admitting
Billing and Accounts
Radiology / X-rays
Nursing
Laboratory (culture, urinalysis, blood counts)
Education
Engineering / Repair and maintenance
Hospital Organization
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Housekeeping
Nuclear Medicine
Dietary
Pharmacy
Physical Therapy
Respiratory Therapy Department
Organization
Medical Director
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Responsible for clinical function of department
Administrative Director
Supervisors
Secretary
Equipment Personnel
Education Coordinator
Therapist/Registered & Certified
Hospital Administration
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Board of Directors
Medical Director
Department Directors & Managers
Triage (order of care)
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CPR
CMV
ICU Care
ER
Postoperative care
O2 and aerosol therapy
IPPB
CPT and IS
Diagnostic studies
Diagnostic Therapy
vs. Clinical Therapy
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Diagnostic Therapy
Clinical Therapy
Principals of code blue
Medical Terminology and
Abbreviations
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Root Words + Combining Form
Prefixes: Begin Word
Suffixes: After Root
Combine Suffixes, Prefixes And Roots
Medical Terminology and Abbreviations
Root
+ Combining Form
Gastr
Cardi
Derm
Pneum
Pleur
Trach
Abdomin+ o
Aden
Hem
Cost
Cyt
+o
+o
+o
+o
+o
+e
+o
+ a/o
+o
+o
= stomach
= heart
= skin
= air
= lung lining
= trachea
= abdomen
= glands
= blood
= ribs
= cells
Medical Terminology and
Abbreviations
Root
+ Combining Form
Vas
Bi
Thorax
Bronch
Myo
Myco
Cyan
Febrile
Aerobic
+o
+o
+a
+o
+o
= vessel
= life
= chest
= bronchus
= muscle
= fungus
= blue
= fever
= in the presence
of O2
Medical Terminology and
Abbreviations
Prefixes: Begin Word
A-, AnAB
Di
Ex
Intra
Infra
Inter
Macro
Mal
Mega
Micro
Neo
Ortho
Sub
negative
away
two
out of
inside
beneath
between
large
abnormal
large
small
new
to correct
below
Trans through
Contra against
Hyper above
Hypo below
Tachy fast
Brady slow
Medical Terminology and
Abbreviations
Suffixes: After Root
Algia
–ectomy
–gen
–oma
–penia
–ostomy
–otomy
–itis
–ology
–gram
–graph
–pnea
pain
removal
agent
tumor
lack
opening
cutting
inflammation
study
tracing
record
breathing
Medical Terminology and
Abbreviations
Combine Suffixes, Prefixes And Roots
Tracheostomy tracheal opening
Tracheotomy tracheal surgery
Adenoma
gland tumor
Pleuralgia
pleural pain
Bronchitis
inflammation of the bronchi
Tachypnea
fast breathing
Bradycardia heart less than 60 beats/min
Hypertrophy an increase in size
Atrophy
wasting away
Medical Terminology and
Abbreviations
Directional Terms
Left: To the subject’s left … not YOUR left
Right: To the subject’s right … not YOUR right
Lateral: Toward the side
Medial: Towards the middle
Anterior: Toward the front of the body
Posterior: Toward the back of the body
Superior: Toward the top of the body
Inferior: Toward the bottom of the body
Dorsal: Along, or toward, the vertebral surface of the body
Ventral: Along, or toward, the belly surface of the body
Caudad (Caudal): Toward the tail
Cephalad: Toward the head
Proximal: nearer the trunk
Distal: farther from the trunk
Medical Terminology and
Abbreviations
Abbreviations
A = alveolar
a = arterial
ATPD = ambient temperature and pressure, dry
ATPS = ambient temperature and pressure, saturated
BTPD = body temperature and pressure, dry
BTPS = body temperature and pressure, saturated
ERV
= expiratory reserve volume
E = exhaled gas
f = frequency
pH = hydrogen ion concentration
P = gas pressure
Medical Terminology and
Abbreviations
Abbreviations
BID
TID
QID
Qh
VT
STAT
WBC
RBC
C¯
s¯
D/C
= 2 times a day
= 3 times a day
= 4 times a day
= every hour
= tidal volume
= immediately
= white blood count
= red blood count
= with
= without
= discontinue or discharge
Medical Terminology and
Abbreviations
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BCLC p. 188 (Table 11-1).
Patient Relationships
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"The Nuremberg Declaration"
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Patient has rights to have informed consent
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Reasons for therapy
Consequences of refusing therapy
If therapy is administered and patient has
refused, may be liable for assault
Patient Relationships
Improved communications help prevent problems
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Respect patient
Explain in layman's language
Show kindness to patient & visitors - privacy
Improved records
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Clarify orders when necessary
Accurately chart
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No white out
One line through error, initial
If it isn’t charted it isn’t done
Neat/legible so it can be read
Patient Relationships
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Insurance
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Covered by school
Covered by hospital
Confidentiality
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No information about patient to anyone
other than patient (or to parent
regarding minor patient).
Avoid discussions in cafeteria, elevator,
hall, public areas, or patients’ rooms, etc.
In case studies, we don't use patient
name, instead use initials, age,
description, etc
Hospital Relationships
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All members of a team
Work within chains of command
Avoid discussions of other personnel
Do not say anything to anyone that you
do not want repeated.
Discuss appropriate information on what
to talk about
Metric System
Basic Rules for English Measures
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Linear
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12 inches = 1 foot
3 feet = 1 yard
Weight
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16 ounces = 1 pound
Volume
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32 fluid ounces = 1 quart
4 quarts = 1 gallon
Metric System
Prefixes for the Metric System
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Kilo - 1000 * or 1.0 * 103(k)
Hecto - 100 * or 1.0 * 102(h)
Deka - 10 * or 1.0 * 101 (da)
Deci - 0.1 * or 1.0 * 10 -1 (d)
Centi - 0.01 * or 1.0 * 10 -2 (c)
Milli – 0.001, or 1.0 * 10 -3 (m)
Micro – 0.000001 or 1.0 * 10 –6 (μ)
Metric Volumes
Prefix
Meaning
Symbol
decicentimilli-
0.1 (1/10)
0.01 (1/100)
0.001 (1/1000)
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A deciliter (dL) is 0.1 liter
A centiliter (cL) is 0.01 liter.
A milliliter (mL) is 0.001 liter.
d
c
m
Metric Length
Prefix
Meaning
Symbol
decicentimillimicro-
0.1 (1/10)
d
0.01 (1/100)
c
0.001 (1/1000)
m
0.000001 (1/1,000,000) mcg/ug
 A decimeter (dm) is 0.1 meters.
 A centimeter (cm) is 0.01 meters.
 A millimeter (mm) is 0.001 meters.
Metric Volumes
Prefix
Meaning
KiloHectoDeka-
1000
100
10
Symbol
k
h
da
A kiloliter (kL) is 1000 liter.
A hectoliter (hL) is 100 liter.
A dekaliter (daL) is 10 liter.
 Each unit is 10 times the next smaller unit.
Lesson: Measurement, Terminology, and Ethics
Metric Weights
Prefix
Meaning
DeciCentiMilliMicro-
0.1 (1/10)
0.01 (1/100)
0.001 (1/1000)
0.000001 (1/1,000,000)
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Symbol
d
c
m
mc
A decigram (dg) is 0.1 gram.
A centigram (cg) is 0.01 gram.
A milligram (mg) is 0.001 gram.
A microgram (mcg/ug) is 0.000001 gram.
Lesson: Measurement, Terminology, and Ethics
Metric Weights
Prefix
KiloHectoDeka
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Meaning
Symbol
1000
100
10
k
h
da
A kiligram (kg) is 1000 gram.
A hectogram (hg) is 100 gram.
A dekagram (dag) is 10 gram.
Each unit is 10 times the next smaller unit.
Metric Length
Prefix
Meaning
KiloHectoDeka-
1000
100
10
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Symbol
k
h
da
A kilometer (km) is 1000 meters.
A hectometer 9hm) is 100 meters.
A dekameter (dam) is 10 meters.
Each unit is 10 times the next smaller unit.
KILO
HECTO
DEKA
METER
LITER
GRAM
DECI
CENTI
MILLI
MICRO
NANO
1,000
100
10
1
.10
.01
.001
.000,001
.000,000,001
Kids Have Dropped Over Dead Converting Metrics
Kangaroos Hop Down Under Dirty Coal Mines
Conversion from Metric to English
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Linear - 1 inch = 2.54 cm
Volume - 1 gallon = 3.8 L
Weight - 1 kilo = 2.2 lb
Temperature (normal oral 98.6° F or 37° C)
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F = (9/5 * C) + 32
C = 5/9 * (F - 32)
K = C + 273
1 cm H2O =0.74 mm Hg
1 mm Hg = 1.36 cm H2O
Conversions
1 cm H2O = 0.74 mm Hg
1 mm Hg = 1.36 cm H2O
Conversions
Linear - 1 inch = 2.54 cm
Volume - 1 gallon = 3.8 L
Weight - 1 kilo = 2.2 lb
Conversions
 F. = [ (9/5) C.] + 32
 C. = 5/9 (F. – 32)
 K. = C. + 273
Temperature Conversions
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F = (C * 1.8) + 32
C = (F -32) /1.8
K = C + 273
Ethical and Legal Implications of
Practice
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Private Law - deals with definition, regulation,
and enforcement of rights in cases between
citizen and citizen or between citizen and
organizations. There are two types of private
law. They are torts and contract law. (Talk
only about torts).
Tort - a legal wrong committed upon a person
or property independent of contract
Ethical and Legal Implications of
Practice
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Intentional tort –
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Assault - willful attempt or threat to inflict
injury on another.
Battery - intentional touching of another
person without consent
Libel - false or malicious writing that is
intended to defame or dishonor another
Slander - spoken form of defamation
Ethical and Legal Implications of
Practice
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Negligent tort – Malpractice carelessness or failure to act with due
care on the part of the professional
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Malfeasance-execution of an unlawful or
improper act
Negligence-reckless disregard for the safety
of another
Basic Principles of Health Care
Ethics
Reciprocal patient rights
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Autonomous choice
Not to be harmed
Fair and equitable treatment
Autonomy-patient personal liberty and their right to
decide their own course of treatment –Informed
consent: educate the patient so that they are able
to make their own course of treatment
Veracity-binds healthcare workers to tell the truth
Basic Principles of Health Care
Ethics
Reciprocal patient rights (cont)
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Benevolent deception-truth is withheld from the
patient for their own good
Non-malfeasance: obligates healthcare worker to
avoid harming patient and try to prevent harm
where possible
Beneficence-healthcare workers go beyond doing no
harm and actively contribute to the health and well
being of their patients
Confidentiality-don’t talk about the patient in areas
where others can hear. Use the report room to
discuss patient information.
Charting
POMR-Problem Oriented Medical Record
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Has 4 basic parts
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Database
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Contains information of a routine nature
General health history
Physical exam results
Results of diagnostic tests
Problem List: Something that interferes with a
patient’s physical or psychological health or
ability to function
Charting
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Has 4 basic parts (cont)
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Plan - Course of action to correct problems from
list
Progress notes
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Contains findings (subjective and objective),
assessment plans, and plans for orders
Charting
Format used is SOAP
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Subjective-information obtained from the patient,
relatives, or similar source
Objective-information based on caregivers
observations of the patient, physical exam, or
diagnostic or laboratory tests
Assessment-refers to the analysis of the patient’s
problem
Plan-plan of action to be taken to resolve the
problem
Charting
Components of a chart
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Admission Record
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States time and date the patient was admitted to the
facility
Patient birthday, address, SSN, telephone number, next of
kin, insurance information
Physician Orders: All orders must contain the date,
time, and physician signatures
Progress notes: Every time the patient is visited by
the doctor, the patient’s progress is recorded
Charting
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Components of a chart (cont)
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History and Physical Examination
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The patient history is obtained from the patient
or relatives upon admission
The initial physical is performed by the attending
physician: it is a head to toe assessment of the
major organ systems
Nursing Data: Includes nursing notes and
nursing assessment records
Charting
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Graphic Record: Contains pulse,
temperature, respirations, blood pressure,
urine output, oral intake, daily weights
Laboratory Reports: CBC, ABG, etc.
Radiology: x-rays, CT scans, MRI, PET,
and ultrasound
Operative Data: Includes operative
consents, operation reports, and anesthesia
and post anesthesia records
Charting
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Medication Administration Record: Provides a
chronology of the medication given to the patient,
quantity, dosage, route, and date & time of
administration
Ancillary Services: Reserved for RT, OT, PT, ST
Discharge Plan
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Denotes patient condition and date and time of discharge
Any prescribed medication(s) and patient teaching
for medication administration are documented here
Preparing for the Patient Encounter
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Role of the RT in Patient Assessment
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Assist physician in determining initial
diagnosis
Assess patient’s response to therapy
Preparing for the Patient Encounter
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Stages of Patient Clinical Interaction
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Preinteraction Stage
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Review patient’s chart to identify important facts
stated in medical history
Introductory Stage
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Introduce yourself to the patient stating your
name, department, and purpose of the visit
Confirm patient identity using his/her wrist ID
bracelet
Preparing for the Patient Encounter
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Stages of Patient Clinical Interaction (cont)
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Initial Assessment Stage
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Treatment and Monitoring Stage
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This stage is done to identify the current health status of the
patient. A brief interview and physical examination are
appropriate
Don’t assume the patient’s condition has changed since the
initial workup by the physician at admission
Provide treatment and monitor patient’s response
Follow-up Stage
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Take a minute to ask the patient about how s/he feels and if
you can do anything else before you leave
Also let the patient know when you will return
Preparing for the Patient Encounter
Communicating the Assessment Findings
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Record details of the patient encounter in the chart
If the patient had complications to the treatment,
verbally communicate this to the patient’s nurse and
physician if the complications are serious
When the patient’s condition takes a turn for the
worse, you should stay with the patient until help
arrives
Preparing for the Patient Encounter
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Use of Space
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Social space (4-12 ft)
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initial introduction
First step in establishing rapport
Personal space (18in -4ft)
Intimate Space (0-18in)
Preparing for the Patient Encounter
Territoriality
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Patients often lay claim to items in their room that
are placed bedside even though the items belong to
the hospital. For this reason never take a bedside
item from Patient A and give to Patient B without
obtaining Patient A’s permission
Respecting the territorial rights of patients is an
excellent way to let patients know you value them
and that you are considerate of their needs
Preparing for the Patient Encounter
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Confidentiality
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All patient records are confidential. What
you read in the chart and what you discuss
with the patient must be shared only with
other healthcare workers who need to know
the information to perform their job
appropriately
Discuss patients in areas outside private
reports rooms must not be done
Preparing for the Patient Encounter
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Express Genuine Concern
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Face the patient squarely
Use eye contact appropriately
Maintain an open posture
Consider appropriate use of touch
Be an active listener
Universal Precautions
The Interview
Principles of Communication
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Each patient has a unique background that includes
level of education, cultural heritage, religious
beliefs, previous experiences, and self concept. All
these factors play a key role in determining the
patient’s response to you and your questions during
the interview
Verbal and nonverbal messages make up each
interview
Nonverbal messages can say more than actual
words
Excellent skills at listening are essential for the
interview
The Interview
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Structuring the Interview
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Project a sense of undivided interest in the
patient during the interview
Introduce yourself in a professional manner
to begin the interview
Be professional in your appearance and
mannerisms during the interview
Interview using a relaxed conversational
style that communicates empathy
The Interview
Questions and Statements Used to Facilitate
Conversational Interviewing
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Open ended questions encourage patients to
describe events as they see them and promote
better understanding of their problem (e.g., How
have you been feeling lately?)
Direct questions are better for the brief interview
such as when following up on the effects of therapy
(e.g., Did the oxygen help?)
Indirect questions are used to clarify issues (e.g.,
Are you saying you can breathe better now that you
are not taking the heart medication?)
The Interview
Questions and Statements Used to Facilitate
Conversational Interviewing (cont)
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Neutral questions and phrases avoid leading the
patient toward a desired answer
Reflecting phrases show interest and let the patient
know you are listening
Communicating empathy during the interview
provides more information to patients, suggesting
you care about them.
The Interview
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Alternate Sources for a patient History
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Family members present during the
interview can be helpful in providing
information that the patient does not know
or remember