Miami Dade College
Medical Campus
School of Health Sciences
Respiratory Care Program
RET 2835 Respiratory Care Clinic 4
(Revised: April 2015)
MIAMI DADE COLLEGE
MEDICAL CAMPUS
SCHOOL OF HEALTH SCIENCES
RESPIRATORY CARE PROGRAM
COURSE OUTLINE
RET 2835 RESPIRATORY CARE CLINIC 4
COURSE OVERVIEW:
RET 2835 is designed to allow the student to develop psychomotor skills related to
critical care procedures of Respiratory Care. The student is responsible for all
objectives in prerequisite and co-requisite courses. During the course, the student is
provided with the opportunity to apply and discuss the theory and techniques as learned
in prerequisite and co-requisite courses.
Clinic Days: _____________________ Clinic Location: ________________________
Clinic Location: ______________________
Instructor: ______________________
Office #: ______________________________
Phone #: ______________________
Beeper #: _____________________________
Office Hours: __________________________________________________________
EVALUATIONS:
1st Clinic Evaluation
40%
2nd Clinic Evaluation
40%
Case Study
10%
Case Presentation
10%
RET 2835
TABLE OF CONTENTS
MODULE 1.0
MONITORING TECHNIQUES
MODULE 2.0
NEONATES
MODULE 3.0
PEDIATRICS
MODULE 4.0
HYPERBARIC MEDICINE
MODULE 5.0
SUBACUTE CARE
MODULE 6.0
SPECIALIZED CRITICAL CARE
MODULE 7.0
CASE PRESENTATION
MODULE 1.0 MONITORING TECHNIQUES
General Objective:
Upon completion of the module, the student will understand various monitoring
techniques, invasive and non-invasive, utilized in critical care.
Specific Objectives:
1.1
Describe the balancing and calibration procedure for the transducer pressure
systems used in hemodynamic monitoring
1.2
Identify the components that comprise an arterial line monitoring system and
pulmonary artery catheter monitoring system
1.3
Identify precautions in preparing and setting up an arterial line and pulmonary
artery catheter
1.4
Describe the technique for drawing blood specimens from arterial line and
pulmonary artery catheter
1.5
Explain the daily maintenance required for a transducer pressure monitoring
system
1.6
List the parameters that can be monitored using an arterial line and pulmonary
artery catheter
1.7
Differentiate between the various pressure readings and waveforms associated
with arterial line and pulmonary artery catheter
1.8
Compare and contrast the hemodynamic data presented by patients to normal
values and identify the cause and effect of that data.
MODULE 2.0 NEONATES
General Objective:
Upon completion of the module, the student will understand the various techniques and
procedures utilized with neonates in the critical care area.
Specific Objectives:
2.1
Identify normal ABG and CBG values for a newborn
2.2
Explain the different assessment scales utilized in the assessment of an infant at
birth (APGAR, etc.)
2.3
Demonstrate skills in collection and evaluation of nursing and respiratory care
data from the patient chart and flow sheet
2.4
Identify important steps to take in the stabilization of a distressed newborn
2.5
Describe and demonstrate neonatal CPR techniques, based upon current
American Heart Association and American Academy of Pediatrics standards and
obtain Neonatal Resuscitation Program (NRP) and Pediatric Advanced Life
Support (PALS) certification.
2.6
Explain techniques of oxygen administration to newborns, and identify the
responsibilities of the respiratory care practitioner in oxygen administration to the
newborn
2.7
Develop an explanation of the etiology, pathophysiology, and treatment of
neonatal pathology/conditions including:
1.
2.
3.
4.
5.
6.
7.
8.
HMD
IVH
ROP (RLF)
RDS II
PFC/PPHN
BPD
IRDS
Apnea of prematurity
2.8
Explain the rationale for and implement the type of ventilation plans and
programs used on newborns in the intensive care unit, particularly the use of
IMV, high frequency ventilation, and inverse I:E ratios
2.9
Explain and demonstrate special considerations in the use of bag/mask and
bag/tube ventilation in the newborn
2.10
Describe and demonstrate techniques for both arterial and capillary sampling
2.11
Discuss the indications, contraindications and hazards of nitric oxide therapy
2.12
Discuss the physiological aspects of nitric oxide (INO) therapy and implement
therapy
2.13
Demonstrate safe setup and use of equipment used to provide and monitor nitric
oxide therapy
2.14
Discuss the indications, contraindications, hazards and physiological aspects of
Extracorporeal Membrane Oxygenation (ECMO)
2.15
Identify the equipment used and the procedure for initiating Extracorporeal
Membrane Oxygenation (ECMO)
2.16
Explain the rationale and techniques for the use of transcutaneous monitors and
pulse oximeters, and compare their use to that of serial arterial sampling as a
tool for the continuous evaluation of oxygenation and ventilation status
2.17
Interpret ABG/CBG results on a variety of patients in the intensive care unit, and
discuss changes in oxygen administrations and/or ventilator parameters, based
upon the interpretation with the respiratory care practitioner
2.18
Participate in physician/patient therapist/patient rounds
2.19
Discuss the importance of thermal regulation in neonates and implement
appropriate procedures.
2.20
Discuss and demonstrate the indications, use of, and contraindications of
exogenous surfactant in the newborn
2.21
Explain the problems associated with fluid balance in the neonate and
recommend corrective action as appropriate.
MODULE 3.0 PEDIATRICS
General Objective:
Upon completion of the module, the student will understand procedures related to the
care and treatment of the pediatric patient in the critical care area.
Specific Objectives:
3.1
Identify the common pathologies found in the pediatric population
3.2
Differentiate among oxygen therapy equipment and techniques used on pediatric
patients
3.3
Identify and discuss pharmacological agents used in the pediatric population
including brand and generic name, dosage, actions, contraindications,
indications, hazards, and adverse reactions
3.4
Define the specific disease entity or condition of assigned children in the pediatric
critical care area
3.5
Describe the hospital course of treatment for the disease or condition and justify
its appropriateness or inappropriateness
3.6
Discuss the indications and patient needs for continuous mechanical ventilation
3.7
Utilizing the patient's chart, investigate data appropriate to the child's clinical
status
3.8
Participate in physician/therapist and therapist/patient rounds
MODULE 4.0 HYPERBARIC OXYGEN THERAPY (HBO)
General Objective:
Upon completion of this module, the student will have a basic understanding of HBO
and its clinical utilization, and chamber operation.
Specific Objectives:
4.1
Define hyperbaric oxygen and hyperbaric medicine
4.2
Discuss the physical and physiological aspects of HBO
4.3
Compare and contrast monoplace and multiplace chambers
4.4
Identify and discuss the criteria utilized during a "dive " procedure
4.5
Review the clinical indications for HBO
4.6
Identify and discuss problems/hazards associated with HBO
4.7
Review the operation of a multiplace and monoplace chamber
4.8
Discuss the role of transcutaneous oxygen and perfusion measurement in HBO
MODULE 5.0 SUBACUTE CARE
General Objective:
Upon completion of the module, the student will have an understanding of the type of
patient and routine of care found in the subacute setting.
Specific Objectives:
5.1
Describe the major types of patients and pathologies encountered in the
subacute setting
5.2
Discuss the routine of care including medical and respiratory care
5.3
Monitor patients receiving continuous mechanical ventilation
5.4
Effectively and safely provide all types of respiratory care as ordered by a
physician and as appropriate to established protocol
5.5
Compare the routine of care in the subacute setting to the acute setting
5.6
Describe the role of the respiratory care practitioner in the subacute setting
5.7
If utilized, discuss the use of therapist driven protocols (TDP) in the subacute
setting
MODULE 6.0 SPECIALIZED CRITICAL CARE
General Objective:
Upon completion of the module, the student will have an understanding of the type of
patient and routine of care found in the specialized critical care settings of Trauma
Intensive Care, Surgical Intensive Care (including transplant and open heart),
Neurologic/Neurosurgical Intensive Care, and Medical Intensive Care.
Specific Objectives:
6.1
Describe the major types of patients and pathologies encountered in each of the
specialized critical care settings
6.2
Discuss the routine of care including rounds, medical and respiratory care
6.3
Monitor patients receiving continuous mechanical ventilation in each of the
specialized critical care settings
6.4
Effectively and safely provide all types of respiratory care as ordered by a
physician and as appropriate to established protocol, in each of the specialized
critical care settings
6.5
Compare and contrast the routine of care in the each of the specialized critical
care settings to the routine of care found in other acute care settings
6.6
Describe the role of the respiratory care practitioner in each of the specialized
critical care settings
6.7
If utilized, discuss the use of therapist driven protocols (TDP) in each of the
specialized critical care settings
MODULE 7.0 – CASE PRESENTATION
During this clinical rotation, the student will present a critical care patient case study. It
shall be typed in the approved format and must be submitted in hard copy (paper) form.
The care study will contribute towards the student's clinic grade.
The patient selected for the case presentation must meet the following criteria:
1.
Patient must be on some form of mechanical ventilation
2.
Patient should have a pulmonary artery catheter inserted
(exceptions can be made with permission from the Director of Clinic
Education [DCE])
3.
Case studies may be chosen from the following patient groups:
a.
Adult ICU
b.
Pediatric ICU
c.
Neonatal ICU
d.
A homecare, ventilator-dependent patient with a
unique diagnosis, e.g., ALS
The written case presentation can be no longer than five typed double space pages in
12-point Arial font. Margins must be no greater than 1 inch on both sides and bottom
and top. It will be written in the narrative form (except for Section Two).
ALL CASE PRESENTATIONS ARE DUE ON: _________________.
PRESENTATIONS WILL NOT BE ACCEPTED AFTER THIS DATE.
The student is responsible to provide information on the selected patient from the date
of admission up the last date of the student’s rotation at the facility. If the selected
patient is transferred from the ICU and/or expires, the student will present the time
period from the date of admission to the date of transfer or expiration.
CASE PRESENTATION FORMAT
The case presentation will be divided into three sections:
Section One: Introduction,
Section Two: Assessment
Section Three: Conclusion.
Each section must be identified in the paper. Each will have specific information that
the student will obtain from a number of sources including the patient's chart, nursing
flow sheet, ventilator flow sheet, and the student’s own knowledge base.
Section One: Introduction
The content of this phase should be developed from information gathered from the
patient's chart and your interpretation of that information. It should contain the name of
the hospital/facility the patient was admitted to, patient age, sex, date of admission,
chief complaint on admission, diagnosis, findings on physical examination and history,
and respiratory status.
The information and the manner in which you present this information should develop
both Section Two and Section Three. The information you have presented here should
be consistent which your information listed in Section Two and discussed in Section
Three.
Section Two: Assessment
This portion of the case presentation should contain a synopsis of the patient's hospital
stay from date of admission to present. This time span may be as little as one day to as
much as several weeks, depending upon the patient you have selected. The information
in this section may be listed according to the numbered categories that follow. Data for
this phase should come from a variety of sources, including the patient's chart, personal
assessment of the patient, nursing flow sheet, etc.
This section should contain the following information:
1. Indication(s) for patient needing ventilatory assistance or support (related to diagnosis, surgery,
etc.)
2. Number of days on the ventilator
3. Type of ventilator ( brand name and classification)
4. Type of ventilatory program instituted ( orders, progress, changes)
5. Respiratory Care orders
6. Summary of ABG's (results must be accompanied by interpretations)
7. All other respiratory care being given to the patient
8. Briefly describe chest x-ray findings (initial and present)
9. What respiratory related medications the patient is receiving (name, type, route, dosage,
indication)
10. Other drug therapy that the patient is receiving (name, type, route, dosage, indication)
11. Summary of fluid balance (including pulmonary artery catheter findings)
12. Major medical problems and/or conditions (non respiratory)
Section Three: Conclusion
The content of this phase should be developed primarily from direct evaluation of your
patient and patient information. This section will contain the "How and Why" of your
presentation. A concise, organized overview of the medical and cardiopulmonary
orders, status, and assessment made by you should be developed in this section. Be
sure to include your rationale for agreement and/or disagreement with the patient's
medical and respiratory care plan. It should contain what you interpret as the outcome
of the current medical and cardiopulmonary regimen.