Clinical Preparedness
Clinic is 12 hours. You are expected to be at clinic 15 minutes early. Please come prepared with your hair
tied back (natural color), no excessive jewelry (wear a watch), tattoos covered, and no artificial nails,
shoes that are black or white and non-porous (no canvas type shoes).
Bring appropriate equipment: stethoscope, watch, notepad for notes, pens, pocket drug guide, Mosby’s
PDQ pocket guide, sign in sheet/CPO forms and SOAP sheets.
You are to go to the RT department at the start of the shift (typically you will have an orientation day
where your clinical instructor from VVC will show you around). You will either be assigned to a therapist
before or after they have gotten report. If you get assigned prior to report, please take report with your
therapist.
Treatment and procedure frequencies
http://www.globalrph.com/abbrev_rst.htm
Treatment orders:
Each patient that is receiving respiratory services will have an order. You must verify this order prior to
delivering services. An example of an order is as follows:




HHN with Albuterol 2.5 mg and 2.5 ml of NS Q4 + Q2Prn for wheezing
O2 via NC @ 2L to keep SpO2 >92%
Advair 250/50 mcg x 1 puff BID
CPT as tolerated QID
ALL PATIENTS ARE ASSESSED PRE and POST therapy. You are not to “stack” treatments, let your RT
know that this is against VVC policy.
Before clinic, you are expected to know and understand the following areas of care:
Patient Assessment (be able to demonstrate and identify abnormalities for each of the following)








Be able to conduct a targeted patient interview, relating to respiratory
Breath sounds (know all adventitious sounds, their causes and possible treatments), know the
technique in obtaining breath sounds
Heart rate/rhythm and respiratory rate/rhythm, know how to obtain each, normal ranges,
what abnormalities represent.
Breathing patterns: signs of WOB/accessory muscle use, hyperventilation, hypoventilation,
tachypnea, bradypnea, kussmauls, Cheyne stokes, Biots, agonal/gasping, upper vs. lower airway
issues, retractions, grunting…
Patient color: cyanosis, pale, mottling, ruddy appearance, dusky, skin turgor
Inspection: How does the patient appear,
awake/alert/confused/combative/lethargic/comatose/in pain/ diaphoretic…
Palpation, percussion: know what dull/resonant and hyper resonate percussion notes represent
Spo2 /Blood pressure monitoring: be able to assess if a patients Spo2 is adequate for their
condition






Cough and sputum assessment: Be able to assess and discuss abnormalities in sputum color,
consistency, smell. Have you patient demonstrate the ability or inability to cough
Lung mechanics: Be able to demonstrate knowledge of a Vital Capacity Maneuver (VC), NIF/MIP
ABG interpretation, and indications for puncture
Basic EKG interpeations: know lead two rhythms (A-fib, Sinus tachycardia, bradycardia, SVT, Vtach, V-fib, Blocks: Types I-III…)
ALL FORMULAS learned: Ve, VA, PAO2, CaO2, total flow, duration of flow…
Be able to make recommendations based on your assessment.
Chart Review (be able to review a chart and extract the below information)







LABS: Be able to interpret and discuss abnormalities, associate them with the patients current
condition
o CBC: WBC (the differential), Hb, RBC, HCT, Platlets
o Electrolytes: K, Na, Ca, Mg, Cl, Phosphorous
o BUN, Creatine
o Liver enzymes: ALT
o Cardiac enzymes: CPK, troponine, BNP
o Sputum, blood and urine analysis/microbiology
o Essentially you are to review all abnormal labs and relate them to the patients current
condition
CXR/CT scan: Review for abnormalities, interpret consolidation, pneumothorax, pleural effusion,
pulmonary edema, atelectasis… All structures, ribs/trachea/stomach...
History and Physical and consultations: all disease you encounter in the chart, please review
them, common issues among patients will include: Diabetes II, CHF, CAD, CRF, ESRD, COPD,
Obesity, OSA, ETOH abuse, Liver cirrhosis, STEMI, CVA, Cancer…
Pulmonary Function tests: Review if the patient has undergone one, and what the results mean
Respiratory and nursing notes
MAR: all medications
Code status, isolation status, known allergens
Bronchial Hygiene (be able to demonstrate knowledge in each of the below topics)




Know indications for bronchial hygiene, including patients who have ineffective coughs, no
cough, congestion or who are predisposed to congestion
Know the following equipment:
o EZPAP
o Acupella
o Flutter devices
o Cough Assist
o Aerobika
o Thera-PEP
Be able to demonstrate proper patient positioning and CPT using hand technique, percussive
device and the vest
Understand the indication and techniques used during bronchoscopy, know the different types



Nasotracheal suctioning vs. Tracheal suctioning, technique and indications, sputum collection
Basic airway management:
o Trachestomy care, intubation, nasal and oral airway placement and indications
Humidity and aerosol therapy: Know when aerosol and humidity is indicated and how to setup:
o Bubble humidifier
o Large Volume nebulizer
o Small volume nebulizer
o Heated humidifier (Passover and wick)
o HME
Positive Pressure/Hyperinflation






Know the indications and basic function of non-invasive positive pressure (BiPAP)
o Be able to describe CPAP vs BiPAP
IPPB: all settings, indications, contraindications and hazards
IPV: all settings, indications, contraindications and hazards
Using a positive pressure mask during CPR
Indications for mechanical ventilation
Indications and use of an Incentive Spirometer
Other Equipment












ALL Oxygen devices, low flow, high flow and enclosure systems
Peak flow meters
Holding chambers
DPI, MDI
Pulse oximeters
Capnography
SVN, BAN (know how to cough and instruct the patient to take a treatment)
Spirometry
Oxygen analyzers
Regulators and cylinders
EKG machines
Hyperbaric Oxygen systems
Pharmacology


Gas therapy: Know indications, hazards/side effects for Oxygen, Heliox, Nitric Oxide
Know indications, hazards/side effects, doses, frequency, and onset/duration, drug
classification, Receptor site mechanisms and mode of action for the following respiratory
therapy drugs:
o Albuterol
o Atrovent
o Duoneb
o Xopenex
o Spiriva
o Combivent
o Serevent
o Dulera
o Foradil
o Racemic
o Advair
o Brovana
Epinephrine
o Symbicort
o Mucomyst
o
o
o
o
o
o
Dornase Alfa
Sodium
Bicarbonate
Nebupent
Flovent
Qvar
Asmanex
o
o
o
o
o
o
o
Breo Elliepta
Tudorza
Curosurf
Pulmicort
Tobi
Predinsone
Solumederol
o
o
o
o
o
o
o
Lasix
Decadron
Singulair
Aerospan
Xolair
Accolate
Flolan