CLINICAL BEHAVIORAL OBJECTIVES
CONCORDE CAREER COLLEGE
*= Completed in the lab and at the clinical site.
CLINICAL ROTATION I, TERM 4
Isolation and Sterilization (week 1 & 2)
Under direct supervision, the student will successfully:
1. *Demonstrate the technique used for 3-minute hand washing.
2. Demonstrate the ability to glove and gown for isolation, including the
following:
a. Wash hands
b. Apply cap to cover hair
c. Apply mask covering mouth and nose
d. Correctly apply gown
3. Demonstrate how to aseptically apply surgical gloves.
4. Demonstrate how to aseptically double bag equipment being removed from
isolation.
5. Demonstrate how to remove gloves, cap, mask, and gown when leaving
isolation.
6. Demonstrate how to perform output sampling on clean and in-use
equipment.
7. *Demonstrate how to correctly perform swab sampling.
8. Fill out a bacterial surveillance record.
Patient Assessment (week 1 & 2)
Under direct supervision, the student will successfully:
1. *Discuss the three most common sites for measuring body temperature.
2. Correctly measure the oral temperature.
3. *Locate the most common sites to measure the pulse.
4. *Measure the pulse and describe the following:
a. Rate
b. Rhythm
c. Normalcy
5. * Measure the respiratory rate, determining if the rate and rhythm are normal.
6. * Correctly measure the blood pressure.
7. * Properly position and prepare the patient for physical assessment of the
chest.
8. * Demonstrate proper inspection of the chest.
9. * Demonstrate palpation of the chest.
10. * Demonstrate percussion of the chest.
11. * Prepare the stethoscope for use with emphasis on aseptic technique.
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CLINICAL BEHAVIORAL OBJECTIVES
CONCORDE CAREER COLLEGE
12. * Test the stethoscope for function and how to troubleshoot the
instrument when it does not function properly.
13. * Auscultate the chest in a systematic way.
14. * Describe the optimal environment for the physical assessment of the chest.
ABG Puncture (week 3 & 4)
Under direct supervision, the student will successfully:
1. Collect and properly assemble the supplies needed for arterial puncture.
2. *Demonstrate how to properly prepare a syringe for arterial puncture.
3. *Locate the three sites for arterial puncture on a patient:
a. Radial
b. Brachial
c. Femoral
4. *Demonstrate the modified Allen’s test for collateral circulation.
5. *Demonstrate the proper procedure for:
a. Radial artery puncture
b. Brachial artery puncture
6.
Demonstrate ability to label and prepare the sample for transport.
7. * Demonstrate how to draw an arterial sample from an indwelling radial
arterial catheter.
Airway Management (week 5 & 6)
Under direct supervision, the student will successfully:
1. *Assemble equipment required for airway aspiration and test it for
proper operation before use.
2. * Demonstrate nasotracheal suctioning (lab=mannequin)
3. * Demonstrate artificial airway aspiration (lab=mannequin)
4. * Correctly assemble, test for function, safely apply and troubleshoot
three types of humidifiers
5. * Discuss the correct use of the humidifiers using appropriate delivery
devices.
6. Correctly monitor the following on the above humidifiers as appropriate:
a. Oxygen concentration
b. Temperature
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CLINICAL BEHAVIORAL OBJECTIVES
CONCORDE CAREER COLLEGE
7. *Correctly assemble, test for function, safely apply, and troubleshoot at least
two types of large volume nebulizers.
8. *Discuss the use of the above nebulizers using appropriate delivery devices.
9. *Correctly monitor the following on the above nebulizers as appropriate:
a. Oxygen concentration
b. Temperature
10. *Correctly assemble, test for function, safely apply, and troubleshoot a
small volume nebulizer.
11. *Discuss the use for a small volume nebulizer with the following delivery
devices:
a. Aerosol mask
b. Briggs adapter/aerosol T
c. Mouth piece
11. Monitor a patient while delivering a small volume nebulizer treatment
with a bronchodilator.
12. Demonstrate the use of an incentive spirometer including:
a. Patient instruction
b. Use of equipment
c. Troubleshooting of equipment
d. Emphasis of self-motivation on the part of the patient
13. *Demonstrate the following adjunctive breathing exercises:
a. Controlled cough including splinting
b. Pursed lip breathing
c. Abdominal breathing
d. Sniffing
e. Panting
14. *Under direct supervision, demonstrate the correct operation of the Bird
Mark 7 and a Bennett PR-2 ventilator when given an order for IPPB therapy:
a. Establish the ordered pressure
b. Establish the ordered tidal volume
c. Establish the ordered ventilatory rate
d. Maintain an I:E ratio of 1:2 or greater
e. Monitor FIO2
15. *Administer IPPB therapy with normal saline.
16. *Demonstrate the ability to evaluate the signs and symptoms of adverse
affects that may result from IPPB therapy.
17. * Verbally state the criteria for terminating IPPB.
18. * Describe the appropriate action that should be taken in the event of
terminating IPPB including:
a. Who should be notified
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CLINICAL BEHAVIORAL OBJECTIVES
CONCORDE CAREER COLLEGE
b. Correct patient assessment and monitoring
c. Correct charting of why the therapy was terminated
19. Demonstrate appropriate charting following the administration of IPPB
therapy.
Artificial Airways (week 7 & 8)
Under direct supervision, the student will successfully:
1. * Demonstrate the manual maneuvers to open the airway.
1. * Demonstrate the correct usage of an oropharyngeal and a nasopharyngeal
airway.
2. * Demonstrate how to assemble, prepare for use, and test for function prior to
use, a self-inflating manual resuscitator.
4. * Demonstrate cuff deflation, inflation, and how to check cuff pressures.
5.
Demonstrate the proper procedure for cleaning a double cannula
tracheostomy tube.
6.
Demonstrate how to properly perform stoma care.
7. * Verbally describe the action to be taken in the event of accidental
decannulation or tube displacement.
8. Using a self-inflating manual resuscitator and a mask, maintain a patient
airway and ventilate a patient for 3 minutes, according to the following criteria:
a. Maintain an I:E ratio of 1:2 or greater
b. Maintain a rate of 12/minute
c. Observe the patient for the following:
1) Vomiting 2) Color 3) Chest expansion 4) Gastric Distention
9. Demonstrate the use of a flow-inflating resuscitator, ventilating the patient
according to the following criteria:
a. Maintain an I:E ratio of 1:2 or greater
b. Maintain a rate of 12/minute
c. Observe the patient for the following:
1) Color
2) Chest expansion
10. *Discuss how to correctly orally intubate an intubation mannequin using
a Miller and MacIntosh laryngoscope blade.
11. *Discuss the rationale for hyperinflation and oxygenation prior to intubation.
12. *Describe the procedure used for nasal intubation, and demonstrate how to
correctly secure a nasal endotracheal tube.
13. *Discuss how to extubate a patient safely.
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CLINICAL BEHAVIORAL OBJECTIVES
CONCORDE CAREER COLLEGE
Hyperbaric Center Rotation (week 9 & 10)
Under direct supervision, the student will successfully:
1.
2.
3.
4.
5.
6.
7.
Describe how hyperbaric therapy is used to treat patients
Describe atmospheric pressure versus hyperbaric atmospheric pressure
Describe the indications for the use of hyperbaric therapy
Describe the contraindications for the use of hyperbaric therapy
Describe the adverse effects of hyperbaric therapy
Describe the regimen used for the hyperbaric chamber
Describe the safety guidelines used with a hyperbaric chamber
Clinical Rotation II, Term 5
Ventilator Classification (week 1)
Under direct supervision, the student will successfully:
1. Be able to identify the two types of ventilators
2. Be able to identify how a ventilator is powered and it’s driving mechanism
3. Be able to list the control variables on the ventilator in use and to identify
which variable is the cycling variable and which is the limiting variable
4. Demonstrate understanding of the flow and pressure patterns
5. Explain the purpose of the ventilator alarm systems and the types of alarms
being used with that ventilator
6. Explain the different modes of ventilation and when each mode would be
appropriate for use
Ventilator Monitoring (week 2)
Under direct supervision, the student will successfully:
1. Assess a patient to determine the need for mechanical ventilation
a. color
b. pulse
c. blood pressure
d. cardiac rate/rhythm
e. level of consciousness
f. breath sounds
2. * Discuss the mechanics of ventilation:
a. Respiratory frequency
b. Minute volume
c. Vital capacity
d. Maximal inspiratory force
e. Peak expiratory flow
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CLINICAL BEHAVIORAL OBJECTIVES
CONCORDE CAREER COLLEGE
3. * Given a physician’s order, demonstrate the ability to adjust ventilator
settings
4. Suction the patient as required
5. Empty the condensate from the tubing
6. Calculate corrected tidal volume
7. Calculate static and dynamic compliance
8. Measure FiO2
9. Measure circuit temperature
10. Record all ventilator settings
11. Use aseptic technique
Ventilator Initiation (week 3)
Under direct supervision, the student will successfully:
Verify the physician’s orders and determine indications
Scan the patient’s chart for pertinent information
Measure the mechanics of ventilation
Assess oxygenation and cardiac status
Gather the required equipment
Assemble and test the equipment
Adjust the ventilator to the ordered settings
Connect the patient
Monitor all ventilator parameters
a. Corrected tidal volume
b. Rate
c. FiO2
d. Adjust sensitivity
e. Adjust flow rate
f. Set pressure limits
g. Set all alarms
h. Record all ventilator parameters
10. Draw arterial blood gases if ordered or monitor oximetry
11. Clean up the area
1.
2.
3.
4.
5.
6.
7.
8.
9.
PEEP, CPAP, SIMV (week 4 & 5)
Under direct supervision, the student will successfully:
1. * Identify the baseline data that should be gathered prior to initiation of
PEEP/CPAP:
a. Cardiovascular
1) Blood pressure
2) Heart rate and rhythm
3) Cardiac output (when information is available)
4) CVP, PAWP (when information is available)
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CLINICAL BEHAVIORAL OBJECTIVES
CONCORDE CAREER COLLEGE
b. Pulmonary
1) Mechanics of ventilation
2) Arterial blood gases
3) Static and dynamic compliance
2. Demonstrate how to initiate CPAP, PEEP, SIMV
with external circuitry including the following:
a. Verify the order
b. Obtain baseline patient data
c. Auscultate the chest and suction the patient as required
d. Assemble, test, and troubleshoot the equipment
e. Monitor the patient
f. Remove unneeded equipment
g. Document the procedure on the patient’s chart
Circuit Change (week 6 & 7)
Under direct supervision, the student will successfully:
1. Assemble the required equipment
a. Personal protective equipment
b. New circuit and humidifer
c. Manual resuscitator
d. Plastic bag for disposal of old circuit
e. Respirometer, if required
2. Suction the patient as required
3. Drain the condensate from the tubing
4. Change the circuit, check for leaks
5. Monitor pressures and tidal volume
6. Monitor the circuit and document the findings on the ventilator flow sheet
7. Reset all alarms
8. Dispose of equipment properly
ABG Management (week 8 & 9 & 10)
Under direct supervision, the student will successfully:
1. Given the following information, assess the need for mechanical ventilation:
a. PaO2
b. P (A-a) O2
c. PaCO2
d. pH
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CLINICAL BEHAVIORAL OBJECTIVES
CONCORDE CAREER COLLEGE
CLINICAL ROTATION III, TERM 6
Neonatal and Pediatric Rotation (week 1 - 10)
Under direct supervision, the student will successfully:
1.
2.
3.
4.
*Describe key elements of fetal circulation
*Demonstrate ability to assess the newborn
*Demonstrate ability to apply respiratory care modalities to infants and children
*Demonstrate knowledge of chart utilization to find etiology, clinical manifestations,
pathophysiology and treatment of selected neonatal disease processes
5. *Describe the anatomic and physiologic events associated with the normal transition
of the fetus from uterine to extrauterine life
6. *List and describe the key anatomic and physiologic differences between the
neonate, child and adult
7. *Differentiate the various methods of assessing the newborn infant, including
maternal and fetal factors
8. *Describe the indications, hazards and special tools and techniques involved in
applying selected respiratory care modalities to infants and children, with a special
emphasis on ventilatory support modes
9. *Describe the etiology, pathophysiology and clinical manifestations, and treatment
regimens for the identified neonatal disease processes
10. *Initiate Newborn Mechanical Ventilation
11. *Monitor Newborn Mechanical Ventilation
12. *Describe the etiology, pathophysiology, clinical manifestations and treatment
regimens for the common pediatric disorders
13. *Completion of all assigned clinical manual check offs
Advanced Pulmonary Function Sciences (week 1 - 10)
Under direct supervision, the student will successfully:
1. *Discuss goals and specific uses of pulmonary function equipment
2. *Describe the general goals and identify specific uses for pulmonary function
testing as a component of respiratory care
3. *Demonstrate ability to discuss rehabilitation potential based on patient and test
data
4. *Differentiate by definition the various conventional tests of lung volumes,
capacities and flows
5. *Describe the clinical test methods commonly employed in the measurement of
lung volumes, capacities and flows
6. *Differentiate among the clinical test methods employed to obtain supplementary
information regarding pulmonary function
7. *Apply pulmonary function data to distinguish among the major patterns of
pulmonary disease
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CLINICAL BEHAVIORAL OBJECTIVES
CONCORDE CAREER COLLEGE
8. *Perform and interpret all major pulmonary function tests
9. *Completion of all assigned clinical manual check offs
CLINICAL ROTATION IV, TERM 7
Emergency Medical Response (week 1 – 10)
Under direct supervision, the student will successfully:
1.
2.
3.
4.
5.
6.
7.
8.
*Provide cardiopulmonary resuscitation
*Implement and monitor cardiac monitoring
*Initiate and monitor oxygen therapy
*Provide aerosol drug medication using a small volume nebulizer
*Perform patient assessment
*Provide mechanical ventilation monitoring
*Intubate (only with DCE approval prior to rotation)
*Complete all assigned clinical manual check offs
Final Critical Care Rotation (week 1 – 10)
Under direct supervision, the student will successfully:
1. Manage an intensive care unit
2. Provide physicians with a complete report of their patients as they rotate through the
critical care unit
3. Manage a full load of therapy
4. *Complete all remaining clinical competencies not previously completed
5. Provide effective time-management skills
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