SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
CLINICAL OBJECTIVES
2012 GRADS
Index of rotations
**For a quick link to the desired rotation objectives, place curser over rotation name and follow
instructions.
Adult ICU
Asthma Education
Community Care
Emergency
Hyperbaric Oxygen Therapy
Neonatal ICU
Operating Room
Pediatric Wards
Pediatric ICU
Pulmonary Functions
Sleep
Wards
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SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
AICU I and II
Rotation overview:
In the AICU clinical rotation students will practice skills and demonstrate knowledge required
to conduct care of critically ill adult patients in the ICU setting. Students are expected to work
with their preceptors to gain experience with the outlined clinical objectives, as well as
practice and achieve competency with related CBO’s. Clinical experience may vary somewhat
based on the type of ICU, and volume of patients, therefore two 4 week rotations are
scheduled at different clinical sites to optimize exposure to the complete list of clinical
objectives and related CBOs. Although the same list of clinical objectives applies to rotation 1
and 2, students will be expected to perform in the 2 nd rotation with more independance, and
assume responsibility for a larger volume of patients and skill sets.
Schedule
Pre Rotation
Site orientation
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Workbook/
Assignment
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Common Day
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Exam
Clinical
Performance
Evaluation
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12 hour shifts which may include nights and weekends.
See Site Schedules
Clinical Simulation Week prior to 1st AICU rotation only
Pre rotational exam prior to 1st AICU rotation only (80% to pass). The
break down for the exam is under AICU Clinical Simulation.
See schedule in Clinical Simulation
Orientation will be provided by the NAIT clinical instructor except for
Red Deer which will be provided by that sites RTs/preceptpors.
Workbook 1 must be done in time for review on AICU 1 common day
Workbook 2 must be done in time for review on AICU 2 common day
Some questions may require presentation on common day
Workbooks will not be marked but are meant as a self study tool and
guide for review on common day
Common class day will be scheduled in the 3rd week of each AICU
rotation
See Common Day Schedule for date, time and location of common day
Post rotation exam 1 will be written at the end of AICU 1 (60% to pass)
Post rotation exam 2 will be written at the end of AICU 2 (60% to pass)
Exams will be graded and count towards the final RET602 mark
Exam dates will be scheduled by NAIT clinical site faculty
One mid rotation evaluation required for each rotation
One end point evaluation required for each rotation
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Clinical Objectives
Upon completion of the AICU Clinical Rotation, the student will be able to:
Professionalism
 Adhere to dress code, and maintain professional appearance
 Report to shifts on time
 Demonstrate respect towards patients, health care staff and preceptors
 Maintain patient privacy and confidentiality
 Advocate patient care and safety
 Demonstrate compassionate care
 Practice within ethical guidelines
 Adhere to scope of practice limitations
 Integrate with an interdisciplinary approach to patient care
 Demonstrate flexibility and adaptability when working with others
 Manage and resolve conflicts constructively
 Demonstrate accountability for actions
Communication
 Clearly and concisely discuss procedures and care with patients and families,
 Use medical terminology in the appropriate context
 Demonstrate appropriate nonverbal communication skills
 Provide effective patient reports (shift end, interdisciplinary rounds etc…)
 Effectively engage in consultation and collaboration with other disciplines
 Report pertinent data to staff in a timely and accurate manner
 Maintain detailed and accurate documentation (hard copy, electronic records)
 Effectively access medical records and information systems
Knowledge
 Recall relevant information from previously taught subject matter
 Acquire and recall information from past clinical experience with preceptors and/or faculty
 Demonstrate an understanding of relevant basic concepts
 Effectively apply learned concepts to practice
Critical Thinking
 Demonstrate sound decision making skills
 Demonstrate problem solving skills
 Provide rationale for procedures and changes in therapy
 Analyze and correlate clinical information
 Integrate input from other health disciplines with own critical judgment
 Develop effective patient care plans
 Demonstrate effective critical evaluation skills of patients, care plans and equipment
 Adapt therapy to changes in patient status
 Use self evaluation effectively to improved performance
Efficiency
 Follow direction appropriately from preceptors
 Complete tasks and assigned workload in a timely manner without prompting
 Apply a systematic approach to completing tasks and workload
 Prioritize tasks and patient care effectively
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Demonstrate effective workload planning skills
Complete tasks in a reliable and safe manner
Performs manual skills safely and according to skills guidelines and hospital protocols
Recognize own limitations and need to ask for help
Initiative
 Clearly outline relevant past experience, abilities, limitations and/or previous clinical
responsibilities
 Discuss goals for improved clinical performance
 Seek, and react positively to, constructive feedback
 Take responsibility for errors and establish strategies to improve
 Attempt to complete tasks and assigned workload in a timely manner without prompting
 Assist others (RTs and other health disciplines) with random tasks
 Seek new clinical experiences and challenges
 Seek repeated clinical experience for improved performance
 Ask questions frequently
 Use “down time” constructively for learning
Health, Safety and Infection Control
 Demonstrate effective coping skills with stressful situations
 Use personal protective equipment appropriately
 Comply with all infection control standards
 Adhere to policy and guidelines on biohazard waste management
 Use patient care equipment and supplies appropriately and safely
 Discuss isolation protocols for significant organism precautions
 Evaluate technique of gown/glove/mask
 Clean and disinfect equipment
 List methods of transmission for different common pathogens
Patient Care
1. Patient Assessment
 Outline information that should be obtained from patient’s chart
 Describe factors affecting patient care plan through a body systems review
 Apply patient assessment results to available RT protocols
 Identify basic structures and ETT placement on CXR
 Associate abnormal CXR findings with patient’s past medical history, current status,
and with previous films
 Analyze patient plan through the evaluation of patient results in diagnostic imaging
databases
 Discuss the indications, function, and troubleshooting of chest tube drainage
2. Blood Sampling
 Establish need for obtaining analysis of arterial blood
 Interpret ABG based on PMHX and current condition
 Suggest corrective action, and discuss issues around the corrections of ABGs
 Calculate the correct minute ventilation for a target PaCO2 based on ABG results
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 Evaluate/suggest arterial gas orders
 Discuss implications of acidosis or alkalosis on patient’s condition and
pharmacological therapy
 Discuss the controversy of correcting metabolic acidosis with alkaline agents
 Discuss blood gas results from mixed venous sites (PAC) and central venous sites
(central lines) and implications for mechanical ventilation and cardiovascular
pharmacological management
3. Pulmonary Diagnostics
 Outline indications for ETCO2 use
 Discuss theory of operation of ETCO2
 Discuss indications for therapeutic and diagnostic bronchoscopy in the AICU
 Evaluate success of bronchoscopy post procedure
 Apply ETCO2 readings to an evaluation of patient deadspace
 Discuss use of ETCO2 when determining optimal PEEP
 Describe theoretic course of action with deteriorating patient status during
bronchoscopy
4. Cardiac Monitoring
 Evaluate patient dysrhythmias and suggest course of action
 Discuss the clinical relevance of pulmonary artery catheter readings (i.e. (CVP, PAP,
PAOP, PVR, SVR, Cardiac Output)
 Describe how disease processes, PPV, and patient condition influence pulmonary
artery catheter (PAC) readings
 Evaluate PAC values and correlate with patient’s current condition and past medical
history
 Discuss patient specific PAC values and implications for mechanical ventilation and
cardiovascular pharmacological management
5. Basic Respiratory Care and Medical Gas Therapy
 Discuss oxygen therapy post-extubation, based on requirements when mechanically
ventilated
 Discuss theory of operation of High Flow Cold Nebulizer to provide humidified
oxygen therapy
 Describe oxygen toxicity in terms of etiology, pathophysiology, effects, prevention
and treatment
 Discuss complications of tracheal suctioning
 Outline indications for sputum collection
 Discuss how contamination may affect results of sputum analysis
 Describe how sputum collection results may affect patient care plan
 Describe indications for xylocaine (and/or short acting boluses of sedative) presuctioning
 Discuss controversies regarding use of instillations
6. Airway Management
 Describe indications for use of an oropharyngeal airway (OPA)
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List indications for intubation
Discuss how the position of the ETT is assessed post intubation
Describe complications of intubation and corrective action for these
Describe extubation parameters measured prior to extubation
Evaluate patients for extubation
Describe complications of extubation and corrective action for these
Discuss theory of cuff pressure monitoring
Discuss complications of cuff management
Discuss indications for tracheostomy
Describe the function and maintenance of Evac tubes
Describe the function of various tracheostomy tube adjuncts including: flange, cuff,
fenestration, inner cannulae, obturator and plug
Describe how to utilize various devices used for difficult intubations
Discuss implications of re-taping an ETT on the development of Ventilator
Associated Pneumonia (VAP)
Describe a comprehensive plan to prevent ventilator associated pneumonia (VAP)
Discuss complications of tracheostomy including the procedure and surgical
technique
Discuss theory behind trach weaning
Evaluate patients for trach downsizing
Evaluate patients for plugging trials
Discuss complications of a trach change and course of action for these
7. Mechanical Ventilation
 Describe the effects of positive pressure ventilation on the various body systems
including: CNS, CVS, Respiratory, GI, GU, and MSK
 Describe the concepts of barotrauma (including volutrauma, atelectrauma, shearing
forces) including etiology, pathophysiology, effects, prevention and treatment
 Describe the concept of permissive hypercapnea,
 Describe the components of the ventilator circuit and their function
 Discuss how resistance and compliance is measured, evaluated and the implications
for mechanical ventilation
 Discuss theory behind initial ventilatory parameters selected for particular patients
 Evaluate ventilatory monitoring for precision, accuracy and completeness
 Describe how to optimally set the following parameters based on your particular
patient’s disease/condition, ventilator parameter analysis, ventilator waveform
analysis, and patient assessment/diagnostic results:
- Vt in VC
- Pressure Limit in PC
- Peak Inspiratory Flow in VC with a set insp flow and set flow waveform
- Ti in a PC or Volume Targeted Mode
- Inspiratory Rise Time or Slope
- Trigger
- Cycling Mechanism (I.E. ESENS)
- PEEP
- Mode
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Evaluate the following ventilator mechanics: CSTAT, AutoPEEP, PPLAT, RAW; and
suggest course of action
Evaluate the following calculations and describe possible course of action
- Alveolar to arterial oxygen gradient
- Deadspace
- A-V Difference
- Oxygen Exchange Ratio
- P/F Ratio
- Classic Shunt Equation
- Oxygen Consumption
- Oxygen Delivery
Contrast and discuss a patient readiness to wean with patient readiness for extubation
- Discuss the use of various weaning and extubation tests including; RSBI, NIF,
Leak around the ETT, VC, P 0.1, and other indices
- Discuss the concepts of “off loading” a patient’s work of breathing, and
strength/endurance training as applied to weaning ventilation
- Evaluate weaning trials
Discuss indications for Non-Invasive Mechanical Ventilation (NIMV)
Describe the following modes; A/C , SIMV, PS, Volume Targeted, VS, MMV, TC,
APRV, PAV, ILV, HFO, in terms of the following:
- indications
- theory of operation
- parameter interfacing
- differences with each ventilator (including the Drager Evita, PB 840, Servo I)
Describe how all adjuncts (e.g. ATC, etc) function on the ventilators listed above
Discuss alternative weaning strategies, used at different sites, when patients are
difficult to wean
Discuss complications for NIMV
Describe how to utilize patient assessment results and diagnostics to optimize NIMV
Comprehensively describe how to utilize ventilator (and other airway pressure/flow
analysis devices as they become more mainstream) waveforms (scalars and loops) to
analyze and optimize mechanical ventilation
Discuss the theory behind the use of airway recruitment maneuvers (ARMS),
indications, and effects
8. Cardiopulmonary Resuscitation
 Describe the RT’s role in a code situation
 Evaluate the effectiveness of chest compressions in a code situation
 Discuss the use of manual ventilations in a code situation
9. Pharmaceuticals
 Compare MDI versus SVN administration to a mechanically ventilated patient in
terms of: technique, efficacy, and infection control
 Evaluate MDI and SVN technique for efficacy, and for infection control
 Describe the classification, indications, mode of action, routes of administration,
therapeutic effects, side effects, and dosages of the following medications:
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Respiratory
- acetylcysteine (Mucomyst and *Parvolex)
- epoprostenol (Flolan / Prostacyclin)
- fluticasone (Flovent), budesonide (Pulmicort) and other inhaled corticosteroids
- heliox
- ipatropium bromide (Atrovent)
- isoflourane
- methylprednisolone (Solu-medrol)
- nitric oxide
- prednisone
- racemic epinephrine (Vaponefrin)
- salbutamol (Ventolin) and other short acting beta agonists
- sodium bicarbonate
- tobramycin (inhaled)
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Describe the classification, indications, therapeutic effects, and side effects of the
following medications:
CNS
- diazepam (Valium)
- neostigmine (Prostigmin)
- fentanyl (Sublimaze)
- nitroglycerin
- haloperidol (Haldol)
- oxycodone (Oxycontin)
- ketamine (Ketalar)
- pancuronium (Pavulon)
- lorazepam (Ativan)
- phenobarbital
- meperidine (Demerol)
- phenytoin (Dilantin)
- methadone
- propofol (Diprivan)
- methylphenidate (Ritalin)
- rocuronium (Zemuron)
- morphine
- succinylcholine (Anectine)
- naloxone (Narcan)
GU
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acetazolamide (Diamox)
furosemide (Lasix)
CVS
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amiodarone (Cordarone)
amlodipine (Norvasc)
atropine
captopril (Capoten)
digoxin (Lanoxin)
diltiazem (Cardizem)
dopamine
drotrecogin (Xigris)
enalapril (Vasotec)
epinephrine
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spironalactone (Aldactone)
mannitol
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heparin
hydralazine (Apresoline)
labetalol (Trandate)
lidocaine
milrinone (Primacor)
metoprolol
norepinephrine
vasopressin (adh)
warfarin (Coumadin)
Systemic
 calcium
 magnesium sulfate
 caspofungin
 metronidazole (Flagyl)
 cefazolen (Ancef)
 piperacillin / tazobactam
 ciprofloxacin (Cipro)
 polystyrene (Kayexalate)
 clindamycin (Dalacin)
 potassium chloride
 fluconazole
 vancomycin (Vancocin)
 linezolid
10. Patient Transport
 Provide estimated cylinder duration for patient transports.
 Describe internal transport preparation based on individual patient and destination
 Outline possible complications and describe course of action during patient
transport
11. Diseases / Conditions
 For the following urgent ventilator/patient conditions, describe how they could be
diagnosed, urgently treated, and prevented:
- secretions in the airway
- acute pulmonary edema
- atelectasis
- bronchospasm
- artificial airway (ETT or trach) plugged with secretions (dried or copious
amount) or blood clot
- water in the circuit
- circuit leak
- cuff leak (hole) or leak around the cuff
- kinked tubing / biting the tube
- tension pneumothorax
- pneumothorax recurring with chest tube present
 For the following diseases/conditions: barotrauma, oxygen toxicity, COPD
(emphysema and chronic bronchitis) exacerbation, Status Asthmaticus, CHF,
myocardial infarction, cardiogenic shock, pneumonia, VAP, ARDS, postoperative situations, head injury, Sepsis, BOOP, Wegener's Granulomatosis,
Goodpasture's Syndrome, SARS, SIRS, Pancreatitis, Neuromuscular Diseases
(e.g. Guillian Barre, ALS, etc), Rhabdomyolysis, DIC, BP Fistula;
- Discuss pathophysiology (including shunt and deadspace, as well as lung
compliance and resistance), etiology, presentation, assessment,
diagnostics, and treatment
- Discuss implications for mechanical ventilation including: goals, modes,
adjuncts/parameters, maintenance, weaning and extubation, and protocols
(such as the ARDSNet Protocol)
 Compare and contrast Hemodialysis; Peritoneal dialysis; Renal replacement
therapy
 Describe the basic function of PRISMA
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SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
ASTHMA EDUCATION CLINIC
Rotation overview:
In this clinical rotation students will be exposed to pediatric and adult patients in a clinic,
where education is provided to the patient on managing their chronic disease.
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1 to 2 days in an asthma education clinic
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1 to 2 days in a COPD education clinic
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These dates will be scheduled in the same week as HBO
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See Site Schedules
Pre Rotation
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N/A
Site orientation
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No clinical site orientation will be provided by NAIT faculty
Workbook/
Assignment
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Clinical assignment must be submitted into Moodle by Sunday
midnight following the rotation.
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Assignment will be reviewed for completion by clinical faculty and full
marks will be given if complete. This assignment mark will count
towards the RET602 final mark.
Common Day
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N/A
Exam
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There is no post rotation exam
Clinical
Performance
Evaluation
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There is no formal evaluation required
Schedule
CLINICAL OBJECTIVES
ASTHMA EDUCATION CLINIC
Upon completion of the Asthma Education clinical rotation, the student will be able to:
1. Objectively measure obstructive airway disease (using most recent Canadian Consensus
Guidelines) by
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a. PEFR
b. Pediatric spirometry
2. discuss the following components of asthma education
a. Definition, pathogenesis and diagnosis of asthma
b. Environmental controls and triggers and strategies to manage
c. Self assessment and monitoring
i. Symptom review
ii. PF monitoring
d. Developing action plan
e. Medication type and delivery
3. Understand the use of
a. Inhaled
i. Steroids (hi and low dose)
 Flovent
 Pulmicort
 QVAR
 Alvesco
ii. Bronchodilators
 Short acting (rescue)
– Ventolin
– Aeromir
– Bricanyl
 Long Acting (preventative)
– Oxeze
– Serevent
iii. Combihalers
 Advair
 Symbicort
iv. Low flow inhalers
v. CFC free inhalers
b. Oral systemic
i. leukotriene antagonists
 Singulair
c. Injection
Xolair
d. Delivery devices
ii. MDI
iii. DPI
iv. Aerochambers
4. Discuss the guidelines to asthma management outlined in the Canadian Consensus
Guidelines on Asthma. Ref. link: http://www.asthmaguidelines.com/home.html
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SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
COMMUNITY CARE
Rotation overview:
The Community Care clinical rotation will provide the student with experience in comprehensive
health care outside of hospitals and the acute care setting. Preceptors will introduce the
student to the clinical environment and students are expected to work with their preceptors to
gain experience with the outlined clinical objectives, as well as practice and achieve competency
with related CBO’s.
Each student will be placed in one of 6 Community Care Options as per their preferences. Below
are broad descriptions of each of the 6 elective options:
Private Home Care
Private Home Care companies are the providers of assessment and equipment. They are
responsible for the delivery, set up and teaching of all respiratory therapy equipment
required in a home setting. The companies are privately owned and operated, and are
funded partially by the AADL program as well other agencies such as; department of
veterans affairs, support for independence, etc.. All clients will be screened for funding
as the equipment is costly to rent or purchase. The role of the RT is diverse, assessment,
education of the equipment as well as the client’s condition is important. RT’s are also
involved in public relations and sometimes equipment sales.
Main program location:
 The student will be paired with one home care company within Edmonton
RRT roles and responsibilities:
 Patient assessment and vital signs
 Comprehend and select appropriate oxygen and related equipment
 Apply AADL knowledge
 Patient Education
 Oximetry and oxygen titration
 Multidisciplinary Communication
 Smoking cessation
 Travel to hospitals/clinics and patients’ homes
Student Expectations:
 The student will travel to the Homecare Companies main office for this rotation
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Pulmonary Rehabilitation
Pulmonary Rehabilitation (PR) has proven to be the standard of care in the management
of Chronic Obstructive Pulmonary Disease (COPD) and has been shown to be more
effective than pharmacologic management of the disease alone. It improves health
status and functional exercise capacity while reducing exacerbations and ER/hospital
admissions. PR is a program for patients with a confirmed diagnosis of chronic lung
disease. It follows a multidisciplinary approach with three major components: exercise,
education and support. It is aimed at improving each participant’s ability to manage
their disease, improve exercise tolerance, reduce shortness of breath, maintain
independence, and improve overall quality of life.
RT Duties:
 Cardiopulmonary Stress Testing
 Exercise prescription (flexibility, aerobic exercise, strength training)
 Monitoring of exercise: oximetry, blood pressure, ECG
 Oxygen titration
 Patient education: group, one-on-one, Telehealth (video conferencing to reach
patients in rural locations)
o Breathing techniques, medication review, exercise action plan , smoking
cessation awareness
 Communication with physicians, homecare providers, etc.
 AADL Oxygen Walk Tests
Student Expectations:
 The student will travel to the General Hospital for this rotation
 Students will work under the supervision of Respiratory Therapists as well as
Respiratory Aides
 Students will participate in all RT responsibilities
 Monday – Friday 8:00 – 16:00 (students may be required to complete some
evening shifts 13:00-20:00 )
Main program location:
 General Hospital, Edmonton - The Centre For Lung Health “Breath Easy Program”
 3C-16, 11111 Jasper Ave
 780 342-8951
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Allied Health and Chronic Disease Management
RRT’s within this program have a wide scope of practice and generally work
independently; they are considered experts in their field and are consulted by other
Health Care Providers for a diverse number of community and client needs. Many
programs have been developed by this dynamic group and their role is ever changing to
fit the needs of the public.
Main program location/s:
 Fort Saskatchewan Hospital
 Leduc Hospital
 Plaza downtown, Edmonton
 Mira Health Centre, Edmonton
 NE Family Care Clinic, Edmonton
Main Programs:
 Pulmonary Rehabilitation
 Supportive Living
 Quite Core
 Family Care clinic
 Outpatient Clinics
RRT roles and responsibilities:
 ABG and Spirometry
 Patient Education and Education for other Health disciplines (IPE)
 Smoking cessation
 Full Respiratory Assessment
 Quality of life Questionnaires
 Oxygen assessments and titration
 AADL criteria
 Use multiple types of Medical record programs
 CPR Instructor
 CRE (Certified Respiratory Educator)
Student Expectations:
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The student will be required to travel to and from multiple sites for a rich and
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diverse experience
AHS Home Living
The AHS home living program provides care for clients within a home setting. The approach
to care is interprofessional, which means that many different healthcare professionals may
be involved with a client and their care. The team consists of Registered nurses, Physical
therapists, Occupational therapists, Social workers, Rehab assistants, LPN’s, SLP’s, Rec
therapists, Registered Dieticians, Physicians, Pharmacists and Respiratory Therapists. The
role of the RT is very diverse and challenging, starting with a comprehensive assessment not
only of the client, but as well their ability to manage their disease process independently or
with the aid of caregivers. The key aspect of this rotation is working within a team, but
autonomously in a client’s home. Education is paramount, as it is necessary that clients
understand their disease, treatment and care. The client populations range from infants
and pediatrics to geriatrics and palliative care. The program is also divided into different
zones within the city and surrounding areas. Our aging populating, people suffering from
COPD, and the increased acuity level of patients being sent home has created a greater
need for the skill and expertise provided by RTs in the home setting.
Main program locations:
 North East – NE/North Palliative/Regional – Kingsway Professional Building
 South East – SE and South Palliative – St. Margerite Health Services Centre
 South West – Mother Rosalie Health Services Centre
 North – Sturgeon Health Services Centre, St Albert
 Strathcona – Strathcona Health Centre, Sherwood Park
 Leduc – Leduc Health Centre
 Children’s – East Edmonton Health Center * Possible Sub-rotation see below
RRT roles and responsibilities:
 Patient, family and caregiver education
 Airway management including trach changes, suctioning and bagging
 Case management/Interprofessional communication
 Proper medication review and delivery techniques
 Smoking cessation
 Thorough assessment and history including psychosocial
 Quality of life and activities of daily living questionnaires
 Ventilator and Bi-level management (more so in children’s)
 Students may also go on joint visits with other disciplines during their rotation
Student Expectations:
 The student may be expected to travel to and from patients homes and the
program office.
** The student may choose AHS home living and request Children’s as the preferred
patient population, keeping the following in mind:
 The student must have completed their child health block previous to entering
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this sub-rotation
 The student must have a strong desire to work with the infant and pediatric
population
 The student must be prepared for complex/high acuity cases within children’s
 Additional driving as children’s covers the entire city and surrounding areas
Chronic Ventilator Management
The goal of a chronic ventilation program is to provide a safe, home like environment for
residents requiring ongoing ventilator-assisted respiration. Patients are stable and have
been ventilated for many months and/or years, and an important goal is to ensure the
environment provides as much freedom as possible by giving physical, emotional, mental
and spiritual care to the resident, family and friends. RRTs work with LPNs, RN, Doctors,
and nursing aids as they aim for this holistic approach to patient care. This rotation is
diverse in that the student will spend the first 3 days at the UofA hospital on the ward
where chronic ventilator patients are managed until they are ready to be discharged. The
student will then spend one day with the Respiratory Outreach program who manages
ventilated patients in their own homes, as well as a few hours with an AADL consultant
for an overview of guidelines and clinical assessment of patients from that perspective.
The last four days will be at the Norwood long term care center where ventilator
dependent patients are managed in a facility setting.
Main program locations:
 UofA (Chronic Ventilator Unit)
 Norwood
 General Hospital (AHS/ AADL / Respiratory Outreach program)
RRT Roles and Responsibilities (Site dependent):
 Suction
 Ventilator set-up/check out/circuit changing
 Trach tube changes and overall management
 Oxiflow and Bipap management
 Patient and caregiver education on Ventilator and related equipment
 Management of the BIPAP patient
 Rounds
 Interdisciplinary communication
 Medication delivery
Student Expectations:
 The student is expected to travel to the main program locations.
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COPD Self Initiative Program “CSI”
This unique program allows RT’s work within the hospital continuum recognizing and
supporting clients with COPD or suspected COPD using the guiding principles of the
Canadian Thoracic Society. Multiple visits with the patient while they are in the hospital
allow Therapists to educate, reinforce disease management and proper medical delivery
device use. Interprofessional relationships and ongoing communication with other allied
health colleagues ensure optimum patient care. Thorough pt assessment and history
taking is a foundation for disease management keeping in mind the psychosocial aspect
of the patient’s life.
Main program location:
 Royal Alexandra Hospital
RRT roles and responsibilities:
 ABG
 Spirometry
 Patient Education
 Proper Medication review and delivery techniques
 Smoking cessation and nicotine replacement therapy
 Classify COPD severity as per Canadian Thoracic Guidelines
 Full Respiratory Assessment and History
 Quality of life Questionnaires
 Walk Tests
 Arrange home oxygen
 Identify and refer appropriate community resources for hospital discharge ex.
Pulmonary rehabilitation
 Outpatient clinics for disease follow-up and diagnosis
Student Expectations:
 The student will travel to the RAH for this rotation
Schedule
Pre Rotation
Site orientation
Workbook/
Assignment







Common Day


8 hour weekdays only and statutory holidays will be days off.
The Center for Lung Health for Pulmonary Rehabilitation may
require some evening shifts 1300-2000
See Site Schedules
Check for Pre-reading documents for your specified area in moodle
Orientation will be provided by the site preceptors
Each student will be required to do a class presentation on the final
day of their rotation. (see presentation instructions)
The presentation will be graded by faculty, and count towards the
RET602 final mark
Common class days will be held the 1st and last day of the rotation
See Common Day Schedule information
17
Exam
Clinical Performance
Evaluation


No exam for this rotation
One end point evaluation required
CLINICAL OBJECTIVES
ASTHMA EDUCATION CLINIC
Upon completion of the Asthma Education clinical rotation, the student will be able to:
1. Objectively measure obstructive airway disease (using most recent Canadian Consensus
Guidelines) by
a. PEFR
b. Pediatric spirometry
2. discuss the following components of asthma education
a. Definition, pathogenesis and diagnosis of asthma
b. Environmental controls and triggers and strategies to manage
c. Self assessment and monitoring
i. Symptom review
ii. PF monitoring
d. Developing action plan
e. Medication type and delivery
3. Understand the use of
a. Inhaled
i. Steroids (hi and low dose)
 Flovent
 Pulmicort
 QVAR
 Alvesco
ii. Bronchodilators
 Short acting (rescue)
– Ventolin
– Aeromir
– Bricanyl
 Long Acting (preventative)
– Oxeze
– Serevent
iii. Combihalers
 Advair
 Symbicort
iv. Low flow inhalers
v. CFC free inhalers
b. Oral systemic
i. leukotriene antagonists
18
 Singulair
c. Injection
Xolair
d. Delivery devices
ii. MDI
iii. DPI
iv. Aerochambers
4. Discuss the guidelines to asthma management outlined in the Canadian Consensus
Guidelines on Asthma. Ref. link: http://www.asthmaguidelines.com/home.html
19
SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
EMERGENCY
Rotation overview:
In the ER clinical rotation students will practice skills and demonstrate knowledge required to
conduct acute and critical respiratory care of mostly adult patients, and some pediatrics in the
emergency room. Students are expected to work with their preceptors to gain experience
with the outlined clinical objectives, as well as practice and achieve competency with related
CBO’s.
Schedule
Pre Rotation
Site orientation
Workbook/
Assignment
Common Day
Exam
Clinical
Performance
Evaluation






12 hour shift schedule which may involve weekends and nights
See Site Schedules
N/A
Clinical site orientation will be provided by NAIT faculty
Clinical assignment on which a quiz will be based
Marks will be given for the assignment and count towards the RET602
final mark
 N/A
 There will be a short quiz in Moodle. (60% required to pass)
 The ER quiz will be graded and count towards the RET602 final mark
 1 end point clinical performance evaluation is required
CLINICAL OBJECTIVES
EMERGENCY
Upon Completion of the Emergency Room clinical rotation, the student will be able to:
1. Patient assessment
a. Discuss information obtained from a patient history.
b. Conduct a complete physical assessment and describe the purpose and procedure
of IPPA.
c. Interpret vital signs
20
d. Discuss and interpret information from the patient’s chart including lab data,
radiology reports, ABG’s, consultative summaries and interdisciplinary
assessment records (nursing, pharmacy, physiotherapy etc…)
e. Develop therapeutic objectives based on comprehensive assessment.
2. Oxygen therapy
a. Describe the indications for oxygen therapy
b. Discuss the physiology of oxygen transport
c. Discuss the pathophysiologic processes behind tissue hypoxia
d. Discuss the toxic effects of oxygen
e. Describe oxygen delivery devices (low and high flow).
f. Describe oxygen storage systems (liquid O2, cylinders).
g. Evaluate the effectiveness of oxygen therapy.
h. Indicate the hazards of oxygen therapy
3. aerosol therapy
a. Provide rationale for the appropriate aerosol delivery device for inhaled
medications
b. Discuss the indications for high flow cold neb (HFCN) therapy
4. pulse oximetry
a. Indicate the need for pulse oximetry
b. Identify factors contributing to erroneous pulse oximetry results
c. Discuss the principles of pulse oximetry
5. Spirometry and peak flow measurement
a. Contrast the range of parameters available by spirometry vs. peak flow meter
b. Rationalize the use of spirometry vs peak flow meter
c. Interpret spirometry results
21
6. Airway management
a. Describe interventions to support an unprotected airway
b. Describe indications for use of an oropharyngeal airway (OPA)
c. List indications for intubation
d. Discuss how the position of the ETT is assessed post intubation
e. Describe complications of intubation and corrective action for these
f. Describe various adjuncts used to manage the difficult to intubate patient
g. Discuss the indications for emergency cricothyrotomy
7. blood sampling
a. Discuss reasons for obtaining arterial blood
b. Discuss appropriate technique for radial artery procurement
c. Discuss appropriate transportation and analysis methods
d. Contrast normal values between arterial and venous blood gasses
e. Describe all parameters analyzed or calculated on the blood gas analyzer
f. Interpret ABG results
g. Identify the need for corrective action based on ABG results, and discuss the
reevaluation of your corrective action
8. Discuss and develop strategies for organizing workloads
9. Professionalism
a. Understand and discuss the benefits to team approach in the ER department
b. Discuss the benefits of effective communication with staff, patients and family
c. Discuss cultural influences on verbal and non verbal communication
d. Identify appropriate terminology in terms of verbal and written communication
10. Infection control
22
a. Describe routine precautions
b. Describe the differences between airborne, droplet and contact isolation
11. CPR
a. Describe the correct procedure in adult or pediatric CPR
b. Discuss the RT’s role in CPR
c. Evaluate the effectiveness of CPR
12. Patient transportation
a. Describe internal transport preparation based on individual patient, destination
and available equipment
b. Outline possible complications and describe course of action during patient
transport
13. pharmaceuticals
Describe the classification, indications, therapeutic effects, and side effects of the
following medications:
Respiratory
 acetylcysteine (Mucomyst and *Parvolex)
 flovent, budesonide (Pulmicort) and other inhaled corticosteroids
 heliox
 ipatropium bromide (Atrovent)
 methylprednisolone (Solu-medrol)
 prednisone
 racemic epinephrine (Vaponefrin) (epinephrine for same treatment indications)
 salbutamol (Ventolin)
 Combivent
CNS







diazepam (Valium)
fentanyl (Sublimaze)
ketamine (Ketalar)
lorazepam (Ativan)
meperidine (Demerol)
morphine
naloxone (Narcan)





23
oxycodone (Oxycontin)
phenobarbital
phenytoin (Dilantin)
propofol (Diprivan)
succinylcholine (Anec
GU



acetazolamide (Diamox)
furosemide (Lasix)
CVS (circulatory)
24
mannitol





















amiodarone (Cordarone)
amlodipine (Norvasc)
atropine
captopril (Capoten)
coumadin
digoxin (Lanoxin)
diltiazem (Cardizem)
dopamine
drotrecogin (Xigris)
enalapril (Vasotec)
epinephrine
heparin
hydralazine (Apresoline)
labetalol (Trandate)
lidocaine
milrinone (Primacor)
metoprolol
Nitroglycerin
Norepinephrine
Tissue Plasminogin Activator
vasopressin (adh)
SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
HYPERBARIC OXYGEN THERAPY (HBO)
Rotation overview:
In the HBO clinical rotation students will observe and assist Respiratory Therapists with the
care of patients undergoing hyperbaric oxygen therapy.
Schedule
Pre Rotation
Site orientation




1 day shift
See Site Schedules
Pre reading material must be reviewed prior to attending this rotation
No clinical site orientation will be provided by NAIT faculty
25
Workbook/
Assignment
Common Day
Exam
Clinical
Performance
Evaluation

Clinical assignment must be submitted into Moodle by Sunday
midnight following the rotation.
 Assignment will be reviewed for completion by clinical faculty and full
marks will be given if complete. This assignment mark will count
towards the RET602 final mark.
 N/A
 There is no post rotation exam
 No evaluation is required for this rotation
CLINICAL OBJECTIVES
HYPERBARIC OXYGEN THERAPY (HBO)
Upon completion of the HBO clinical rotation the student will be able to:
1. Describe the history of HBO. (discovery of oxygen, pressurized air and oxygen under
pressure)
2. Discuss the physiological effects of hyperbarism and hperbaric oxygen
3. Explain the toxic effects of oxygen
4. Explain the physiological mechanisms which lead to decompression sickness (“the bends”)
5.
Describe the following in relation to HBO therapy:
- Atmospheric pressure
- Absolute pressure
- Gauge pressure
6.
Relate the following gas laws to the application of HBO therapy:
- Boyle’s Law
- Henry’s Law
- Charles’s Law
7.
List the approved standard and adjunctive indications for HBO therapy
8.
Describe the absolute and relative contraindications for HBO therapy
9.
List and explain side effects of HBO therapy
10. Explain the safety precautions that must be considered in providing HBO therapy
11. Explain the basic operation of the Sechrist ventilator in a monoplace chamber
26
12. Discuss the complication of administering HBO regarding:
- IV access
- Ventilator management
- Patient communication
13. Identify the uses of TcPO2 monitoring in terms of wound management
14. Discuss the experimental and future application of HBO therapy
15. Differentiate the indications and safety issues of multiplace HBO chambers
27
SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
NEONATAL INTENSIVE CARE
Rotation overview:
In the NICU clinical rotations students will practice skills and demonstrate knowledge required
to conduct acute and critical respiratory care of term and preterm infants with a broad range
of medical disorders and surgical needs.
The neonatal portion of the Child Health rotation will include 2 different clinical
environments:
 1 week NICU (Grey Nuns), gives the student experience with stabilization and
resuscitation of the newborn in the labor and delivery suite.
 3 weeks NICU (Royal Alexandra), gives the student experience with term and pre term
infants requiring respiratory care, including mechanical ventilation for a variety of
disorders, as well as attend and participate in high risk deliveries.
 1 week NICU (University/Stollery), gives the student experience with mostly term
infants that require surgical interventions for a variety of disorders, many of which are
associated with the airway and congenital heart repairs. Students will work with
ventilated and nonventilated infants.
Students are expected to work with their preceptors to gain experience with the outlined
clinical objectives, as well as practice and achieve competency with related CBO’s.
Schedule
Pre Rotation
Site orientation
Workbook/
Assignment








Common Day


Exam

12 hour shifts which may include nights and weekends.
See Site Schedules
Clinical Simulation Week
Pre rotational exam written in clinical simulation week (80% to pass).
The break down for the exam is under Child Health Clinical Simulation.
See schedule in Clinical Simulation
Formal orientation will be provided by the NAIT clinical instructor for
the NICU (RAH) and NICU (UAH)
Neonatal part of Child Health workbook must be done for Child Health
Common day
Workbooks will not be marked but are meant as a self study tool and
guide for review on common day
Some questions may require presentation on common day
See Common Day Schedule for date, time and location of Child Health
common day which will include review of the pediatric and neonatal
workbook questions and concepts.
The Child Health Exam will incorporate the neonatal test questions,
28

Clinical
Performance
Evaluation




and will occur in the last week of the Child Health block. (60% to pass)
Test questions will be based on clinical experience and objectives from
all 3 neonatal rotations within the Child Health block.
Exam will be graded and count towards the final RET602 mark
Exam date and time will be scheduled by NAIT clinical site faculty
One mid and end point evaluation required for NICU (RAH) and PICU
(UAH)
One end point evaluation required for NICU (GNH), and NICU (UAH).
CLINICAL OBJECTIVES
NEONATAL INTENSIVE CARE
Upon Completion of the NICU clinical rotations, the student will be able to:
A. Patient Assessment
1. Assess relevant patient information
i. Access patient and maternal history from the patient chart, and respiratory
therapy information card indexing system/binder
ii. Use information obtained from report and rounds to develop a care plan
iii. Modify existing care plan based on patient assessment
2. Assess patient for relevant clinical signs.
i. Spontaneous breathing rate and apneas
ii. Signs of respiratory distress
iii. Vital signs
iv. Auscultation
3. Blood gas analysis.
i. Determine need for sample
ii. Analyze sample and correlate clinically
iii. Recommend appropriate action
4. CXR
i. Promote neutral position of endotracheal tube during the process of
repositioning patient for CXR and utilize neck brace if applicable
ii. Assess position of endotracheal tube and advance or retract ETT if indicated
iii. Identify specific abnormalities
iv. Compare with previous films
B. Communication
1. Documentation
i. Clearly and concisely document patient assessment and patient progress
ii. Document patient procedures
iii. Chart with reference to established guidelines
29
2. Verbal Communication
i. Communicate effectively with patient’s caregivers and health care team
ii. Provide accurate and relevant patient report
iii. Present information on patient rounds
iv. Suggest respiratory care plan
C. General Therapeutics
1. Oxygen therapy
i. Assess need
ii. Select appropriate delivery device
iii. Administer oxygen via appropriate delivery device.
iv. Assess clinical effectiveness and titrate
v. Record data
vi. Discuss various methods of applying oxygen via CPAP devices including high
flow nasal cannula, nasal prongs, nasal masks and nasopharyngeal tube.
2. Humidity Therapy
i. Demonstrate ability to maintain appropriate humidity and temperature control
with all medical gases
ii. Evaluate effectiveness of therapy and modify if needed
3. Aerosol Therapy
i. Assess need for aerosol/inhaled medication
ii. Select appropriate device or method for the application of aerosol/inhaled
medication
iii. Evaluate effectiveness of therapy and record appropriate data
iv. Identify the specific drug names, indications, relative contraindications,
effects, side effects, routes, and dosages of the following inhaled drug
classifications
1. beta two agonists/alpha one agonists
2. corticosteroids
4. Airway Management
i. Intubation and tracheostomy
1. prepare equipment
2. assist with procedure
3. secure tube and evaluate placement
4. perform tracheostomy care
5. record appropriate data
ii. Extubation and decannulation
1. assess patient for extubation readiness
2. perform extubation
3. provide post extubation care
30
4. assess patient as per patient assessment and site policy
5. record appropriate data
iii. Suction Therapy (oral, nasal, and into artificial airway via inline or glove and
catheter)
1. assess need for suctioning and instillation (instillation as per site
policy)
2. assemble required equipment
3. initiate procedure
4. monitor effects of therapy
iv. Manual Ventilation
1. assemble equipment and ensure function
2. perform ventilation with self inflating, flow inflating units and t-piece
resuscitators
3. assess effectiveness of therapy and modify as needed
5. Mechanical Ventilation
i. Discuss the available modes and particulars of the following ventilators; Servo
300 & Servo i, Drager Evita 2, 4 & XL, Drager Babylog, Arabella Blender,
Viasys SiPAP Unit, Sensormedics 3100A
ii. Perform initial checkout of standby ventilator
iii. Select appropriate ventilator parameters as per protocol, modifying for patient
clinical presentation and/or manual ventilation results
iv. Initiate therapy
v. Assess initial patient response and modify accordingly
vi. Select appropriate alarm and apnea settings
vii. Measure and assess patient respiratory mechanics
viii. Optimize ventilation
ix. Determine suitability for weaning
x. Develop weaning plan based on rounds
xi. Perform weaning based on ABG results, ETC02 and clinical presentation
D. Diagnostics
1. Pulse Oximetry/ ETCO2/Transcutaneous Monitoring
i. Assess need
ii. Gather equipment (for all of the available units) and follow set-up procedure
iii. Apply monitor/probe correctly
iv. Establish reliability of measurement
v. Troubleshoot as required
vi. Correlate readings with ABG results
vii. Modify therapy based on readings
viii. Record appropriate data
31
E. Transport
1. Discuss use of isolette and transport isolette to maintain a neutral thermal
environment for the neonate.
2. Identify equipment needed for in and out of hospital transports
3. Discuss implications to therapy from high altitude environments during transport
4. Discuss function of transport ventilator.
F. Medications
1. Discuss the indications, effects, (and dosages and side effects where applicable) of the
following medications:
 caffeine
 morphine
 indomethacin (Indocid)
 Narcan (naloxone)
 HCO3/Tham
 chloral hydrate
 Acetate
 phenobarbital
 surfactant (BLES)
 midazolam (Versed)
 epinephrine
 valium (Diazepam)
 dobutamine
 digoxin
 dopamine
 nitric oxide
 atropine
 sildenafil (Viagra)
 magnesium sulfate
 Lasix (furosemide)
 dexa / betamethasone
 Aldactazide
 cortisone
 racemic epinephrine
 Vitamin K
(Vaponefrin)
 succinylcholine
 prostaglandin E1,/ alprostadil
 Pavulon / Rocuronium
(Prostin)
 neostigmine
 fentanyl/sufentanil
 ventolin (salbutamol)
G. Disease / Condition
1. Discuss the presentation, pathophysiology, and treatment for the following
diseases/conditions:
32





















RDS & CLD
PPHN
CDH
CHD
MAS
Hydrops
TTN
Apnea of Prematurity
PDA
IVH
ROP
Chromosomal Abnormalities
Air leak syndromes
Pneumonia
Pulmonary hypoplasia/agenesis
Hyperbilirubinemia
Pierre Robin
Placenta Previa
Placenta Abruptio
Omphalocele
Gastroschesis
Other
1.Discuss indications, theory, procedure and use of the equipment/attachments for the
following items:
 High Frequency Ventilation / Oscillation
 Nitric Oxide
 Transillumination
 Hyperoxygen, Hyperventilation Test
 Responding to Brads / Apneas
 Bronchoscopies
33
SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
OPERATING ROOM
Rotation overview:
In the OR clinical rotation students will practice skills and demonstrate knowledge required to
prepare and manage equipment and patients pre operatively, intra operatively and post
operatively. Preceptors will introduce the student to the clinical environment and students
are expected to work with their preceptors to gain experience with the outlined clinical
objectives, as well as practice and achieve competency with related CBO’s.
Schedule
Pre Rotation
Site orientation
Workbook/
Assignment
Common Day
Exam
Clinical
Performance
Evaluation





Monday to Friday 8 hour day shifts
Statutory holidays will be a day off for the student
Strongly recommended to review Anesthesia course notes and related
text material
Informal orientation will be provided by site RT/preceptor
N/A
 N/A
 There will be a post rotation exam on the final day of the rotation
(60% required to pass)
 The OR exam will be graded and count towards the RET602 final mark
 1 end point clinical performance evaluation is required
CLINICAL OBJECTIVES
OPERATING ROOM
Upon completion of this rotation the student will be able to:
1. Describe component parts and principles of operation of the anaesthetic gas machine (AGM)
a. vaporizers
b. circuits
i. circle
ii. Jackson
c. scavenging systems
i. active vs passive
d. Modes of ventilation
e. safety mechanisms
i. color coding
ii. o2 flush
34
iii.
iv.
v.
vi.
f. alarms
i.
ii.
iii.
pressure limit
o2 alarm
one way valve mechanism
electro-mechanical system to prevent hypoxic mixture
anaesthetic gas analyzer
pressure and volume
O2 analyzer
2. Discuss what quality assurance relates to the maintenance of an AGM
a. initial check out
b. Preventative maintenance
3. Explain and contrast the terms
a. Anesthesia
b. Analgesia
c. hypnosis
d. amnesia
4. Describe how each of the following influence risk to the patient during anaesthesia
a. age
b. weight
c. substance abuse
d. pregnancy
e. pathophysiology of the
i. cardiovascular system
ii. central nervous and neuromuscular system
iii. respiratory system
iv. renal system
5. Distinguish between the following methods of anaesthesia
a. regional
i. spinal, epidural, nerve block
b. local
i. freezing
c. general
i. volatile agent
ii. IV sedation (propofol, versed, fentanyl, remi fentanil)
6. Explain what is meant by “induction” as well as the following associated methodology
a. inhalation
b. intramuscular
c. intravenous
d. rapid sequence
i. indications
ii. contraindications
7. Discuss the physiologic principles of uptake and elimination of volatile anaesthetic agents,
taking into consideration
a. alveolar ventilation
35
b. blood flow
c. anaesthetic agent stability
8. Discuss the meaning and application of
a. MAC values
b. the second gas effect
9. Describe the equipment and/or skills used, and importance of, monitoring the following
intraoperatively:
a. cardiovascular system
b. central nervous system
c. fluids and electrolytes
d. body temperature
e. respiratory status
i. ABG
ii. SpO2
iii. EtCO2
f. nerve stimulator, and implications for
i. drive to breath
ii. abdominal muscle effort
10. Differentiate in general terms the following drug classifications and explain indications
therapeutic effects/mechanism of action, contraindications and adverse effects of the listed
specific agents.
a. barbiturates
i. sodium thiopental (pentathol)
b. narcotics
i. fentanyl, morphine, remi fentanil
c. benzodiazepines
i. vallium, ativan
d. ketamine
e. propofol
f. inhaled volatile anaesthetic agents
i. sevoflurane
ii. isoflurane
iii. desflurane
g. nitrous oxide
h. Neuromuscular blockers
i. depolarizing
 succinylcholine
ii. non-depolarizing
 rocuronium
 pancuronium
i. reversal agents
i. narcan
ii. neostigmine
j. anticholinergics
i. atropine
k. Antiemetics
i.
36
11. Explain precipitating factors as well as treatment of the following anesthesia related
complications:
a. allergic reactions
b. aspiration
c. barotrauma
d. hyper/hypotension
e. hypothermia
f. malignant hyperthermia
g. nerve injury
h. air embolism
i. CNS depression
j. diffusion hypoxia
12. Discuss fluid management and indications for:
a. colloids
b. crystalloids
c. blood products
d. Fluid warming
e. Cell saver
13. Discuss tracheal intubation in terms of
a. indications
b. evaluating ease / difficulty of procedure
i. mallampati score
ii. Cormack
c. preferred route (oral vs. nasal)
d. conventional supplies needed for procedure
e. techniques
i. BURP
ii. Sellick
f. adjunctive devices used to manage a difficult airway
i. bougie
ii. glidescope
iii. bullard
iv. bronchoscope
v. intubating LMA
vi. light wands
g. complications during procedure
14. Discuss cricothyrotomy in terms of
a. indications
b. equipment
c. procedure
d. risks
15. Discuss the management of an laryngeal mask airway (LMA) in terms of:
a. indications
37
b.
c.
d.
e.
equipment
procedure
risks
ability to ventilate
16. Understand techniques in manual ventilation with a flow inflating bagger, by mask on a non
intubated patient (via AGM)
17. Discuss techniques and strategies in maintaining a patent airway using
a. proper patient positioning
b. oral pharyngeal tubes (OPA)
c. Jaw thrust
d. Head tilt, chin lift
18. Explain the post-operative management of
a. emergence
b. atelectasis
c. hypotension
d. hypoventilation
e. hypoxia
f. laryngospasm, laryngeal edema and stridor
g. pain
h. vomiting and aspiration
i. pulmonary edema
i. negative pressure
ii. fluid overload
38
SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
PEDIATRICS (PICU and Peds Wards)
Rotation overview:
In the PICU and PW clinical rotations students will practice skills and demonstrate knowledge
required to conduct acute and critical respiratory care of pediatric patients with a broad range
of medical disorders and surgical needs.
The pediatrics rotation makes up 4 weeks of the Child Health block and consists of two
different experiences.
 Pediatric wards is a one week rotation where you will be exposed to pediatric
tracheostomy care, chronic ventilator management, pediatric Bipap, oxygen therapy and
sleep studies.
 The other three weeks of this rotation are spent in PICU, which is divided into a
medical and cardiac PICU. In the medical PICU you will be exposed to ventilator and
Bipap management of children with a wide variety of acute and chronic medical
conditions. In the cardiac PICU you will be exposed to a variety of congenital heart
defects at various stages of surgical correction.
Students are expected to work with their preceptors to gain experience with the outlined
clinical objectives, as well as practice and achieve competency with related CBO’s.
Schedule
Pre Rotation
Site orientation
Workbook/
Assignment








Common Day


Exam



12 hour shifts which may include nights and weekends.
See Site Schedules
Clinical Simulation Week
Pre rotational exam written in clinical simulation week (80% to pass).
The break down for the exam is under Child Health Clinical Simulation.
See schedule in Clinical Simulation
Formal orientation will be provided by the NAIT clinical instructor for
the PICU.
Pediatric part of Child Health workbook must be done for Child Health
Common day
Workbooks will not be marked but are meant as a self study tool and
guide for review on common day
Some questions may require presentation on common day
See Common Day Schedule for date, time and location of Child Health
common day which will include review of the pediatric and neonatal
workbook questions and concepts.
The Child Health Exam will incorporate the Pediatric test questions,
and will occur in the last week of the Child Health block. (60% to pass)
Exam will be graded and count towards the final RET602 mark
Exam date and time will be scheduled by NAIT clinical site faculty
39
Clinical
Performance
Evaluation


One mid and end point evaluation required for PICU
One end point evaluation required for PW
CLINICAL OBJECTIVES
PEDIATRIC WARDS
Upon completion of the Pediatric Wards Clinical Rotation the student will be able to:
Professionalism
 Utilize self analysis and preceptor feedback to plan specific daily and rotation goals and
objectives
 Describe appropriate responses to patient and family members when: inquiries are made
regarding patient condition, and when providing patient and family education
Infection Control
 Discuss isolation protocols for significant organism precautions
 Evaluate technique of gown/glove/mask
 Evaluate method of disinfecting equipment
Patient Assessment
 Outline information that should be obtained from patient’s chart
 Apply patient assessment results to develop a care plan appropriate for patient condition
Consultation and Communication
 Evaluate patient shift reports, and medical rounds reports, for essential and non-essential
information
 Provide accurate and relevant patient shift report
 Evaluate documentation for clarity, accuracy, and completeness
Blood Sampling
 Establish need for obtaining analysis of capillary or venous blood
 Interpret results based on PMHX and current condition
Basic Respiratory Care and Medical Gas Therapy
 Discuss indications for oxygen therapy
 Discuss appropriate oxygen therapy delivery devices
Airway Management
 Discuss indications for tracheostomy
 Discuss complications of tracheal suctioning
 Discuss complications of a tracheotomy tube change
 Discuss indications for a cough assist device
Mechanical Ventilation
 Describe the components of the ventilator circuit and their function
 Evaluate weaning trials
40

Discuss indications for Non-Invasive Mechanical Ventilation
Cardiopulmonary Resuscitation

Describe the RT’s role in a code situation

Evaluate the effectiveness of chest compressions in a code situation

Discuss the use of manual ventilations in a code situation



Pharmaceuticals
Describe the classification, indications, mode of action, routes of administration,
therapeutic effects, side effects, and dosages of the following medications:
 Acetylcistine
 Fluticasone, budesonide and other inhaled corticosteroids
 Levo epinephrine
 Pentamidine
 Salbutamol and other short acting beta agonists
 Tobramycin
Diseases / Conditions

Discuss the following diseases /conditions
 Brain injury
 Bronchiolitis
 Bronchopulmonary dysplasia
 Central Hypoventilation Syndrome
 Cerebral palsy
 Croup
 Epiglottitis
 Laryngomalacia
 Neuromuscular diseases affecting ventilation
 Pierre-Robin Syndrome
 Tracheomalacia
 Treacher Collins Syndrome
41
SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
CLINICAL OBJECTIVES
PEDIATRIC INTENSIVE CARE
Upon completion of the PICU Clinical Rotation(s), the student will be able to:
A.
Patient Assessment
Assess relevant past medical history and gather pertinent data
- summarize pertinent medical history from patient chart
-
use information obtained from Respiratory Therapy report and team rounds to develop a care plan
consistent with patient condition
-
explain rationale and implications for Respiratory care plan
Assess patient for relevant clinical signs
- respiratory status/pattern
- thoracic dimensions/deformity
- bilateral chest excursion
- tracheal position
- auscultation: assess presence of breath sounds and intensity, and describe the
presence, location, quality, and phase of adventitious sounds
Blood Analysis
- determine the need for sampling
- obtain capillary blood gas sample
- analyze sample and assess the reliability of results
- interpret results and evaluate in accordance with patient clinical status
- correlate with monitoring devices
- recommend appropriate action for clinical situation
CXR
- assess position of endotracheal tube
- identify specific abnormalities
- compare current CXR with previous films
a. Cardiovascular Assessment
- evaluate heart rate, blood pressure, and mean arterial pressure
- evaluate pulmonary artery pressure and pulmonary artery occlusion pressure
- measure Qs/Qt
- interpret data/correlate with ventilator management
42

Communication
Documentation
- clearly and concisely document patient assessment and patient progress
- document patient procedures
- chart with reference to established guidelines
Verbal Communication
- communicate effectively with patient, family, and other members of the health care
team
- provide accurate and relevant patient report
- present information at patient rounds
- suggest respiratory care plan and alternatives
C.
General Therapeutics
1. Oxygen Therapy
- assess the need for oxygen therapy
- select appropriate device
- administer oxygen therapy via nasal cannula, oxygen mask, and high flow nebulizer
- assess clinical effectiveness of oxygen therapy
- titrate oxygen therapy appropriately
2. Humidity/Aerosol Therapy
- administer appropriate humidity and temperature control with all medical gas
administration
- list the indications, contraindications, routes of administration, dosage, desired
effect, and side effects of the following:
- salbutomol and other Beta Agonists
- racemic epinephrine
- inhaled corticosteroids
- inhaled antibiotics
- assess need for inhaled medications
- select appropriate delivery device and administer medication using proper
technique; ventilated and non ventilated patient
- monitor patient for beneficial effects and side effects of medication
- evaluate treatment plan; recommend changes to therapy as necessary
43

D.
Airway Management
1. Intubation and Tracheostomy
- perform checks of emergency intubation equipment and crash carts
- select and prepare equipment for intubation
- assist with intubation
- assess proper tube placement
- secure endotracheal tube/tracheostomy tube
- perform cuff management
- perform repositioning of endotracheal tube
- perform extubation
- perform tracheostomy care
- perform insertion of oropharyngeal airway/nasopharyngeal airway
- manage accidental extubation/decannulation
2. Suction Therapy
- assess the need for suctioning/instillation
- select and assemble appropriate equipment
- perform oral and tracheal suctioning
- collect sputum sample
- assess patient response to therapy
A.
Manual Ventilation
B.
select and assemble appropriate equipment
ensure function of equipment
perform manual ventilation via artificial airway
assess effectiveness of manual ventilation and modify therapy as necessary
Mechanical Ventilation
1. Initiation
-
set up standby ventilator and verify function
select appropriate ventilator and initial parameters according to clinical indications
initiate ventilation
monitor initial patient response and adjust parameters as necessary
select appropriate alarm/apnea backup settings
2. Management
- evaluate patient–ventilator interaction
- verify and monitor ventilator settings
- measure/assess respiratory mechanics
- static and dynamic compliance
- plateau pressures
- auto-PEEP
- airway resistance
- waveforms
- measure and assess oxygenation status
- PaO2, SpO2, SaO2, PaO2/FiO2, DO2, CaO2, C(a-v)O2, oxygen index
- measure/assess ventilation status
44
-
PaCO2, PetCO2, VD/VT
adjust ventilator settings to obtain optimal patient/ventilator synchrony and
minimize the adverse effects of positive pressure ventilation
adjust ventilator settings to meet therapeutic goals
perform ventilator circuit/component changes as necessary
3. Weaning
- assess patient’s condition to determine readiness for weaning
- obtain weaning indices when appropriate and assess validity of results
- VC, VT, NIF, P.01, rapid/shallow breathing index
- select appropriate weaning method consistent with weaning protocol and patient
condition
- assess patient response to weaning
- monitor and evaluate weaning process
- adjust or discontinue weaning method as necessary
C.
Pathophysiology
-
describe the following diseases/conditions
describe common respiratory therapy goals and methods of treatment
1. Pulmonary
- ARDS
- pulmonary edema
- chest wall abnormality
- COPD/BPD
- asthma
- pneumonia
- chest trauma
- neuromuscular diseases affecting ventilation
- pulmonary embolus
2. Cardiac
- HLHS
- PDA
- VSD and ASD
- AVSD
- Coarctation of the aorta
- Transposition of the great vessels
- TAPVD
- Tetrology of Fallot
- Valvular atresia
- Aortic stenosis
- Truncus arterioisis
3. Other Body Systems
- Shock
- Sepsis
- Head injury
- Renal failure
45
D.
Depressed ventilatory drive (O.D., post anesthesia)
Infection Control
-
follow standard and universal precautions
use appropriate hand washing technique
identify and use appropriate isolation procedure as required
use sterile or aseptic technique where indicated
follow procedures for biological and ‘sharp’ disposals
carry out equipment exchanges
46
SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
PULMONARY FUNCTION
Rotation overview:
In the PFT clinical rotation students will practice skills and demonstrate knowledge required to
obtain pulmonary diagnostics on adult patients. Preceptors will introduce the student to the
clinical environment and students are expected to work with their preceptors to gain
experience with the outlined clinical objectives, as well as practice and achieve competency
with related CBO’s.
Schedule
Pre Rotation
Site orientation
Workbook/
Assignment








Common Day
Exam
Clinical
Performance
Evaluation




Monday to Friday 8 hour day shifts
Statutory holidays will be a day off for the student
Workbook 1 must be complete before the rotation starts
Informal clinical site orientation will be provided by RT/preceptor
Workbooks for this rotation are intended to help students understand
the concepts related to PFT and are excellent study tools for the post
rotation exam.
Workbook 1 must be complete before the rotation starts
Workbook 2 must be complete during the rotation
The workbooks will not be graded but may be verified for completion
by clinical faculty and/or site RT/preceptor
N/A
There will be a post rotation exam on the final day of the rotation
(60% required to pass)
The PF exam will be graded and count towards the RET602 final mark
1 end point clinical performance evaluation is required
CLINICAL OBJECTIVES
PULMONARY FUNCTION
Upon completion of the Pulmonary Function rotation, the student is expected to be able to:
1. List the indications and contraindications for pulmonary function testing.




medical
urgical
disability evaluation
research
47
2. Explain the significance of the following:









VT, f, VE, Vp, VA, VD/VT
IRV, ERV, RV, IC, FRC, SVC, TLC, RV/TLC, CV, CC
FVC, FEV1%, FEV1, FEF25-75%, PEFR, FEF 200-1200
V, VMAX 75%, 50%, 25%, FEF 25%, 50%, 75%, MVV
VTG, RAW, GAW, CL
DLcoSB, DLcoSS
VO2, VCO2, respiratory exchange ratio
MIP, MEP
PIF, PEF
3. Explain the significance of the following on predicted values:






age
sex
height
rate
the use of +/-20% and standard deviation
weight when applicable
4. Describe the factors affecting validity of test results according to American Thoracic Society
Standardization of Spirometry.







equipment recommendations
equipment validation
equipment quality control
maneuver performance recommendations
measurement procedures
acceptability and reproducibility
reference values and interpretation standardization
5. Explain the indications for termination of a test.
6. Explain the principles of the following tests:




lung volumes and capacities
ventilation/perfusion
pulmonary mechanics
diffusion
7. Explain the rationale for pre and post bronchodilator testing.
8. Compare the principles of operation, advantages and disadvantages of the following types of
equipment:
48




volume displacement spirometers
- water seal
- dry rolling seal
- bellows
flow measuring spirometers
- turbines
- differential pressure pneumotachometers
- thermal anemometers
- ultrasonic sensors
plethysmographs
- variable pressure type
- flow or variable volume type
gas analyzers
- infrared absorption
- thermal conductivity
- emission spectroscopy (Giesler tube)
9. List the advantages and disadvantages of computerized system.
10. Describe quality control measures.

quality assurance program
- equipment
- tests (ex. patient sitting or standing)
- calibration procedures for volume, flow and time
11. Describe the differences between:




Morris
Knudson
Kory
Polgar
12. Derive the predicted pulmonary function values from a nomogram.
13. Identify the pattern of abnormality of pulmonary function results using the following criteria:



Select the best test according to the standards
Interpret the test results
Assess the effectiveness of bronchodilators
14. Perform routine and Advanced Pulmonary Function maneuvers.



FVC, Flow Volume Loop (assessment of bronchodilator therapy)
Spirometry
MVV
49


NWm (FRC/RV)
Body Plethysmography
- Airway resistance
 Diffusion Capacity
 BTPS correction factors
15. Differentiate between function test results in terms of:
Interpret pulmonary function test results in terms of:














normal pattern
obstruction patterns
upper airways
fixed
variable intra-thoracic
variable extra-thoracic
lower airway
restrictive patterns
pulmonary parenchyma
non-pulmonary parenchyma
pulmonary
extra pulmonary
diffusion defects
combination patterns
16. Know infection control procedures utilized in the pulmonary function lab.
17. Document pertinent information and observations.
18. Describe the purpose of exercise testing.
50
SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
CLINICAL OBJECTIVES
SLEEP
Rotation overview:
In the Sleep Diagnostics clinical rotation students will observe and assist in Level I sleep
diagnostics and a CPAP clinic. Students will have exposure to patients with sleep disordered
breathing, diagnostic results, as well as diagnostic and therapeutic technology used in level I
and level III clinical environments.
Schedule
Provincial Sleep Lab at the Edmonton General hospital



Monday 0700-1830
Tuesday 1945 - 0720 (night shift)
Friday - 1 day at a CPAP clinic reviewing test data, fitting patients with
appropriate masks and CPAP devices, and educating the patient and family

See Site Schedules for CPAP Clinic rotation
Or
Avant Sleep Lab
 All of the clinical rotation including CPAP will be at the Avant Lab
 Monday 0900-1700
 Tuesday 0900-1700
 Wednesday 0900-1700
 Thursday 2030-0700 (night shift)
In the event of a statutory holiday falling in the week of your rotation, see
below:
If the Stat Falls on a Monday at the General Sleep Lab the schedule will be:
 Tuesday, 0700-1830 at the Edmonton General Hospital
 Wednesday, 1945-0720 at the Edmonton General Hospital
 Friday day shift at a CPAP clinic, refer to:
o CPAP Clinic Schedule for the clinical site you are scheduled at
and Clinical Site Information for site details and shift hours
If the Stat Falls on a Friday your CPAP clinic day will be on Thursday instead
(if the CPAP clinic schedule does not reflect this please contact your clinical
instructor)
If the Stat falls on a Monday at Avant Sleep Lab your shifts will be :
51
Pre Rotation
Site orientation
Workbook/
Assignment



Tuesday 0900-1700
Wednesday 0900-1700
Thursday 2030-0700



Pre reading material must be reviewed prior to attending this rotation
Informal clinical site orientation will be provided by RT/preceptor
Complete the Sleep Diagnostics clinical assignment in Moodle. You
will need to refer to the Polysomnography file to answer one of the
questions in the assignment.
Due on the Sunday at midnight following the end of the rotation.
Assignment will be reviewed for completion by clinical faculty and full
marks will be given if complete. This assignment mark will count
towards the RET602 final mark.
N/A
There is no post rotation exam
One evaluation is required for the Level 1 Sleep Lab experience after
completion of night shift.


Common Day
Exam
Clinical
Performance
Evaluation



CLINICAL OBJECTIVES
SLEEP
Upon completion of the Sleep clinical rotation, the student will be able to:
1. Discuss the scope of practice in modern sleep diagnostics
2. Understand the impact of undiagnosed sleep disorders
3. Define OSA and OSAS as well as related pathophysiology
4. Describe risk factors associated with Obstructive Sleep Apnea (OSA)
5. List symptoms associated with Obstructive Sleep Apnea Sysndrome (OSAS)
6. Describe the relationship between OSA and the following conditions:
a. Hypertension
b. Cardiovascular disease
c. Cerebral vascular disease
d. Cardiac arrhythmias
7. Describe the apnea-hypopnea index (AHI) and diagnostic criteria for OSAS
8. Define central sleep apnea (CSA) as well as related pathophysiology
9. Define hypoventilation syndromes
10. Define Cheyne-Stokes breathing pattern
52
11. Describe equipment used, and parameters measured during PSG testing in a level 1 sleep
study.
12. Contrast level 1 PSG studies versus sleep screening.
13. Define the term “Epoch” as it relates to sleep studies.
14. Recognize and interpret sleep study results for the following conditions:
a. Obstructive apnea
b. Central apnea
c. Mixed apnea
d. CPAP titration
e. Cheyne Stokes respirations
15. Discuss the significance in correlating chart review, patient assessment, and sleep study
interpretation in the diagnoses of OSA.
16. Compare and contrast surgical versus non surgical management of OSAS
17. Discuss the titration of:
a. Oxygen
b. CPAP
c. Bi-Level
18. Contrast the effectiveness of positive airway pressure (PAP) on:
a. OSA
b. CSA
c. Hypoventilation syndromes
19. Describe components to positive airway pressure (PAP) devices used in treatment of
OSAS.
20. Understand the differences between and indications for CPAP, bilevel, APAP, and ASV.
21. Recognize the differences and appropriate use of different types of PAP interfaces
(masks, pillows etc…)
22. Describe how oxygen is integrated into CPAP and Bilevel devices
23. Discuss considerations in patient comfort when initiating PAP therapy for sleep
disordered breathing
24. Describe and recognize adverse conditions that can develop from PAP therapy in
treatment of sleep disordered breathing
25. Discuss possible modifications in therapy to improve patient comfort and compliance.
53
26. Explain the importance of, and assist with patient education regarding testing and
diagnoses as well as equipment related to treatment.
54
SCHOOL OF HEALTH SCIENCES RESPIRATORY THERAPY
WARDS
Rotation overview:
In the Wards clinical rotation students will practice skills and demonstrate knowledge
required to conduct respiratory care of adult patients with acute and chronic respiratory
disease/disorder. Students are expected to work with their preceptors to gain experience
with the outlined clinical objectives, as well as practice and achieve competency with related
CBO’s.
Schedule
Pre Rotation
Site orientation




Workbook/
Assignment



Common Day







Exam
Clinical
Performance
Evaluation
12 hour shifts which may include nights and weekends.
See Site Schedules
N/A
Formal orientation will be provided by the NAIT clinical instructor
except for Red Deer which will be provided by that sites
RTs/preceptors.
Workbook must be done in time for review on Wards common day
Some questions may require presentation on common day
Workbooks will not be marked but are meant as a self study tool and
guide for review on common day
Common class day will be scheduled in the 3rd week of the rotation
See Common Day Schedule for date, time and location of common day
Post rotation exam will be written at the end of rotation (60% to pass)
Exams will be graded and count towards the final RET602 mark
Exam date and time will be scheduled by NAIT clinical site faculty
One mid rotation evaluation required
One end point evaluation required
CLINICAL OBJECTIVES
WARDS
Upon completion of the Wards Rotations, the student will be able to:
Patient Assessment
1. Take a patient history.
2. Conduct a complete physical assessment and describe the purpose and procedure of
IPPA.
55
3. Review and interpret significant information from the patient’s chart including lab data,
radiography reports, ABG’s, medications, and past medical history.
4. Develop therapeutic objectives based on assessment.
5. Document patient assessment.
Oxygen Therapy
1. Describe the indications, hazards and complications of oxygen therapy.
2. Assess the patient’s need for oxygen therapy utilizing total body system review.
3. Describe oxygen delivery devices (low and high flow).
4. Describe oxygen storage systems (OCD’s, liquid O2, cylinders).
5. Assess the clinical effectiveness of oxygen therapy.
6. Calculate the duration of various oxygen storage systems.
7. Describe the calibration and troubleshooting of an oxygen analyzer.
Arterial Blood Gases
1. List the various sample sites.
2. List the indications and contraindications for taking ABG’s.
3. Interpret results.
4. Record appropriate data.
Pulse Oximetry
1. Describe the indications for pulse oximetry.
2. List the sites that may be used for obtaining SpO2 measurements.
3. Describe the factors that affect the accuracy of results.
Bedside Spirometry
1. List the indications for performing spirometry.
2. Record appropriate data.
3. Discuss the use of bedside spirometry versus peak expiratory flowrates for assessment
of obstructive lung disease.
56
Sputum Induction
1. List the indications.
2. Determine appropriate agent.
3. List the indications for sputum induction.
4. Describe the sputum induction procedure.
5. Discuss the side effects of agents.
6. Describe the various methods of obtaining a sputum sample.
7. State the various devices used to promote deep breathing and coughing.
8. Identify the various sputum tests and their indications (C+S, AFB, cytology).
57
Humidity and Aerosol Therapy
1. List the indications for humidity and aerosol therapy.
2. Discuss humidity and aerosol delivery devices.
3. Describe the proper administration of each type of aerosol generating device.
4. List the indications, contraindications, routes of administration, dosage, desired effect
and side effect of the following:
a. Salbutamol and other Beta agents
b. Ipatropium Bromide
c. Racemic Epinephrine
d. N-Acetylcysteine
e. Inhale Corticosteroids
f. Long acting Beta 2 agonists
g. Anti Leukotrienes
5. Perform a MDI start with appropriate patient instruction.
6. Instruct the patient in the use of a spacer device.
7. Assess the effectiveness of the bronchodilator therapy and adjust treatment plan
accordingly.
8. Discuss the rationale for changes to an appropriate delivery for medication
administration.
58