August 2015 Angelina College Health Careers Division RSPT 2305 Pulmonary Diagnostics General Syllabus I.COURSE DESCRIPTION: RSPT 2305. PULMONARY DIAGNOSTICS: Three hours credit. The theories and techniques involved in pulmonary function testing diagnostics with emphasis on blood gas theory and analysis, quality control, oximetry, and capnography. Three lecture hours per week. Learning Outcomes: Perform and interpret basic and advanced pulmonary function testing; and describe principles/concepts involved in blood gas analysis and quality control; and describe the application/troubleshooting of oximetry and capnography devices. Understand and explain hemodynamic pressures from CVP and PAP lines INTENDED AUDIENCE : Second-Year students already enrolled in the Respiratory Care Program. INSTRUCTOR: Instructor’s Name: David Henson BS RRT RPFT Office Hours: 1:30 - 3:00 PM on T & R; (or) 09:00am – 11:30am on Friday: call voice mail for appointment Phone: (936) 633-5418 E-mail Address: dhenson@angelina.edu II. INTENDED STUDENT OUTCOMES A. Core Objectives Required for this Course 1. Critical Thinking: to include creative thinking, innovation, inquiry, and analysis, evaluation and synthesis of information 2. Communication: to include effective development, interpretation and expression of ideas through written, oral and visual communication 3. Empirical and Quantitative Skills: to include the manipulation and analysis of numerical data or observable facts resulting in informed conclusions 4. Teamwork: to include the ability to consider different points of view and to work effectively with others to support a shared purpose or goal 5. Social Responsibility: to include the ability to connect choices, actions and consequences to ethical decision-making 6. Personal Responsibility: to include intercultural competence, knowledge of civic responsibility, and the ability to engage effectively in regional, national, and global communities B. Course Learning Outcomes for all Sections C. Course Objectives (common to all sections) 1. To gain adequate knowledge and understanding of the key terms used in diagnostic studies. 2. To introduce the student to basic and advanced procedures and techniques in pulmonary function tests (PFT) including interpretation of values to diagnose specific lung disease as well as extent. 3. To introduce the student to the various methods of assessment of heart and lung function as well as developing course of treatment and monitor effectiveness via different methodology such as pulse oximetry, capnography, CVP and PAP lines 4. To familiarize the student with cardiopulmonary dynamics through electrocardiogram (ECG) and CVP and PAP waveforms and pressures that will aid in the assessment and indications for clinical oxygenation, ventilation and general cardiopulmonary dysfunction. 1 5. To increase the student's appreciation for diagnostic tests and support in the assessment of cardiopulmonary diseases and how mechanical ventilation effects hemodynamic status and thus cellular oxygenation. III. ASSESSMENT MEASURES A. Assessments for the Core Objective 1. Critical Thinking: to include creative thinking, innovation, inquiry, and analysis, evaluation and synthesis of information 2. Communication: to include effective development, interpretation and expression of ideas through written, oral and visual communication 3. Empirical and Quantitative Skills: to include the manipulation and analysis of numerical data or observable facts resulting in informed conclusions 4. Teamwork: to include the ability to consider different points of view and to work effectively with others to support a shared purpose or goal 5. Social Responsibility: to include the ability to connect choices, actions and consequences to ethical decision-making 6. Personal Responsibility: to include intercultural competence, knowledge of civic responsibility, and the ability to engage effectively in regional, national, and global communities B. Assessments for Objectives Specific to the Course CORE COMPETENCIES: SCANS - (Secretary’s Commission on Academic Necessary Skills) Students are expected to demonstrate basic competency in academic and workforce skills. The following are competencies with evaluation are included in RSPT 1410. SCAN Skills Assessments Foundation Skills Written Assignments Oral Presentations Required Readings Critical Thinking Case Studies Demonstrated Competency in Clinical Workplace Competencies Computer Assisted Instruction Critical Thinking Case Study Assessments Demonstrated Competency in Clinical IV. INSTRUCTIONAL PROCEDURES The methods of instruction used in this course includes but not limited to the following: Lecture, discussion, performance, audiovisual, computer assisted instruction, independent study, Blackboard Instruction, role playing and critical-thinking patient case studies. V. COURSE REQUIREMENTS AND POLICIES A. Required Textbooks, Materials and Equipment Wanger Jack (2012) Pulmonary Function Testing Jones Bartlet Learning Third Edition Wilkins, Robert L, (2014) Clinical Assessment in Respiratory Care, Mosby-Elsevier Publishers 7th Edition 2 The student will need a basic calculator for simple mathematical calculations. A medical dictionary would be helpful but not required.Cell phones must be in silent mode or turned off. B. Assignments - Class meets Tuesday and Thursdays 10:00 – 11:30 am August 27 Unit I Syllabus Review – Sept 1 - Sept 3 Wanger Chapter 1 Sept 8 – Sept 10 Wanger Chapter 1 Sept 15 – Sept 17 Wanger Chapter 1 Sept 22 – Sept 24 Unit Test I Wagner Chapter 2 Sept 29 - Oct 1 Wanger Chapter 2 Oct 6 – Oct 8 Wanger Chapter 2 Oct 13 – Oct 15 Unit Test II - start unit III Wagner 3 Oct 20 – Oct 22 Wagner 3 - Wilkins Chap 8 Oct 27 – Oct 29 Wilkins Chap 11 – Wilkins Chap 11 Nov 3 – Nov 5 Wilkins 15 – Wilkins Chap 16 Nov 10 – Nov 12 Wilkins 16 – Unit Test III Nov 17 – Nov 19 Ruppel Chap 7 Ruppel Chap Nov 24 – Nov 26 Ruppel Chap 10 - Thanksgiving Day No Class Dec 1 – Dec 3 Ruppel Chap 11 - Wilkins Chap 18 Dec 8 - Dec 10 Unit IV Completed and Review - Unit Test IV Dec 15 Final Exam Course Policies – This course conforms to the policies of Angelina College as stated in the Angelina College Handbook. 1. Academic Assistance – If you have a disability (as cited in Section 504 of the Rehabilitation Act of 1973 or Title II of the Americans with Disabilities Act of 1990) that may affect your participation in this class, you should see Karen Bowser, Room 208 of the Student Center. At a post-secondary institution, you must self-identify as a person with a disability; Ms. Bowser will assist you with the necessary information to do so. To report any complaints of discrimination related to disability, you should contact Dr. Patricia McKenzie, Administration Building, Room 105 or 936-633-5201. 2. Attendance – Attendance is required as per Angelina College Policy and will be recorded every day. Any student with three (3) consecutive absences of four (4) cumulative absences may be dropped from the class. Records will be turned in to the academic dean at the end of the semester. Do not assume that non-attendance in class will always result in an instructor drop. You must officially drop a class or risk receiving an F. This is official Angelina College Policy. 3 3. Additional Policies Established by the Instructor VI. COURSE CONTENT C. Content/ Topics Unit One: Indications for Pulmonary Function and Understanding and Performing Spirometry After completion of this unit, the student will be able to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Categorize Pulmonary Function Testing according to specific purposes. List indications for spirometry, lung volumes, and diffusion capacity Relate pulmonary history to indications for performing Indentify indications for exercise testing Describe diseases that cause air trapping Determine whether spirometry test is acceptable or not Identify airway obstruction using Vital Capacity and Forced Expiratory Volume 1 sec Determine whether there is a signification response to bronchodilators Identify pathological reasons for using Maximal Inspiratory and Expiratory pressures Recognize normal and abnormal values for airway resistance and specific conductance Develop Skills to use PFTs to design treatment plans and adjust medications in treatment Describe the technique for measuring pulmonary compliance Describe and perform simple spirometry Determine whether spirometry is acceptable and repeatable Identify obstructive and restrictive airway disease using VC FEV1 FVC/FEV1 Ratio, Peak flow and FEF 25 -75 or FEF 200 – 1200 Determine whether there is a significant response to bronchodilators. Describe the degree of obstruction or restriction according to ATS – ERS criteria Select the appropriate VC and FEV1 patient effort for reporting Describe and evaluate flow volume curve. Unit II: Lung Volumes and Gas Diffusion After completion of this unit, the student will be able to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Describe the measurement of lung volumes using gas dilution and washout methods Explain the advantages of using a body plethysmograph Calculate residual volume and total lung capacity from FRC and the subdivisions of VC. Identify a restrictive and obstructive disease process from measured lung volumes Calculate FRC using both Helium Equilibration and Nitrogen Washout Identify diffusion disorders in restrictive and obstructive lung diseases Use Spirometry, Lung Volumes and Diffusion Levels in concert to diagnosis lung diseases Describe MIP MEP NIF and how the measurements indicate and stratify neuromuscular diseases Describe at least three types of neuromuscular diseases and their treatment Calculate the VD/VT ratio and describe its use in assessing ventilation Use lung volumes and diffusion levels to aid in diagnosing restrictive and neuromuscular diseases 4 Unit Three (III) Perform and interpret Arterial Blood Gases and EKGs. Also Assess Cardiac Output and Hemodynamic Monitoring After completion of this unit; the student will be able to: 1. Describe how ph and PCO2 are used to assess acid-base status 2. Interpret PO2 and Oxygen Saturation and Content to assess tissue oxygenation 3. Describe the proper procedure for obtaining an arterial blood gas specimen 4. Describe common causes of acid base disorders and their compensation methods 5. Explain the use of capnography to assess changes in ventilation perfusion patterns of lung 6. Describe situations where Pulse Oximetry can be effectively used and difficult situations 7. Describe indications for performing an EKG 8. Identify the key components of the heart’s electrical system and how it works 9. Explain depolarization and repolarization 10. Describe the normal time interval for each electrical wave generated by the heart 11. Identify several common EKG abnormalities 12. Identify lethal EKG rhythms 13. Describe treatment for lethal rhythms 14. Define cardiac output, index, stroke volume and venous return 15. Describe the percentage of total blood volume in the venous system 16. Describe the effect of blood loss on the circulatory system and how it compensates 17. Describe the effect of mechanical ventilation on cardiac output 18. Describe Cardiac index, ejection fraction, stroke volume, end diastolic and systolic volume 19. Explain Preload and Postload 20. Describe different methods for determining Cardiac output 21. Describe what a CVP line is and when its used 22. Explain CVP pressures and waveforms 23. Describe a PA catheter and its reason for placement 24. Explain PA waveforms and pressures 25. Explain the effect mechanical ventilation has on PA waveforms and pressures Unit IV: Cardiopulmonary Exercise Testing, Specialized Testing, PFT Equipment, Quality Control in ABG and PFT Equipment and Nutritional Assessment After completion of this unit, the student will be able to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Understand and select appropriate exercise testing based on patient symptoms and needs Identify the ventilatory/anaerobic threshold Describe methods for measuring ventilation, oxygen consumption and CO2 production Explain exercise limitation as caused by cardiovascular, ventilatory, gas exchange abg abnormalities or deconditioning Explain breathing kinetics during exercise Describe the indications for respiratory muscle strength testing Describe methods and normal’s for exhaled nitric oxide testing Select appropriate tests used in evaluating disabilities Describe two types of volume displacement spirometers List two principals used by flow sensing equipment Describe the difference between pressure sensing and hot wire transducers Describe the difference between He equilibration and N2 washout Describe calibration methods using 1 and 2 point calibration Describe Quality Assurance Material, testing and accuracy standard Describe CVM “ Linearity Material” its use and importance 5 16. 17. 18. Describe Intra Lab correlation studies for ABG and PFT systems Describe and interpretation of Levey-Jennings graph and Westgard Rules Define methods of determining when ABGs and PFTs are in error by reviewing values B. Additional Content: Students must score 105 correct answers on #2 and 3 CRT Simulation Exam VII. EVALUATION AND GRADING A. Grading Criteria 1. Lecture: Computer Lab Assignments 10 % Assignments/Quizzes 30 % Unit Examinations 40% Final Examination 20% ----------100% Total Score 2. Laboratory: Performance Evaluation (as needed). 3. Score 98 questions correct on Lindsey Jones TMC exam 1, 2, 3 or 4 B. Determination of Grade The alphabetic grading for this course is as follows: A = 92 - 100 B = 83 - 91 C = 75 - 82 D = 70 - 74 F = 69 & below C. Students must be present and on time for all Unit exams and Quizzes. If the student misses a Unit exam, the student may apply to the instructor for a makeup Unit exam. The makeup exam for Unit Tests will be at a time determined by the instructor and will not be the same exam others have taken. Daily quizzes will have no makeup. If you miss a daily quiz you will receive a “0”. Usually one daily Quiz with the lowest grade is dropped for the semester. All exams (and written assignments) become the property of the Respiratory Care Program. VIII. SYLLABUS MODIFICATION The instructor may modify the provisions of the syllabus to meet individual class needs by informing the class in advance as to the changes being made. Unscheduled quizzes may be given during the semester. 6