HS-TGM-12. Students will demonstrate understanding of advanced technical skills in respiratory care – Respiratory Therapy.

a. Identify normal and abnormal respiratory effort. b. Demonstrate correct placement of cannula and

mask for oxygen therapy. c. Describe croup tent usage and maintenance. d. Correctly apply pulse oximeter for measurement of

oxygen saturation and recognize the difference between normal and abnormal readings.

e. Assist clients with respiratory management devices.

f. Demonstrate techniques for suctioning based on facility protocol.

g. Describe and demonstrate care for a tracheostomy based on facility guidelines within their scope of practice.

Scope of Practice for Respiratory Therapists

Management of patients with respiratory diseases and disorders may require a variety of devices and equipment.

It is important for healthcare workers involved in

caring for patients with respiratory disorders to understand how to monitor, recognize and report problems in respiratory effort.

Additionally, the healthcare worker must be able to

recognize types of respiratory care devices and understand the use of and how to safely manage devices.

How do body systems and structures operate to maintain normal functioning of the respiratory system?

How are patients with disorders or diseases of the respiratory system managed to meet their respiratory care needs?

What is the role of respiratory therapists, nurses and patient care technicians in providing care for patients with respiratory diseases or disorders?

How is oxygen therapy provided in a safe and therapeutic manners?

Students should know:

The differences between normal and abnormal respiratory effort

Croup tent usage and maintenance

Types, use and care of various respiratory devices

Safety issues related to respiratory therapy

How to monitor and provide care for patients with respiratory system diseases or disorders

Students should be able to demonstrate:Setting up for oxygen administration via Nasal Cannula,

Oxygen Mask, Venturi Mask and Non-Rebreather Mask

Use of nasopharyngeal and oropharyngeal airways

Pulse oximetry measurement, normal and abnormal values

Suctioning the airway using a Yankauer catheter

Assisting with artificial airway care

Use of Ambu Bag

Describe your breathing in terms of work of breathing (how easy/hard is it) on a sheet of paper.

Pass out drinking straws to each student in class. Instruct them that they are going to be involved in an activity to simulate breathing difficulties. Tell them that they will be breathing through the straw while pinching their nose closed. Students should be sitting down at this time.

Begin the timer and time them for one minute.

Ask students to describe their breathing and how they felt during this exercise.

Now ask them to do the same exercise while jogging in place. Time them for a minute.

Now describe in writing how their breathing felt during this part of the exercise.

Think about what it might be like to fight for every breath you take.

How would having breathing problems affect everyday living (sleep, eating, activities, going to the bathroom, mowing the grass, washing clothes, working, etc.)?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Use the following acronym and recall the structures through which air passes during inhalation

N___________________P ___________________L ___________________T ___________________B ___________________Br __________________A ___________________

What gas is inhaled?_____________________

What gas is exhaled?_____________________

The right lung has _____ lobes

The left lung has _____ lobes

1 breath in and 1 breath out=1 respiration

Accessory Muscle which separates the thoracic and abdominal cavities and flattens during inspiration is called ___________________.

This muscle contracts and pulls down during inspiration, enlarging the thoracic cavity which allows the lungs to expand.

During expiration, this muscle relaxes, forcing the air out of the lungs. What other muscle helps with the process of

breathing?

Lungs protected by bony frameworkName the structures of the bony framework using

the acronym belowSRVReview:

How many pairs of ribs do we have?Which vertebrae is referred to above?

Important for respiratory and cardiovascular systems to work together to meet the oxygen needs of the body

In the respiratory system, structures must function properly to allow exchange of O2 and CO2

What is the role of the cardiovascular system?

Blood must circulate to and from the heart

Exchange of O2 and CO2 must be able to take place between capillaries and cells

Nervous System plays an important role

Diseases of and injury to the nervous system can affect respiratory muscles

Breathing may be difficult

Brain damage can affect respiratory rate

Respirations increase when oxygen level is low

Which part of the brain controls respirations? _______________________

Too much ____________ and too little __________________ will cause the brain to think something’s wrong and increase the respiratory rate.

Aging also affects the respiratory system:Decreased function

because of weaker muscles

Lung tissue loses elasticity

Exercise- increases needMuscles need O2 to

work

DrugsSome may depress

the respiratory center in brain and cause respiratory depression which can lead to respiratory arrestNarcotics given to

patients for pain control

SmokingCauses lung cancer

and COPD & risk factor for Disease of Coronary Arteries

AllergiesSensitivity to

substances in which the body reacts when exposedrunny nose, itchy

eyes, wheezing, congestion and swelling in the airway which can become severe

Exposure to PollutantsHarmful substances

in air or water like asbestos, toxic fumes which can be at work, school, or home

Nutrition Needs to be

adequate for production of red blood cells which carry O2

Vitamins are important to produce the cells such as vitamin C, B12, Folic Acid

AlcoholDepresses brain

function and can depress cough reflex in excess

Gag reflex can also become depressed

HypoxiaCells do not have

enough oxygenBrain reacts to low

oxygen person may becomeRestlessDisorientedDizzyDrowsyPersonality change Tachycardia

Abnormal respirationsBradypnea

Slow breathing- <12/min

TachypneaRapid respirations >25

Apnea Absence of respirations

Dyspneadifficulty breathing-may

be labored or painfulOrthopnea

breathe normally when in sitting position

Cheyne-StokesRespirations increase

in rate and depth and then become shallow and slow, periods of apnea may occur also

Kussmaul’s RespirationsDeep and RapidSeen in Diabetic

Ketoacidosis* and Renal Failure

HypoventilationSlow, shallow, &

sometimes irregular Pneumonia, disease of

alveoli (Emphysema)Nervous system

disorder affecting respiratory system

HyperventilationRapid and deeper than

normal respirationsCan be caused by

Asthma

Responsibilities include Patient assessmentDisease managementDiagnostic evaluationManagementEducationRehabilitationCare of patients

The scope of practice includes the application of technology and the use of protocols across all care sites including.

They are not just in hospitals anymore….

Diagnostic Activities include:Obtain and analyze physiological specimensInterpret physiological dataPerform tests and studies of the

cardiopulmonary systemPerform neurophysiological studiesPerform sleep disorder studies

Therapy includes but is not limited to:The application and monitoring of medical

gases and environmental control systemsMechanical ventilator managementInsertion and care of artificial airwaysBronchopulmonary hygieneAdministration of Pharmacological agents Cardiopulmonary rehabilitationHemodynamic cardiovascular supportSleep support

Nasal Cannula and Mask Use-demo at bedsideCroup Tent-handoutPulse Oximeter-demo/handoutMDI-handout/demonstrationIncentive Spirometry-demonstrationPeak Flow Meter-demonstration/return demoSuctioning-handout/demo at bedside (Yankaeur’s)Nasopharyngeal and Oropharyngeal Airway-demoTrach Care

http://www.youtube.com/watch?v=Wimw7bz0fLoAmbu bag use review (CPR)