RC 232 - Respiratory Care Special Procedures II

Upon completion of this course, the student will be able to:

1. describe the purpose of arterial puncture;
2. list arterial blood gas sample requirements;
3. identify the radical, brachial, ulnar, and femoral artery;
4. describe the advantages, disadvantages, and order of preference associated with the site arterial blood can be drawn from;
5. describe the significance of and properly perform the modified Allen’s test;
6. describe hazards associated with an arterial puncture;
7. list equipment needed to perform an arterial puncture;
8. properly perform an arterial puncture on a laboratory practice arm;
9. describe common errors associated with arterial blood gas sampling;
10. describe the chemical principles which are utilized in the operation of the following: pH electrode, PCO2 electrode, PO2 electrode;
11. describe the importance of calibrating a blood gas machine;
12. describe arterial line insertion and point of care;
13. describe quality control in ABG analysis;
14. list normal blood and body fluid values used in the assessment and the significance associated with each value. Included in this would be, but not limited to: ABG, CBC, urinalysis, and electrolytes;
15. state the indications for pulse oximetry (single and overnight use), co-oximetry, capnography, transcutaneous PO2 and PCO2, and apnea monitors;
16. safely set up, use, and troubleshoot various devices including capnography, transcutaneous monitoring, and apnea monitoring;
17. determine how to interpret the complete blood count and other hematology tests; and
18. determine how to interpret blood chemistry tests such as electrolytes, renal function, serum enzymes, and serum glucose.

Part II: Hemodynamic Monitoring

Upon completion of this course, the student will be able to:

19. describe the roles of arteries, arterioles, capillaries, and veins in contributing to vascular resistance, cardiac output, oxygen delivery, and cardiac function;
20. calculate vascular resistance in the pulmonary and central circulation;
21. list the normals for pulmonary and systemic vascular resistance;
22. list the normals of pulmonary vascular pressures; compare them to systemic circulation;
23. correlate elevated pulmonary vascular pressure with left or right heart failure;
24. describe the procedures involved for each of the invasive cardiac function tests:
    1. arterial mixed venous samples;
    2. arterial pressure monitoring;
    3. central venous pressures;
    4. pulmonary artery pressures; and
    5. cardiac output.
25. describe normal and abnormal values, indications, contraindications, and complications of the above texts;
26. calculate the following given the appropriate variables:
    1. cardiac output;
    2. cardiac index;
    3. stroke volume;
    4. stroke index;
    5. C_aO₂, C_vO₂, CaO2-C_vO₂ ; and
    6. Q_s / Q_T.

Part III: Pulmonary Function Testing (PFT)

Upon completion of this course, the student will be able to:

27. describe the value of pulmonary function testing;
28. identify and define the following volumes and capacities: VT, IRV, ERV, RV, TLC, VC, IC, and FRC;
29. use a nomogram to obtain normal predicted values;
30. perform and calculate the percent predicted for the following tests of pulmonary function via spirometry: FVC FEV₁, FEV₁ / FVC, FEF 25 - 75;
31. demonstrate correction of volume measurements from ATPS to BTPS and describe the purpose for this;
32. perform calibration of the laboratory spirometers using a 3-liter calibration syringe;
33. explain reasons why PFT may need to be postponed;
34. recognize specific details of improper performance techniques;
35. describe the criteria for acceptable trials of the FVC and FEV₁;
36. identify normal, obstructive, restrictive, and mixed ventilatory patterns from a spirogram and spirogram values;
37. determine the degree of obstruction and restriction;
38. state the effort-dependent and independent portions of the spirogram;
39. describe the nitrogen washout, helium dilution, and body plethysmography methods for determining FRC;
40. describe the plethysmographic method for determining Raw;
41. list advantages of the flow volume loop curve;
42. describe the significance of the Viso V;
43. describe the single-breath nitrogen elimination test;
44. discuss the clinical significance of closing volume;
45. describe the diffusion capacity test;
46. list the factors that affect diffusion capacity;
47. state normal values for Viso V, CV, Raw, and DLCO;
48. describe the analyzers used in PFT: nitrogen, helium, and CO; and
49. describe quality control in PFT.

Part IV: Electrocardiography

Upon completion of this course, the student will be able to:

50. describe the clinical uses of the EKG;
51. describe the structure and function of the following anatomical components of the heart: sinoatrial node, atrioventricular node, bundle of His, bundle branches, Purkinje fibers;
52. describe the electrochemical and mechanical events that occur during a single cardiac cycle as seen on an EKG;
53. describe the significance of the following: P wave, PR interval, QRS complex, ST segment, and T wave;
54. define the items listed on the EKG terminology handout;
55. state what the horizontal and vertical axes on the EKG paper represent;
56. determine the following: PR interval, QRS interval, and cardiac rate and rhythm from an EKG tracing;
57. describe the function of EKG machine controls;
58. demonstrate electrode placement and EKG performance;
59. list common causes of artifacts; and
60. identify and state the treatment of the following arrhythmias: sinus arrhythmia, atrial fibrillation, PAC, PNC, unit and multi-focal PVC, bigeminy, trigeminy, quadrigeminy, SVT, PVT, atrial flutter, ventricular flutter, atrial fibrillation, ventricular fibrillation, and heart blocks.

Part V: Chest Drainage Systems and Thoracentesis

Upon completion of this course, the student will be able to:

61. describe the main reason for chest drainage;
62. identify normal intrapleural pressures;
63. write two reasons why air, blood, or pus in the pleural space causes the lung to collapse;
64. define the following terms: pneumothorax, hemothorax, empyema, subcutaneous emphysema, thoracentesis, transudate, exudates;
65. list physical findings in pneumothorax and pleural effusion;
66. state the proper location for chest tubes to drain air or fluid;
67. describe the functions and drawbacks of one, two, and three-bottle chest drainage systems;
68. describe the proper care of chest drainage tubing;
69. describe normal findings in a postoperative thoracotomy patient;
70. explain findings in the water seal chamber that indicate the presence or absence of a leak in the chest drainage system;
71. explain the proper set-up of chest drainage suction;
72. describe the proper actions to take if chest drainage becomes disrupted;
73. state the indications for thoracentesis; and
74. describe the technique for performing a thoracentesis.