Lab Exercises For Competency In Respiratory Care 3rd Edition By Thomas J Butler

Contents Contributing Authors xiv Preface xv Acknowledgments xvi Introduction xvii Procedural Competency Evaluations Directory xxii CHAPTER 1 Laboratory and Clinical Safety 1 Exercises 1 Professionalism 2 AARC ...

Contents Contributing Authors xiv Preface xv Acknowledgments xvi Introduction xvii Procedural Competency Evaluations Directory xxii CHAPTER 1 Laboratory and Clinical Safety 1 Exercises 1 Professionalism 2 AARC Guide to Professionalism Module 3 Medical Director or Physician Interaction 3 Safety Considerations 3 Scene Survey 5 Patient Positioning 5 Laboratory Report 7 Procedural Competency Evaluations 11 Clinical Orientation 11 Patient Positioning and Safety 13 Patient and Caregiver Training 15 CHAPTER 2 Communication and Cultural Diversity in Health Care 17 Exercises 17 Communication 18 Cultural Diversity 18 Laboratory Report 19 CHAPTER 3 Infection Control 21 Exercises 22 Hand Washing 23 Hand Sanitation 24 Surgical Scrub 24 Barrier Precautions/Personal Protective Equipment 24 Laboratory Report 35 Procedural Competency Evaluations 37 Hand Hygiene 37 Patient Standard Precautions/Transmission-Based Isolation Procedures 39 CHAPTER 4 Sterilization and Disinfection 41 Exercises 42 Handling and Disposal of Infectious Equipment and Waste 42 Preparation of Equipment for Disinfection/ Sterilization by Autoclave, Ethylene Oxide, Activated Glutaraldehyde, or Pasteurization 43 Monitoring Infection Control Procedures 44 Laboratory Report 47 Procedural Competency Evaluation 49 Sterilization and Disinfection 49 CHAPTER 5 Medical Record 51 Exercises 52 Chart Review, Patient Interview, and History 52 Medical Record Documentation (Charting) 54 Laboratory Report 55 Procedural Competency Evaluations 61 Medical Record Review 61 Medical Record Documentation 63 Patient Interview and History 65 Case Study Presentation 67 CHAPTER 6 Patient Assessment: Basic Skills—Vital Signs 69 Exercises 70 Primary Survey 70 Secondary Survey 74 Vital Signs 77 Basic Pulse Oximetry 82 Laboratory Report 83 Procedural Competency Evaluations 89 Vital Signs: Pulse and Respiration 89 Blood Pressure 91 Pulse Oximetry 93 vii CHAPTER 7 Patient Assessment: Advanced Skills 95 Exercises 96 Physical Assessment of the Chest 96 Auscultation 101 Laboratory Report 103 Procedural Competency Evaluations 105 Physical Assessment of the Chest 105 Auscultation 107 Common Performance Elements 109 CHAPTER 8 Bedside Assessment of Pulmonary Mechanics 111 Exercises 112 Obtaining Vt, Ve, and Va 113 Obtaining Negative Inspiratory Force and Maximum Expiratory Pressure 114 Obtaining a Slow Vital Capacity 115 Obtaining Peak Expiratory Flow Rate Measurements 115 Obtaining Data on Patients With Artifi cial Airways 116 Laboratory Report 117 Procedural Competency Evaluation 121 Bedside Pulmonary Mechanics 121 CHAPTER 9 Oxygen Supply Systems 123 Exercises 124 Medical Gas Cylinders 124 Reducing Valves, Regulators, and Flowmeters 126 Air Compressors 129 Blenders 130 Bulk Storage Systems 130 Zone Valves and Wall Outlets 131 Laboratory Report 133 Procedural Competency Evaluations 139 Bulk Medical Gas Supply System 139 Gas Pressure and Flow Regulation 141 Oxygen Blender 143 CHAPTER 10 Oxygen Analysis 145 Exercises 146 Oxygen Analyzer Components 146 Calibration of Oxygen Analyzers 146 Oxygen Analysis 147 Laboratory Report 149 Procedural Competency Evaluation 151 Oxygen Analysis 151 CHAPTER 11 Oxygen Therapy Administration 153 Exercises 154 Oxygen Device Identifi cation 154 Oxygen Therapy Administration 157 Air Entrainment (Venturi) Mask 162 Troubleshooting 163 Laboratory Report 165 Procedural Competency Evaluation 171 Oxygen Therapy 171 CHAPTER 12 Humidity Devices 173 Exercises 174 Bubble Humidifi er 174 Heat and Moisture Exchanger (HME) 175 Wick Humidifi er 176 Laboratory Report 179 Procedural Competency Evaluations 183 Humidifi cation Therapy 183 Humidifi cation With Artifi cial Airway 185 CHAPTER 13 Aerosol Generators 187 Exercises 188 Large-Volume Nebulizer (LVN) 188 Aerosol Delivery Devices 190 Ultrasonic Nebulizer (USN) 192 Gas Titration 193 Tandem Nebulizer Setup 194 Laboratory Report 195 Procedural Competency Evaluation 199 Aerosol Generators: Large-Volume Nebulizers (LVNs) 199 CHAPTER 14 Cardiopulmonary Pharmacology Review 201 Exercises 202 Review of Respiratory Medications 203 Calculation of Drug Dosages 204 Laboratory Report 205 Procedural Competency Evaluation 209 Calculation of Drug Dosages 209 CHAPTER 15 Aerosol and Medication Therapy 211 Exercises 212 Small-Volume Nebulizers 212 Identifi cation of Component Parts of Additional Delivery Devices 213 viii • CONTENTS Specialty Nebulizers 216 Aerosol Medication Administration 218 Filtered Nebulizers 222 Sputum Induction 222 Laboratory Report 223 Procedural Competency Evaluations 229 Aerosol Medication Delivery: Nebulized Solutions 229 Aerosol Medication Delivery: Continuous Bronchodilator Nebulization 231 Aerosol Medication Delivery: MDI, DPI 233 Sputum Induction 235 CHAPTER 16 Hyperinfl ation Therapy Techniques 237 Exercises 238 Incentive Spirometry 238 Identifi cation of Intermittent Positive-Pressure Breathing Machine Component Parts and Controls 241 Intermittent Positive-Pressure Breathing Circuitry Assembly 242 Manipulation of Intermittent Positive-Pressure Breathing Controls 243 Intermittent Positive-Pressure Breathing Therapy 244 Computerized Lung Simulator: Effect of Compliance and Resistance Changes on Intermittent Positive-Pressure Breathing Volumes 245 Laboratory Report 247 Procedural Competency Evaluations 253 Incentive Spirometry 253 Intermittent Positive-Pressure Breathing (IPPB) 255 CHAPTER 17 Bronchial Hygiene: Chest Physiotherapy 257 Exercises 258 Identifi cation of Lung Lobes and Segments 258 Postural Drainage 261 Chest Percussion 263 Expiratory Vibration 264 Chest Physiotherapy Treatment 264 Laboratory Report 267 Procedural Competency Evaluation 271 Chest Physiotherapy 271 CHAPTER 18 Adjunct Techniques for Bronchial Hygiene 273 Exercises 273 Directed Cough 274 Vibratory Positive Expiratory Pressure (PEP) Therapy 276 Breathing Exercises 278 Inspiratory-Resistive Muscle Training 280 Laboratory Report 283 Procedural Competency Evaluations 285 Breathing Exercises 285 Directed Cough 287 Positive Expiratory Pressure (PEP) Therapy/ Vibratory PEP 289 Inspiratory Resistive Muscle Training 291 Intrapulmonic Percussion Ventilation (IPV) 293 CHAPTER 19 Manual Resuscitators and Manual Ventilation 295 Exercises 296 Assembly and Disassembly of Resuscitators 296 Pressure Relief Valves 297 Measurement of Pressures, Stroke Volumes, and Fio2 297 Mouth-to-Mask Ventilation 298 Manual Ventilation With Mask 299 Manual Ventilation With an Intubated Mannequin 299 Manual Ventilation While Compressions Are Performed 300 Assisted Manual Ventilation in a Spontaneously Breathing Subject 300 Laboratory Report 301 Procedural Competency Evaluation 307 Manual Ventilation 307 CHAPTER 20 Pharyngeal Airways 309 Exercises 310 Identifi cation of Airway Adjuncts 310 Selection and Insertion of a Nasopharyngeal Airway 311 Selection and Insertion of an Oropharyngeal Airway 312 Laboratory Report 313 Procedural Competency Evaluation 317 Pharyngeal Airway Insertion 317 CONTENTS • ix CHAPTER 21 Suctioning 319 Exercises 320 Suction Equipment Identifi cation 320 Oropharyngeal Suctioning 322 Suction Kits 322 Nasotracheal Suctioning 323 Endotracheal Suctioning 324 Endotracheal Suctioning With a Closed System 325 Obtaining a Sputum Sample 326 Laboratory Report 327 Procedural Competency Evaluations 331 Endotracheal Suctioning 331 Nasotracheal Suctioning 333 CHAPTER 22 Endotracheal Intubation 335 Exercises 336 Intubation Equipment and Preparation 336 Orotracheal Intubation 341 Securing an Endotracheal Tube 347 Laboratory Report 349 Procedural Competency Evaluation 353 Oral Endotracheal Intubation 353 CHAPTER 23 Tracheostomy Care 355 Exercises 356 Tracheostomy Tubes 356 Tracheostomy Tube Care 360 Laboratory Report 363 Procedural Competency Evaluations 365 Tracheostomy Care 365 Tracheostomy Tube Change 367 CHAPTER 24 Artifi cial Airway Care and Maintenance 369 Exercises 370 Cuff Care 370 Resecuring and Repositioning of an Endotracheal Tube and Oral Hygiene 372 Extubation 373 Airway Emergencies 373 Laboratory Report 377 Procedural Competency Evaluations 381 Cuff Care 381 Extubation 383 Artifi cial Airway Care 385 CHAPTER 25 Noninvasive Blood Gas Monitoring 387 Exercises 388 Pulse Oximetry 388 Capnography 390 Transcutaneous Monitors 392 Laboratory Report 395 Procedural Competency Evaluations 403 Pulse Oximetry 403 Capnography/Capnometry 405 Transcutaneous Monitoring 407 CHAPTER 26 Arterial Blood Gas Sampling 409 Exercises 410 Preparation of Blood Gas Kit Components 410 Modifi ed Allen’s Test 412 Performance of Arterial Puncture 414 Arterial Line Sampling 416 Capillary Sampling 420 Laboratory Report 423 Procedural Competency Evaluations 427 Arterial Puncture 427 Arterial Line Sampling 429 Capillary Sampling 431 CHAPTER 27 Arterial Blood Gas Analysis and Maintenance 433 Exercises 434 Blood Gas Analysis Using a Bench-Top Blood Gas Analyzer 434 Blood Gas Analysis Using Point-of-Care Testing 439 Co-oximetry 440 Laboratory Report 441 Procedural Competency Evaluations 449 Bench-Top ABG Analyzer Maintenance 449 ABG Analysis 451 CHAPTER 28 Blood Gas Interpretation and Calculations 453 Exercises 454 Interpretation of Arterial Blood Gas Values 454 Calculation of Oxygenation Parameters 456 Acid–Base Calculations 458 Laboratory Report 459 Procedural Competency Evaluation 465 Arterial Blood Gas Interpretation 465 x • CONTENTS CHAPTER 29 Basic Chest X-ray Interpretation 467 Exercises 468 Identifi cation of Positions 469 Identifi cation of Major Organs and Landmarks 470 Hyperinfl ation 472 Pneumothorax 472 Atelectasis or Consolidation 473 Endotracheal Tube Position 474 Kyphoscoliosis 475 Infant and Pediatric Films 476 Other Abnormal Patterns 478 Laboratory Report 479 Procedural Competency Evaluation 489 Chest X-ray Interpretation 489 CHAPTER 30 Pulmonary Function Testing 491 Exercises 492 Equipment Identifi cation 492 Calibration and Maintenance of Spirometric Equipment 494 Respiratory History 496 Spirometry Screening 496 Calculation of Spirometric Results 503 Postbronchodilator Study 506 Maximum Voluntary Ventilation 506 Flow-Volume Loops 507 Laboratory Report 511 Procedural Competency Evaluations 519 Screening Spirometry 519 Flow-Volume Loop (FVL) 523 Maximum Voluntary Ventilation (MVV) 525 Spirometry Screening Interpretation 527 CHAPTER 31 Electrocardiography 529 Exercises 530 Cardiac Anatomy 530 Identifi cation of Electrocardiograph Machine Controls 531 Preparation and Attachment of Limb Leads 532 Preparation and Attachment of Precordial (Chest) Leads 533 Electrocardiograph Artifact 534 Cleanup Procedures 536 Rate and Rhythm Interpretation 536 Laboratory Report 539 Procedural Competency Evaluations 549 Electrocardiography 549 ECG Interpretation 551 CHAPTER 32 Hemodynamic Monitoring 553 Exercises 554 Identifi cation of the Components of a Flow-Directed Pulmonary Artery Catheter 554 Assembly and Calibration of a Fluid-Filled Monitoring System 555 Transducer Calibration 557 Identifi cation of Pressure Waveforms 559 Thermodilution Cardiac Output Determination 560 Hemodynamic Calculations 561 Laboratory Report 565 Procedural Competency Evaluations 573 Hemodynamic Measurements 573 Shunt Studies 575 CHAPTER 33 Phlebotomy 577 Exercises 578 Identifi cation of Veins 578 Preparation of the Subject for Phlebotomy 579 Preparation for Phlebotomy 579 Phlebotomy Procedure 579 Phlebotomy Troubleshooting 580 Laboratory Report 583 Procedural Competency Evaluation 587 Venipuncture 587 CHAPTER 34 Intravenous Insertion and Maintenance 589 Exercises 590 Identifi cation of Veins and Catheter Parts 590 Preparation of the Subject for Intravenous Insertion 590 Intravenous Insertion Procedure 590 Intravenous Rate Infusion Calculation 592 Intravenous Catheter Maintenance 593 Intravenous Catheter Removal 593 Laboratory Report 595 Procedural Competency Evaluation 599 IV Insertion 599 CONTENTS • xi CHAPTER 35 Chest Tube Drainage Systems 601 Exercises 602 Wet Chest Drainage Systems 602 Dry Chest Drainage Systems 603 Maintaining and Troubleshooting Chest Drainage Systems 605 Laboratory Report 607 Procedural Competency Evaluation 611 Chest Drainage System Assembly 611 CHAPTER 36 Bronchoscopy Assisting 613 Exercises 614 Identifi cation of Components 614 Preparation of the Patient for Bronchoscopy 615 Equipment Preparation for Bronchoscopy 615 Bronchoscopy Procedure 616 Bronchoscopy Recovery 617 Bronchoscopy Complications 617 Laboratory Report 619 Procedural Competency Evaluation 623 Bronchoscopy Assisting 623 CHAPTER 37 Noninvasive Ventilation 625 Exercises 626 Negative-Pressure Ventilator 627 Continuous Positive Airway Pressure Setup 628 BiPAP Setup 630 Laboratory Report 633 Procedural Competency Evaluation 637 CPAP/BiPAP Initiation (Noninvasive Ventilation) 637 CHAPTER 38 Pressure Ventilators 639 Exercises 640 Identifi cation of an Adult Breathing Circuit and Leak Testing 640 Pressure, Flow, Volume, and Time Relationships 641 Initiation and Monitoring 642 Laboratory Report 643 CHAPTER 39 Continuous Mechanical Ventilation 647 Exercises 648 Ventilator Assembly 648 Identifi cation of Controls 649 Leak Testing 649 Determination of Tubing Compliance Factor and Calculation of Lost Volume 649 Pressure, Flow, Volume, and Time Relationships 650 Laboratory Report 651 CHAPTER 40 Ventilator Modes 655 Exercises 656 Control and Assist/Control 657 Pressure Control Inverse I:E Ratio 659 Synchronized Intermittent Mandatory Ventilation 659 Positive End-Expiratory Pressure/Continuous Positive Airway Pressure 660 Pressure Support Mode 661 Advanced Modes Using Targeting Schemes 662 Laboratory Report 665 CHAPTER 41 Ventilator Initiation 679 Exercises 680 Setting Alarm Parameters 680 Ventilator Initiation 682 Circuit Changes 683 Laboratory Report 685 Procedural Competency Evaluations 695 Adult Ventilator Initiation 695 Ventilator Circuit Change 697 CHAPTER 42 Patient-Ventilator System Care and Maintenance 699 Exercises 700 Basic Ventilator Monitoring 700 Data Generation for Evaluation of Patient Status 702 Waveform Identification and Interpretation 703 Setting Modifi cation and Documentation 708 Laboratory Report 711 Procedural Competency Evaluation 719 Adult Patient-Ventilator System Care 719 xii • CONTENTS CHAPTER 43 Discontinuation of Mechanical Ventilation 721 Exercises 722 Weaning Modalities 722 Assessment During Weaning 722 Weaning Protocols 723 Computer-Directed Weaning Options 723 Laboratory Report 725 Procedural Competency Evaluation 731 Ventilator Weaning Protocols 731 CHAPTER 44 Neonatal/Pediatric Respiratory Care 733 Exercises 734 Patient Assessment in the Newborn 734 Nasal Continuous Positive Airway Pressure for the Infant 737 Laboratory Report 739 Procedural Competency Evaluations 743 Nasal CPAP Initiation 743 Oxygen Hood 745 Oxygen Tent 747 CHAPTER 45 Neonatal/Pediatric Ventilation 749 Exercises 750 Time-Cycled/Pressure-Limited Ventilators 750 High-Frequency Ventilators 751 Initiating Mechanical Ventilation in an Infant 752 Pediatric Ventilation 754 Laboratory Report 755 Procedural Competency Evaluations 763 Neonatal/Pediatric Ventilator Initiation 763 Neonatal/Pediatric Patient-Ventilator System Care 765 CHAPTER 46 Respiratory Care in Alternate Settings 767 Exercises 768 Long-Term Oxygen Therapy 768 Portable Liquid Oxygen Systems 770 Oxygen Concentrators 771 Oxygen-Conserving Devices 771 Home Disinfection Techniques 773 Home Care/Portable Ventilator Initiation 773 Discharge Planning 774 Home Evaluation Assessment 774 Laboratory Report 777 Procedural Competency Evaluations 785 Oxygen-Conserving Devices 785 Discharge Planning 787 Home Care Evaluation 789 Home Care Ventilation 791 Home Oxygen Administration 793 Home Nebulizer Administration 795 Home CPAP Application 797 Home Apnea Monitoring 799 APPENDIX A: Normal and Critical Values, Formulas, and Rules of Thumb 801 APPENDIX B: Common Performance Elements 809 Glossary 811 Index 821