Welcome to RT 210: Introduction to Applied Respiratory Therapeutics

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Welcome to RT 210Introduction to Applied
Respiratory Therapeutics

• Instructor Ms. K. Walker, BS, RRT

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Respiratory Therapy Organizations

• Associations
• AARC American Assn. for Respiratory Care
• Promotes Profession
• Respiratory Care and AARC magazines
• Clinical Practice Guidelines (CPGs)
• Governmental representation
• State Society for Respiratory Care (FSRC)
• Education
• Newsletters

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Respiratory Therapy Organizations

• Associations (cont)
• NBRC National Board for Respiratory Care
• Testing National exams accepted by most states
  for licensure
• Certified Respiratory Therapist (CRT)
• Registered Respiratory Therapist (RRT)
• CoARC Committee on Accreditation for
  Respiratory Care
• Accreditation of RT schools

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Respiratory Therapy Organizations

• Groups that affect healthcare
• Insurance Companies
• Government Medicare
• Consumer Groups Ex AARP

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Hospital Organization

• Admitting
• Billing and Accounts
• Radiology / X-rays
• Nursing
• Laboratory (culture, urinalysis, blood counts)
• Education
• Engineering / Repair and maintenance

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Hospital Organization

• Housekeeping
• Nuclear Medicine
• Dietary
• Pharmacy
• Physical Therapy

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Respiratory Therapy Department Organization

• Medical Director
• Responsible for clinical function of department
• Administrative Director
• Supervisors
• Secretary
• Equipment Personnel
• Education Coordinator
• Therapist/Registered Certified

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Hospital Administration

• Board of Directors
• Medical Director
• Department Directors Managers

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Triage (order of care)

• CPR
• CMV
• ICU Care
• ER
• Postoperative care
• O2 and aerosol therapy
• IPPB
• CPT and IS
• Diagnostic studies

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Diagnostic Therapy vs. Clinical Therapy

• Diagnostic Therapy
• Clinical Therapy
• Principals of code blue

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Medical Terminology and Abbreviations

• Root Words Combining Form
• Prefixes Begin Word
• Suffixes After Root
• Combine Suffixes, Prefixes And Roots

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Medical Terminology and Abbreviations
Root Combining Form Gastr o
stomach Cardi o heart Derm o
skin Pneum o air Pleur o lung
lining Trach e trachea Abdomin o
abdomen Aden o glands Hem a/o
blood Cost o ribs Cyt o cells
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Medical Terminology and Abbreviations
Root Combining Form Vas o
vessel Bi o life Thorax a
chest Bronch o bronchus Myo
muscle Myco fungus Cyan o
blue Febrile fever Aerobic in the
presence of O2
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Medical Terminology and Abbreviations
Prefixes Begin Word A-, An- negative AB away
Di two Ex out of Intra inside Infra beneath
Inter between Macro large Mal abnormal
Mega large Micro small Neo new Ortho to
correct Sub below
Trans through Contra against Hyper above Hypo belo
w Tachy fast Brady slow
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Medical Terminology and Abbreviations
Suffixes After Root Algia pain ectomy removal
gen agent oma tumor penia lack ostomy open
ing otomy cutting itis inflammation ology st
udy gram tracing graph record pnea
breathing
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Medical Terminology and Abbreviations
Combine Suffixes, Prefixes And Roots  Tracheostom
y tracheal opening Tracheotomy tracheal
surgery Adenoma gland tumor Pleuralgia pleural
pain Bronchitis inflammation of the
bronchi Tachypnea fast breathing Bradycardia heart
less than 60 beats/min Hypertrophy an increase
in size Atrophy wasting away
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Medical Terminology and Abbreviations
Directional Terms Left To the subjects left
not YOUR left Right To the subjects right not
YOUR right Lateral Toward the side Medial
Towards the middle Anterior Toward the front of
the body Posterior Toward the back of the
body Superior Toward the top of the
body Inferior Toward the bottom of the
body Dorsal Along, or toward, the vertebral
surface of the body Ventral Along, or toward,
the belly surface of the body Caudad (Caudal)
Toward the tail Cephalad Toward the
head Proximal nearer the trunk Distal farther
from the trunk
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Medical Terminology and Abbreviations
Abbreviations A alveolar a arterial ATPD
ambient temperature and pressure, dry ATPS
ambient temperature and pressure, saturated BTPD
body temperature and pressure, dry BTPS
body temperature and pressure, saturated ERV
expiratory reserve volume E exhaled gas f
frequency pH hydrogen ion concentration P
gas pressure
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Medical Terminology and Abbreviations
Abbreviations BID 2 times a day TID 3
times a day QID 4 times a day Qh every
hour VT tidal volume STAT immediately WBC
white blood count RBC red blood count C
with s without D/C discontinue or
discharge
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Medical Terminology and Abbreviations

• BCLC p. 188 (Table 11-1).

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Patient Relationships

• "The Nuremberg Declaration"
• Patient has rights to have informed consent
• Reasons for therapy
• Consequences of refusing therapy
• If therapy is administered and patient has
  refused, may be liable for assault

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Patient Relationships

• Improved communications help prevent problems
• Respect patient
• Explain in layman's language
• Show kindness to patient visitors - privacy
• Improved records
• Clarify orders when necessary
• Accurately chart
• No white out
• One line through error, initial
• If it isnt charted it isnt done
• Neat/legible so it can be read

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Patient Relationships

• Insurance
• Covered by school
• Covered by hospital

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Confidentiality

• No information about patient to anyone other than
  patient (or to parent regarding minor patient).
• Avoid discussions in cafeteria, elevator, hall,
  public areas, or patients rooms, etc.
• In case studies, we don't use patient name,
  instead use initials, age, description, etc

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Hospital Relationships

• All members of a team
• Work within chains of command
• Avoid discussions of other personnel
• Do not say anything to anyone that you do not
  want repeated.
• Discuss appropriate information on what to talk
  about

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Metric System

• Basic Rules for English Measures
• Linear
• 12 inches 1 foot
• 3 feet 1 yard
• Weight
• 16 ounces 1 pound
• Volume
• 32 fluid ounces 1 quart
• 4 quarts 1 gallon

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Metric System

• Prefixes for the Metric System
• Kilo - 1000 or 1.0 103(k)
• Hecto - 100 or 1.0 102(h)
• Deka - 10 or 1.0 101 (da)
• Deci - 0.1 or 1.0 10 -1 (d)
• Centi - 0.01 or 1.0 10 -2 (c)
• Milli 0.001, or 1.0 10 -3 (m)
• Micro 0.000001 or 1.0 10 6 (µ)

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Lesson Measurement, Terminology, and Ethics
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Lesson Measurement, Terminology, and Ethics
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Kids Have Dropped Over Dead Converting Metrics
Kangaroos Hop Down Under Dirty Coal Mines
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• Conversion from Metric to English
• Linear - 1 inch 2.54 cm
• Volume - 1 gallon 3.8 L
• Weight - 1 kilo 2.2 lb
• Temperature (normal oral 98.6 F or 37 C)
• F (9/5 C) 32
• C 5/9 (F - 32)
• K C 273
• 1 cm H2O 0.74 mm Hg
• 1 mm Hg 1.36 cm H2O

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• Conversions
• Linear - 1 inch 2.54 cm
• Volume - 1 gallon 3.8 L
• Weight - 1 kilo 2.2 lb

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Temperature Conversions

• F (C 1.8) 32
• C (F -32) /1.8
• K C 273

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Ethical and Legal Implications of Practice

• Private Law - deals with definition, regulation,
  and enforcement of rights in cases between
  citizen and citizen or between citizen and
  organizations. There are two types of private
  law. They are torts and contract law. (Talk only
  about torts).
• Tort - a legal wrong committed upon a person or
  property independent of contract

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Ethical and Legal Implications of Practice

• Intentional tort
• Assault - willful attempt or threat to inflict
  injury on another.
• Battery - intentional touching of another person
  without consent
• Libel - false or malicious writing that is
  intended to defame or dishonor another
• Slander - spoken form of defamation

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Ethical and Legal Implications of Practice

• Negligent tort Malpractice - carelessness or
  failure to act with due care on the part of the
  professional
• Malfeasance-execution of an unlawful or improper
  act
• Negligence-reckless disregard for the safety of
  another

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Basic Principles of Health Care Ethics

• Reciprocal patient rights
• Autonomous choice
• Not to be harmed
• Fair and equitable treatment
• Autonomy-patient personal liberty and their right
  to decide their own course of treatment Informed
  consent educate the patient so that they are
  able to make their own course of treatment
• Veracity-binds healthcare workers to tell the
  truth

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Basic Principles of Health Care Ethics

• Reciprocal patient rights (cont)
• Benevolent deception-truth is withheld from the
  patient for their own good
• Non-malfeasance obligates healthcare worker to
  avoid harming patient and try to prevent harm
  where possible
• Beneficence-healthcare workers go beyond doing no
  harm and actively contribute to the health and
  well being of their patients
• Confidentiality-dont talk about the patient in
  areas where others can hear. Use the report room
  to discuss patient information.

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Charting

• POMR-Problem Oriented Medical Record
• Has 4 basic parts
• Database
• Contains information of a routine nature
• General health history
• Physical exam results
• Results of diagnostic tests
• Problem List Something that interferes with a
  patients physical or psychological health or
  ability to function

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Charting

• Has 4 basic parts (cont)
• Plan - Course of action to correct problems from
  list
• Progress notes
• Contains findings (subjective and objective),
  assessment plans, and plans for orders

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Charting

• Format used is SOAP
• Subjective-information obtained from the patient,
  relatives, or similar source
• Objective-information based on caregivers
  observations of the patient, physical exam, or
  diagnostic or laboratory tests
• Assessment-refers to the analysis of the
  patients problem
• Plan-plan of action to be taken to resolve the
  problem

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Charting

• Components of a chart
• Admission Record
• States time and date the patient was admitted to
  the facility
• Patient birthday, address, SSN, telephone number,
  next of kin, insurance information
• Physician Orders All orders must contain the
  date, time, and physician signatures
• Progress notes Every time the patient is visited
  by the doctor, the patients progress is recorded

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Charting

• Components of a chart (cont)
• History and Physical Examination
• The patient history is obtained from the patient
  or relatives upon admission
• The initial physical is performed by the
  attending physician it is a head to toe
  assessment of the major organ systems
• Nursing Data Includes nursing notes and nursing
  assessment records

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Charting

• Graphic Record Contains pulse, temperature,
  respirations, blood pressure, urine output, oral
  intake, daily weights
• Laboratory Reports CBC, ABG, etc.
• Radiology x-rays, CT scans, MRI, PET, and
  ultrasound
• Operative Data Includes operative consents,
  operation reports, and anesthesia and post
  anesthesia records

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Charting

• Medication Administration Record Provides a
  chronology of the medication given to the
  patient, quantity, dosage, route, and date time
  of administration
• Ancillary Services Reserved for RT, OT, PT, ST
• Discharge Plan
• Denotes patient condition and date and time of
  discharge
• Any prescribed medication(s) and patient teaching
  for medication administration are documented here

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Preparing for the Patient Encounter

• Role of the RT in Patient Assessment
• Assist physician in determining initial diagnosis
• Assess patients response to therapy

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Preparing for the Patient Encounter

• Stages of Patient Clinical Interaction
• Preinteraction Stage
• Review patients chart to identify important
  facts stated in medical history
• Introductory Stage
• Introduce yourself to the patient stating your
  name, department, and purpose of the visit
• Confirm patient identity using his/her wrist ID
  bracelet

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Preparing for the Patient Encounter

• Stages of Patient Clinical Interaction (cont)
• Initial Assessment Stage
• This stage is done to identify the current health
  status of the patient. A brief interview and
  physical examination are appropriate
• Dont assume the patients condition has changed
  since the initial workup by the physician at
  admission
• Treatment and Monitoring Stage
• Provide treatment and monitor patients response
• Follow-up Stage
• Take a minute to ask the patient about how s/he
  feels and if you can do anything else before you
  leave
• Also let the patient know when you will return

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Preparing for the Patient Encounter

• Communicating the Assessment Findings
• Record details of the patient encounter in the
  chart
• If the patient had complications to the
  treatment, verbally communicate this to the
  patients nurse and physician if the
  complications are serious
• When the patients condition takes a turn for the
  worse, you should stay with the patient until
  help arrives

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Preparing for the Patient Encounter

• Use of Space
• Social space (4-12 ft)
• initial introduction
• First step in establishing rapport
• Personal space (18in -4ft)
• Intimate Space (0-18in)

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Preparing for the Patient Encounter

• Territoriality
• Patients often lay claim to items in their room
  that are placed bedside even though the items
  belong to the hospital. For this reason never
  take a bedside item from Patient A and give to
  Patient B without obtaining Patient As
  permission
• Respecting the territorial rights of patients is
  an excellent way to let patients know you value
  them and that you are considerate of their needs

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Preparing for the Patient Encounter

• Confidentiality
• All patient records are confidential. What you
  read in the chart and what you discuss with the
  patient must be shared only with other healthcare
  workers who need to know the information to
  perform their job appropriately
• Discuss patients in areas outside private reports
  rooms must not be done

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Preparing for the Patient Encounter

• Express Genuine Concern
• Face the patient squarely
• Use eye contact appropriately
• Maintain an open posture
• Consider appropriate use of touch
• Be an active listener
• Universal Precautions

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The Interview

• Principles of Communication
• Each patient has a unique background that
  includes level of education, cultural heritage,
  religious beliefs, previous experiences, and self
  concept. All these factors play a key role in
  determining the patients response to you and
  your questions during the interview
• Verbal and nonverbal messages make up each
  interview
• Nonverbal messages can say more than actual words
• Excellent skills at listening are essential for
  the interview

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The Interview

• Structuring the Interview
• Project a sense of undivided interest in the
  patient during the interview
• Introduce yourself in a professional manner to
  begin the interview
• Be professional in your appearance and mannerisms
  during the interview
• Interview using a relaxed conversational style
  that communicates empathy

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The Interview

• Questions and Statements Used to Facilitate
  Conversational Interviewing
• Open ended questions encourage patients to
  describe events as they see them and promote
  better understanding of their problem (e.g., How
  have you been feeling lately?)
• Direct questions are better for the brief
  interview such as when following up on the
  effects of therapy (e.g., Did the oxygen help?)
• Indirect questions are used to clarify issues
  (e.g., Are you saying you can breathe better now
  that you are not taking the heart medication?)

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The Interview

• Questions and Statements Used to Facilitate
  Conversational Interviewing (cont)
• Neutral questions and phrases avoid leading the
  patient toward a desired answer
• Reflecting phrases show interest and let the
  patient know you are listening
• Communicating empathy during the interview
  provides more information to patients, suggesting
  you care about them.

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The Interview

• Alternate Sources for a patient History
• Family members present during the interview can
  be helpful in providing information that the
  patient does not know or remember