Medical Terminology, 2nd Edition

Competency 1: Differentiate professional agencies

Learning Objectives:

• Examine the NBRC matrix
• Summarize key principles within HIPAA
• Identify the important agencies related to respiratory therapy
• Describe the purpose of the agencies
• Relate their role in credentialing and certification
• Examine AARC Code of Ethics and the State of Wisconsin License guidelines

Competency 2: Perform pulse oximetry

Learning Objectives:

• Select the correct oximeter
• Perform all critical steps in the right order
• Properly identify patient according to National Safety Standards
• Employ pulse oximetry
• Wear personal protective equipment
• Follow safety procedures
• Verbalize an explanation of the process as you perform it
• Explanation presents sound reasoning as you describe the decisions you make throughout the process

Competency 3: Relate gas laws to respiratory function

Learning Objectives:

• Solve gas law problems
• Apply gas law problems to respiratory care patient situations.
• Solution is complete
• Solution is correct and uses proper units

Competency 4: Examine the role of a respiratory therapist in healthcare

Learning Objectives:

• Examination includes the job description
• Examination includes an evaluation of the Respiratory Therapist's scope of practice
• Examination includes the duties and responsibilities of a Respiratory Therapist
• Examination includes the role of the RT within the healthcare team
• Examination includes concentrations within RT

Competency 5: Explore legal and ethical issues related to respiratory care

Learning Objectives:

• Response clearly states the dilemma in the scenario
• Response includes a course of action to resolve the dilemma
• Response course of action reflects competent practice within the legal/ethical framework of health care
• Response includes a defense of the course of action or give a rationale for the action
• Response is appropriate within the legal framework of respiratory therapy

Competency 6: Adapt communication strategies to a diverse patient population

Learning Objectives:

• Display verbal and nonverbal communication techniques appropriate to the population
• Consider age, gender, cultural, etc. differences
• Provide support for individuals with special needs

Competency 7: Review the medical record utilizing medical record keeping and charting methods consistent with hospital policy and procedures

Learning Objectives:

• Select pertinent data for Respiratory Care practice
• In a simulated patient, you identify appropriate documentation
• Document consistent with hospital accreditation standards
• Identify the components of a care plan

Competency 8: Utilize infection control principles

Learning Objectives:

• Implement standard precautions
• Demonstrate proper isolation equipment application and removal without contamination.
• Evaluate potential causes and methods of transmitting infection (e.g., contact, airborne, common vehicle, vector-borne)
• Confine, contain or reduce the danger
• Prevent cross contamination

Competency 9: Obtain a focused health history

Learning Objectives:

• Identify kinds of questions you can ask
• Identify psycho-social issues

Competency 10: Evaluate patient data

Learning Objectives:

• Make a recommendation for further testing
• Identify normal values
• Utilize appropriate terminology in identifying patient data

Competency 11: Perform a basic cardiovascular assessment

Learning Objectives:

• Maintain privacy
• Assess apical and peripheral pulses for rate, rhythm, and amplitude
• Assess skin perfusion (color, temperature, and sensation)
• Modify assessment techniques to reflect variations across the lifespan
• Document actions and observations
• Recognize and report significant deviations from norms

Competency 12: Perform a respiratory assessment

Learning Objectives:

• Provide privacy
• Assess chest and respiratory status using designated format
• Differentiate between normal and abnormal lung sounds
• Modify assessment techniques to reflect variations across the lifespan
• Document actions and observations
• Recognize and report deviations from norms

Competency 13: Obtain vital signs

Learning Objectives:

• Perform blood pressure, pulse, respirations and temperature
• Accurately record vital signs
• State the normal range of blood pressure, pulse, respirations and temperature for the adult
• Note variants in range across the lifespan
• Identify possible implications of abnormal vital signs

Competency 14: Develop a care plan

Learning Objectives:

• Classify the components of a Respiratory care plan
• Perform a respiratory therapy assessment
• Explain the role of protocols for respiratory care plans
• Discuss the importance of critical thinking in the development of the respiratory care plan

Competency 15: Perform procedures to assess oxygenation

Learning Objectives:

• Perform a respiratory care assessment
• Utilize standard precautions
• Perform appropriate patient identification
• Perform a patient interview
• Utilize therapeutic communication for patient interaction
• Document a complete respiratory assessment

Competency 16: Evaluate oxygenation

Learning Objectives:

• Perform pulse oximetry
• Identify oxygenation assessment parameters from a physical exam
• Perform a physical exam to assess for oxygenation
• Document pulse oximetry
• Document physical exam parameters that assess for oxygenation

Competency 17: Perform calculations for oxygen therapy

Learning Objectives:

• Calculate delivered FiO2 for a low flow oxygenation system
• Determine PaO2 based on patient age
• Explain FiO2 measurements and calculations

Competency 18: Demonstrate the use of medical gas equipment

Learning Objectives:

• Differentiate medical gases that are used in the clinical setting
• Explain differences in storage and distribution of liquid and gaseous oxygen
• Calculate the contents of a liquid and compressed gas system
• Explain proper storage, transport and use of compressed gas cylinders
• Discuss the role of bulk systems in hospital systems
• Explain the safety systems for gas distribution
• Evaluate pressure regulators and flowmeters
• Troubleshoot Gas delivery systems
• Describe flow calculations of different gases
• Explain safety requirements required for the use of compressed gases
• Explain the function of the oxygen analyzer
• Analyze an oxygen system utilizing an oxygen analyzer

Competency 19: Assess the need for medical gas therapy

Learning Objectives:

• Identify the need for Oxygen therapy
• Distinguish the precautions, hazards, of oxygen therapy
• Complete a respiratory care plan that includes application of oxygen therapy
• Select the best oxygen delivery device based on a respiratory care plan
• Explain differences in the administration of oxygen to adults, children and infants
• Explain the evaluation and monitoring of the response to oxygen therapy
• Develop a protocol for the delivery of oxygen therapy
• Discuss the indications, hazards, contraindications of hyperbaric oxygen therapy
• Explain the use of Nitric oxide therapy
• Evaluate the use of Heliox therapy

Competency 20: Assess patient need for humidity and bland aerosol therapy

Learning Objectives:

• Care plan includes subjective data
• Care plan includes objective data
• Care plan includes an assessment of the data
• Care plan includes a therapeutic intervention related to the data
• Care plan includes an outcomes assessment
• Care plan includes modification
• Care plan response is supported by relevant evidence
• Care plan identifies appropriate modification to therapy based on patient response
• Care plan is based on indications for sputum induction, humidification, aerosol treatment and USN

Competency 21: Demonstrate the use of humidity and bland aerosol equipment

Learning Objectives:

• Select appropriate aerosol and/or humidity therapy to condition a patients inspired gas
• Utilize humidity and heating systems safely
• Describe when to humidify and warm inspired gases
• Identify the need for humidity and aerosol therapy
• Troubleshoot large volume bland aerosol systems

Competency 22: Demonstrate medication delivery devices

Learning Objectives:

• Explain the characteristics of an aerosol
• Explain how particle size, motion, and airway characteristics affect aerosol deposition
• Describe aerosol generation
• List the hazards of an aerosol drug therapy
• Select the best aerosol drug delivery system for a patient
• Develop a teaching plan for MDI and DPI self-administration
• Describe assessment of patient response to bronchodilator therapy
• Formulate a plan of action for a "non-traditional" delivery environment
• Discuss the risks of exposure to aerosolized medications

Competency 23: Relate gas laws to respiratory function

Learning Objectives:

• Calculate Gas Laws
• Perform simple Applied Physics calculations as they apply to the practice of Respiratory Care
• Explain each physical law and give its correct mathematical formula.
• Perform conversions from one measurement system to another
• Apply physical laws to clinical situations using clinical case study data

Competency 24: Perform arterial puncture

Learning Objectives:

• Identify the indications, hazards and contraindications for the arterial puncture
• Explain the precautions needed to perform an ABG
• Delineate the steps required for performing an ABG
• Discuss risks of a bloodborne exposure while obtaining an ABG
• Document an ABG

Competency 25: Perform airway clearance therapies (e.g. bronchial hygiene)

Learning Objectives:

• Perform all relevant steps on the procedure checklist
• Assessment includes review of patient data and recommendation of additional data if needed
• Assessment supports airway clearance technique selected
• Assessment supports airway clearance equipment selected
• Assessment follows available clinical practice guidelines
• Assessment includes appropriate outcome assessment for technique selected
• Use airway clearance equipment
• Assemble airway clearance equipment
• Modify therapy based on patient response
• Troubleshoot airway clearance equipment

Competency 26: Perform volume expansion therapies (i.e. IPPB, IS, CPAP, PEP)

Learning Objectives:

• Write a respiratory careplan that includes volume expansion therapies
• List the physiological basis of volume expansion
• Classify the different types of atelectasis
• List diagnostic modalities used to assess for lung expansion therapy
• Identify the patient populations that require volume expansion therapy
• Describe the clinical findings of a patient with atelectasis
• Distinguish the indications, hazards, and complications of volume expansion therapy
• Differentiate the various forms of volume expansion therapy
• Document Lung expansion administration

Competency 27: Develop an educational plan for patient and family

Learning Objectives:

• Educational plan is age appropriate
• Educational plan includes but not limited to therapy goals, breathing training, pharmacy, oxygen, secretion management, equipment, disease, smoking cessation, nutrition as appropriate
• Educational plan reflects cultural, ADA, gender, age, literacy and socioeconomic status
• Implement the plan with a simulated patient

Competency 28: Develop a multidisciplinary pulmonary rehabilitation care plan

Learning Objectives:

• List the goals of pulmonary rehabilitation
• Evaluate the scientific basis for pulmonary rehabilitation
• Discuss the response to exercise in the normal and diseased patient
• List the outcomes utilized in the evaluation of a pulmonary rehabilitation program
• Discuss the indications, hazards and contraindications of pulmonary rehabilitation
• Develop a pulmonary rehabilitation protocol
• Describe the pulmonary rehabilitation team members
• List the equipment required for a pulmonary rehabilitation program

Competency 29: Adapt therapeutic interventions for delivery in an alternate care setting

Learning Objectives:

• Identify the alternate or post-acute care settings
• Describe the formulation of discharge planning
• Describe the delivery of respiratory care services in the alternate care settings
• Describe the benefits, challenges, and limitations of the delivery of services in the alternate care settings
• Discuss education of patients in the alternate care settings

Competency 30: Perform 12 lead ECG

Learning Objectives:

• Select the correct instruments/equipment
• Perform all critical steps in the right order
• Follow safety procedures
• Verbalize an explanation of the process as you perform it
• Explanation presents sound reasoning as you describe the decisions you make throughout the process

Competency 31: Investigate evidence-based medicine and respiratory care protocols

Learning Objectives:

• Describe the purpose for care protocols
• Explain the correlation between evidence-based medicine and respiratory care protocols
• Apply protocols to patient cases

Competency 32: Demonstrate the use of manual resuscitators

Learning Objectives:

• Assemble and troubleshoot manual resuscitator
• Clean manual resuscitator
• State the factors that may affect the FiO2 of various devices
• Utilize manual resuscitator to deliver appropriate volumes for a variety of patients
• Compare and contrast different types of resuscitators

Competency 33: Assess the need for artificial airways

Learning Objectives:

• Distinguish normal and abnormal anatomy and physiology of the airways
• Assess patient's ability to protect airway
• Assess patient for airway obstruction
• Assess patient's ability to mobilize secretions
• Recognize need to provide invasive ventilatory support
• Recommend appropriate artificial airways for patient situation
• Evaluate legal and ethical considerations associated with the use of artificial airways

Competency 34: Apply basic artificial airways

Learning Objectives:

• Demonstrate use, maintenance, and infection control of selected basic artificial airways (i.e. OPA, NPA)
• Select the appropriate basic artificial airways for the patient situation
• Monitor patient's response to basic artificial airways

Competency 35: Apply advanced artificial airways

Learning Objectives:

• Demonstrate use, maintenance, and infection control of selected advanced artificial airways (i.e. ETT, supraglottic airways, tracheostomy)
• Select the appropriate advanced artificial airways for the patient situation
• Monitor patient's response to advanced artificial airways and ensure proper placement
• Summarize why a laryngectomy would be performed
• Utilize devices that assist with artificial airway management

Competency 36: Apply specialized airway adjuncts

Learning Objectives:

• Demonstrate use, maintenance, and infection control of selected specialized airway adjuncts (i.e. speaking valves, specialty tracheal tubes, trach buttons)
• Select the appropriate specialized airway adjuncts for the patient situation
• Monitor patient's response to specialized airway adjuncts

Competency 37: Demonstrate skill of secretion removal

Learning Objectives:

• Perform endotracheal, nasotracheal, oropharyngeal and tracheostomy tube suctioning according to the procedure checklist
• Select, use, maintain and troubleshoot equipment needed for secretion removal
• Assess the need for secretion removal
• Recommend techniques to enhance secretion removal

Competency 38: Analyze criteria for discontinuing artificial airways

Learning Objectives:

• Assess patient's readiness for artificial airway discontinuation
• Select appropriate strategy(ies) for artificial airway discontinuation
• Select, assemble, utilize, and troubleshoot equipment used for artificial airway discontinuation
• Monitor patient status following artificial airway discontinuation
• Evaluate legal and ethical considerations associated with discontinuation of artificial airway
• Perform procedures to safely remove artificial airways

Competency 39: Assess the need for mechanical ventilation

Learning Objectives:

• Assessment includes results of non-invasive monitoring
• Assessment includes recognition of impending ventilatory and/or oxygenation failure
• Assessment includes results of cardiopulmonary assessment
• Assessment includes recommendation for gathering further data as needed

Competency 40: Explain general principles of mechanical ventilation

Learning Objectives:

• Classify ventilators
• Compare ventilator modes
• Discuss the patient-ventilator interface
• Calculate simple pulmonary mechanics to determine ventilator settings

Competency 41: Apply non-invasive mechanical ventilation

Learning Objectives:

• Identify candidates for non-invasive mechanical ventilation
• Select appropriate mode and ventilator parameters
• Select, assemble, use and troubleshoot equipment
• Select, assemble, use, and troubleshoot the patient interface
• Modify therapy based on patient response
• Evaluate and monitor patient's objective and subjective responses to therapy

Competency 42: Apply invasive mechanical ventilation

Learning Objectives:

• Identify candidates for invasive mechanical ventilation
• Select appropriate mode and ventilator parameters
• Select, assemble, use and troubleshoot equipment
• Evaluate and monitor patient's objective and subjective responses to therapy

Competency 43: Manage patients requiring mechanical ventilation

Learning Objectives:

• Select appropriate ventilator settings for patient situation
• Assemble and configure operation
• Correctly operate ventilator according to patient response
• Troubleshoot ventilator and circuit
• Modify therapy based on patient response and patient/ventilator synchrony

Competency 44: Interpret waveforms and graphics

Learning Objectives:

• Interpretation includes selection of the appropriate graphics
• Interpretation includes recognition of the mode being delivered
• Interpretation includes triggering of the ventilator
• Interpretation includes identification of waveform components
• Interpretation includes association of waveforms with clinical abnormalities such as excessive work, insufficient time, auto PEEP, over-distension
• Interpretation includes modification of ventilator based on waveform analysis

Competency 45: Evaluate patient response to mechanical ventilation

Learning Objectives:

• Calibrate the capnography equipment
• Demonstrate proper use of the capnography equipment
• Interpret arterial blood gases and make recommendations for ventilator adjustments including adjuncts such as high frequency ventilation and recruitment maneuvers
• Interpret capnography and make recommendations for ventilator adjustments
• Correlate capnography with arterial blood gases
• Correlate pulse oximetry with arterial blood gases

Competency 46: Apply weaning/liberation strategies to mechanically ventilated patients

Learning Objectives:

• Assess patient's readiness for weaning to include MIP, MEP, VC, RSBI and nutritional status
• Select appropriate weaning strategy
• Monitor the weaning process
• Select, assemble, use and troubleshoot equipment used during the weaning process
• Recommend modification and/or termination of the weaning process

Competency 47: Analyze the legal and ethical implications of initiation, continuation, and end of life situations/scenarios

Learning Objectives:

• Identify clinical situations in which life support would be initiated, continued, and/or withdrawn
• Explain the procedures to assess for termination of life support (i.e. apnea testing, neurologic assessment)
• Describe legal implications involved in initiation, continuation, and withdrawal of life support
• Describe ethical implications involved in initiation, continuation, and withdrawal of life support
• Examine the process for surge planning and triage for mass casualties

Competency 48: Implement mechanical ventilation strategies to various disease states according to evidenced based practice

Learning Objectives:

• Identify candidates for nonconventional ventilation strategies (i.e. ARDS, asthma, COPD)
• Select appropriate mode and ventilator parameters
• Modify therapy based on patient situation and response (i.e. VAI, VAE, lung protective strategies)
• Evaluate and monitor patient's objective and subjective responses to therapy

Competency 49: Apply strategies to prevent ventilator associated events

Learning Objectives:

• Position the patient
• Provide appropriate oral care
• Monitor parameters for the ventilator bundle
• Confirm compliance with the VAE prevention methods

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