TermPaperWarehouse.com - Free Term Papers, Essays and Research Documents

The Research Paper Factory

Free Essay

Elderly Patients

In:

Submitted By Labratre
Words 4345
Pages 18
|CognitiveLevel||3rd Ed. Page References|
|Recall|Application|Analysis|Totals||
I. PATIENT DATA EVALUATION AND RECOMMENDATIONS|11|14|1|26||
A. Review Data in the Patient Record|4|||4||
1. Patient history e.g.,• present illness• admission notes• respiratory care orders• medication history• progress notes• diagnoses• DNR status• patient education (previous)|||||pp 33, 82, 47|
2. Physical examination relative to the cardiopulmonary system e.g., vitalsigns, physical findings|||||pp 33-35, 35-45, 47, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177|
3. Laboratory data e.g.,• CBC• electrolytes• coagulation studies• culture and sensitivities• sputum Gram stain|||||pp 45-47|
4. Pulmonary function results|||||pp 47, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197|
5. Blood gas results|||||pp 47, 124-126, 126-127, 127-128, 151-153, 153-155, 156-158, 158-163|
6. Imaging studies e.g.,• radiograph• CT• MRI|||||pp 33-45, 47, 151-153, 175-177|
7. Monitoring data||||||
a. fluid balance|||||pp 139-140|
b. pulmonary mechanics e.g., maximum inspiratory pressure, vitalcapacity|||||pp 47, 139, 191-194, 194-196|
c. respiratory e.g.,• rate• tidal and minute volume• I:E|||||pp 47, 139, 191-194, 194-196|
d. pulmonary compliance, airways resistance, work of breathing|||||pp 47, 137-139, 141-143|
e. noninvasive e.g.,• pulse oximetry• VD/VT• capnography• transcutaneous O2 / CO2|||||pp 20-21, 47, 137-139, 167-172, 172-175|
8. Cardiac monitoring|||||pp 35-45, 158-163|
a. ECG data results e.g., heart rate, rhythm|||||pp 35-45, 103-111, 158-163|
b. hemodynamic monitoring results e.g.,• blood pressure• CVP• PA pressure• cardiac output / index|||||pp 35-45, 111-119, 158-163|
9. Maternal and perinatal / neonatal history and data • Apgar scores• gestational age• L / S ratio|||||pp 167-172, 172-175|
B. Collect and Evaluate Additional Pertinent Clinical Information|6|11|1|18||
1. Assess a patient's overall cardiopulmonary status by inspection todetermine|||||pp 35-45, 49-50, 50-64|
a. general appearance e.g.,• venous distention• edema• accessory muscle activity• chest wall movement• diaphoresis• clubbing• cyanosis• breathing pattern|||||pp 35-45, 49-50, 50-64, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177|
b. airway assessment e.g., macroglossia, neck range of motion|||||pp 49-50, 50-64|
c. cough, sputum amount and character|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177|
d. Apgar score, gestational age, transillumination of chest|||||pp 167-172, 172-175|
2. Assess a patient's overall cardiopulmonary status by palpation todetermine|||||pp 35-45, 139-140|
a. pulse, rhythm, force|||||pp 35-45, 75-77, 139-140|
b. asymmetrical chest movements, tactile fremitus, crepitus,tenderness, secretions in the airway, and tracheal deviation|||||pp 35-45, 49-50, 50-64, 139-140|
3. Assess a patient's overall cardiopulmonary status by percussion|||||pp 139-140|
4. Assess a patient's overall cardiopulmonary status by auscultation todetermine presence of|||||pp 35-45, 139-140, 151-153, 155-156, 158-163|
a. breath sounds|||||pp 35-45, 50-64, 139-140, 151-153, 153-155, 155-156, 156-158, 158-163|
b. heart sounds and rhythm|||||pp 35-45, 139-140, 151-153, 155-156, 158-163|
c. blood pressure|||||pp 35-45, 139-140, 151-153, 155-156, 158-163|
5. Interview a patient to determine|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
a. level of consciousness and orientation, emotional state, and ability tocooperate|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
b. level of pain|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
c. presence of dyspnea, sputum production, and exercise tolerance|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
d. nutritional status|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
e. social history e.g., smoking, substance abuse|||||pp 33-35, 151-153, 153-155, 155-156, 156-158, 158-163|
f. advance directives e.g., DNR status|||||pp 33-35, 82, 151-153, 153-155, 155-156, 156-158 |
6. Assess a patient’s learning needs||||||
7. Review a chest radiograph to determine|||||pp 35-45, 139-140|
a. position of endotracheal or tracheostomy tube|||||pp 35-45, 139-140|
b. presence of, or change in, cardiopulmonary abnormalities e.g.,• pneumothorax• consolidation• pleural fluid• pulmonary edema|||||pp 35-45, 139-140|
c. position of indwelling tubes and catheters|||||pp 35-45, 167-172, 172-175|
d. presence of foreign bodies|||||pp 35-45, 49-50, 175-177|
e. position of or change in hemidiaphragms or mediastinum|||||pp 35-45, 151-153, 155-156, 156-159|
8. Review lateral neck radiographs e.g., epiglottitis, foreign body|||||pp 35-45, 175-177|
9. Perform procedures||||||
a. 12-lead ECG|||||pp 103-11|
b. transcutaneous monitoring|||||pp 167-172, 172-175|
c. pulse oximetry and capnography|||||pp 20-21, 50-64, 137-139|
d. tidal volume, minute volume, vital capacity, and peak flowmeasurements|||||pp 139, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196 |
e. bedside spirometry e.g., FVC, FEV1|||||pp 139, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
f. arterial sampling - percutaneous or line|||||pp 121-122|
g. arterialized capillary blood sampling|||||pp 167-172, 172-175|
h. timed walk test e.g., 6-minute||||||
i. oxygen titration with exercise|||||pp 111-119, 151-153, 153-155, 155-156, 156-158, 158-163|
j. blood gas / hemoximetry analysis|||||pp 124-126, 126-127, 127-128, 139|
k. cardiopulmonary calculations e.g., P(A-a)O2, VD / VT|||||pp 18-19, 122-124, 140-141|
l. hemodynamic monitoring e.g., blood pressure, CVP||||||
m. lung mechanics e.g.,• plateau pressure• MIP• MEP• airways resistance• compliance|||||pp 137-139, 141-143, 191-194, 194-196|
n. apnea monitoring|||||p 190|
o. overnight pulse oximetry|||||pp 20-21, 151-153, 153-155, 155-156, 156-158, 158-163, 163-165|
p. tracheal tube cuff pressure and / or volume|||||pp 64-67|
q. arterial line insertion||||||
r. stress testing e.g., ECG, pulse oximetry|||||pp 119-120|
s. pulmonary function laboratory studies|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197|
t. CPAP / BIPAP titration during sleep|||||pp 163-165|
10. Interpret procedure results including||||||
a. 12-lead ECG e.g.,• rate• irregular rhythm• artifacts|||||pp 103-11|
b. transcutaneous monitoring|||||p 171|
c. pulse oximetry and capnography|||||pp 20-21, 50-64, 137-139|
d. tidal volume, minute volume, vital capacity, and peak flowmeasurements|||||pp 139, 191-194, 194-196|
e. bedside spirometry e.g., FVC, FEV1|||||pp 139, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194|
f. arterial sampling - percutaneous or line|||||pp 121-122, 139|
g. arterialized capillary blood sampling|||||p 171|
h. timed walk test e.g., 6-minute||||||
i. oxygen titration with exercise|||||pp 111-119, 151-153, 153-155, 155-156, 156-158, 158-163|
j. blood gas / hemoximetry analysis|||||pp 21, 124-126, 126-127, 127-128|
k. cardiopulmonary calculations e.g., P(A-a)O2, VD / VT|||||pp 18-19, 122-124, 140-141|
l. hemodynamic monitoring e.g., blood pressure, CVP|||||pp 140-141, 158-163|
m. lung mechanics e.g.,• plateau pressure• MIP• MEP|||||pp 141-143, 196|
n. apnea monitoring|||||p 190|
o. overnight pulse oximetry|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 163-165|
p. tracheal tube cuff pressure and/or volume|||||pp 66-67|
q. arterial line insertion|||||pp 20-21|
r. stress testing e.g., ECG, pulse oximetry|||||pp 20-21, 119-120|
s. pulmonary function laboratory studies|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197|
t. CPAP / BIPAP titration during sleep|||||pp 163-165|
C. Recommend Procedures to Obtain Additional Data|1|3|0|4||
1. Radiographic and other imaging studies|||||pp 35-45, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177|
2. Diagnostic bronchoscopy e.g., evaluate hemoptysis, atelectasis|||||pp 69-71|
3. Sputum Gram stain, culture and sensitivities e.g., pneumonia|||||pp 199-200|
4. Bronchoalveolar lavage (BAL)|||||pp 156-158|
5. Pulmonary function testing|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
6. Lung mechanics e.g., compliance, airways resistance|||||pp 137-139, 141-143|
7. Blood gas analysis, pulse oximetry, and transcutaneous monitoring|||||pp 20-21, 124-126, 126-127, 127-128, 167-172, 172-175|
8. ECG|||||pp 103-111|
9. Capnography|||||pp 50-64|
10. Hemodynamic monitoring e.g., blood pressure, CVP|||||pp 111-119, 158-163|
11. Sleep studies|||||pp 163-165|
II. EQUIPMENT MANIPULATION, INFECTION CONTROL, AND QUALITYCONTROL|5|15|9|29||
A. Manipulate Equipment by Order or Protocol|4|10|8|22||
1. Oxygen administration devices|||||pp 7-18|
a. low-flow devices e.g., nasal cannula|||||pp 7-18|
b. high-flow devices e.g., air entrainment mask|||||pp 7-18|
c. high-flow nasal cannula|||||pp 7-18|
2. CPAP devices – mask, nasal, or bilevel|||||pp 20, 167-172, 172-175|
3. Humidifiers|||||pp 23-27|
4. Nebulizers|||||pp 20, 27-31|
5. Resuscitation devices e.g., manual resuscitator (bag-valve), mouth-to-valvemask resuscitator|||||pp 77-79|
6. Ventilators||||||
a. pneumatic, electric, fluidic, and microprocessor|||||pp 86-93, 129-131|
b. noninvasive positive pressure|||||pp 129-131|
7. Artificial airways|||||pp 50-64|
a. oro- and nasopharyngeal airways|||||pp 50-64|
b. endotracheal tubes|||||pp 50-64|
c. tracheostomy tubes and devices|||||pp 50-64|
d. speaking tubes and valves|||||pp 50-64|
e. intubation equipment|||||pp 50-64|
f. laryngeal mask airway (LMA)|||||pp 50-64|
g. esophageal-tracheal Combitube®|||||pp 50-64|
8. Suctioning devices|||||pp 64-67|
9. Gas delivery, metering, and clinical analyzing devices||||||
a. gas cylinders, regulators, reducing valves, connectors andflowmeters, and air / oxygen blenders|||||pp 1-7, 7-18|
b. oxygen conserving devices e.g., reservoir cannula, pulse-dose|||||pp 7-18, 187-190|
c. oxygen concentrators|||||pp 187-190|
d. air compressors||||||
10. Point-of-care analyzers e.g., blood gas, electrolytes|||||p 128|
11. Patient breathing circuits||||||
a. continuous mechanical ventilation|||||pp 129-131|
b. IPPB|||||pp 86-93|
c. CPAP and PEEP valve assemblies||||||
d. non-invasive ventilation|||||pp 129-131|
12. Environmental devices|||||pp 7-18, 27-31, 175-177|
a. aerosol (mist) tents|||||pp 7-18|
b. oxygen hoods|||||pp 7-18, 167-172, 172-175|
13. Incentive breathing devices|||||pp 93-94|
14. Airway clearance devices||||||
a. percussors and vibrators|||||pp 96-100|
b. positive expiratory pressure (PEP) devices|||||pp 100-102|
c. vibratory PEP devices|||||pp 100-102|
15. Manometers e.g., aneroid, digital, water||||||
16. Respirometers e.g., flow-sensing devices|||||pp 197-198|
17. ECG monitors|||||pp 103-111|
18. ECG machines (12-lead)|||||pp 103-111|
19. Vacuum systems e.g.,• pumps• regulators• collection bottles• pleural drainage devices|||||pp 64-67|
20. Oximetry monitoring devices e.g., pulse oximeter, transcutaneous|||||pp 20-21, 167-172, 172-175|
21. Metered dose inhalers (MDI) and MDI spacers|||||pp 27-31|
22. Dry powder inhalers|||||p 185|
23. Bedside screening spirometers|||||pp 197-198|
24. CO, He, O2 and specialty gas analyzers|||||p 21|
25. Bronchoscopes|||||pp 69-71|
B. Ensure Infection Control|0|2|1|3||
1. Assure cleanliness of equipment by• selecting or determining appropriate agent and technique fordisinfection and/or sterilization• performing procedures for disinfection and/or sterilization• monitoring effectiveness of sterilization procedures|||||pp 187-190, 199-200, 201-202|
2. Assure proper handling of biohazardous materials|||||p 202|
3. Incorporate ventilator-associated pneumonia protocol|||||p 149|
4. Implement infectious disease protocols e.g.,• avian flu• SARS• transmission prevention|||||pp 202-203|
5. Adhere to infection control policies and procedures e.g., StandardPrecautions|||||pp 86-93, 202-203|
C. Perform Quality Control Procedures For: |1|3|0|4||
1. Blood gas analyzers, co-oximeters|||||p 128|
2. Gas analyzers|||||pp 20, 21|
3. Point-of-care analyzers|||||p 128|
4. Pulmonary function equipment|||||pp 191-194, 194-196|
5. Mechanical ventilators||||||
6. Gas metering devices e.g., flowmeter||||||
7. Noninvasive monitors e.g., transcutaneous||||||
8. Record and monitor QC data using accepted statistical methods||||||
III. INITIATION AND MODIFICATION OF THERAPEUTIC PROCEDURES|19|45|21|85||
A. Maintain Records and Communicate Information|2|3|0|5|pp 47, 86-93, 96-100, 100-102|
1. Record therapy and results using conventional terminology as required inthe health care setting and/or by regulatory agencies|||||pp 47, 86-93, 96-100, 100-102|
a. specify therapy administered, date, time, frequency of therapy,medication, and ventilatory data|||||pp 47, 86-93, 96-100, 100-102|
b. note and interpret patient's response to therapy|||||pp 47, 86-93, 96-100, 100-102|
1) effects of therapy, adverse reactions, patient's subjective andobjective response to therapy|||||p 47|
2) verify computations and note erroneous data|||||p 47|
3) auscultatory findings, cough and sputum production andcharacteristics|||||pp 47, 35-45|
4) vital signs|||||p 47|
5) pulse oximetry, heart rhythm, capnography|||||pp 47, 20-21|
2. Communicate information|||||p 47|
a. regarding patient's clinical status to appropriate members of the health care team|||||p 47|
b. relevant to coordinating patient care and discharge planning|||||p 47|
3. Accept and verify patient care orders|||||p 47|
4. Apply computer technology to|||||p 47|
a. document patient management|||||p 47|
b. monitor workload assignments|||||p 47|
c. patient safety initiatives e.g., drug dispensing, order entry|||||p 47|
5. Communicate results of therapy and alter therapy by protocol(s)|||||p 47|
6. Explain planned therapy and goals to a patient in understandable termsto achieve optimal therapeutic outcome|||||p 47|
7. Educate a patient and family concerning smoking cessation and health management|||||p 47|
B. Maintain a Patent Airway Including the Care of Artificial Airways|2|2|3|7||
1. Properly position a patient|||||pp 49-50, 50-64|
2. Insert oro- and nasopharyngeal airways|||||pp 50-64|
3. Perform endotracheal intubation|||||pp 50-64|
4. Maintain position in the airway and appropriate cuff inflation of:|||||pp 50-64|
a. LMA|||||pp 50-64|
b. esophageal-tracheal Combitube®|||||pp 50-64|
c. endotracheal tube|||||pp 50-64|
d. tracheostomy tube|||||pp 50-64|
5. Assess tube placement|||||pp 50-64|
6. Perform tracheostomy care|||||pp 50-64|
7. Change tracheostomy tubes|||||pp 50-64|
8. Maintain adequate humidification|||||pp 23-27|
9. Perform extubation|||||pp 64-67|
C. Remove Bronchopulmonary Secretions|1|3|0|4||
1. Perform:|||||pp 151-153, 153-155, 155-156, 156-158, 158-163|
a. postural drainage, percussion, or vibration|||||pp 96-100, 151-153, 153-155, 155-156, 156-158, 158-163|
b. nasotracheal suctioning|||||pp 64-67, 151-153, 153-155, 155-156, 156-158, 158-163|
c. oropharyngeal suctioning|||||pp 64-67, 151-153, 153-155, 155-156, 156-158, 158-163|
d. airway clearance using mechanical devices e.g., high frequencychest wall oscillation, vibratory PEP|||||pp 100-102, 151-153, 153-155, 155-156, 156-158, 158-163|
2. Suction artificial airways|||||pp 64-67, 151-153, 153-155, 155-156, 156-158, 158-163|
3. Administer aerosol therapy with prescribed drugs|||||pp 27-31, 151-153, 153-155, 155-156, 156-158, 158-163, 179-185|
4. Instruct and encourage bronchopulmonary hygiene techniques|||||pp 96-100, 100-102, 151-153, 153-155, 155-156, 156-158, 158-163|
D. Achieve Adequate Respiratory Support|2|5|1|8||
1. Instruct a patient in:|||||pp 93-94|
a. deep breathing and incentive spirometry techniques|||||pp 93-94|
b. inspiratory muscle training techniques|||||pp 93-94|
2. Initiate and adjust|||||pp 7-18|
a. IPPB therapy|||||pp 7-18, 86-93|
b. continuous mechanical ventilation settings|||||pp 7-18, 131-137, 145-146, 146-147, 149|
c. noninvasive ventilation|||||pp 129-131|
d. elevated baseline pressure e.g., CPAP, PEEP|||||pp 131-137|
3. Select ventilator graphics e.g., waveforms, scales|||||pp 147-149|
4. Initiate and select appropriate settings for high frequency ventilation|||||pp 144-145|
5. Administer medications|||||pp 151-153, 155-156, 156-158, 158-163|
a. aerosolized|||||pp 27-31, 151-153, 155-156, 156-158, 158-163, 175-177, 179-185|
b. dry powder preparations|||||pp 151-153, 155-156, 156-158, 158-163, 185|
c. endotracheal instillation|||||pp 79-81, 151-153, 155-156, 156-158, 158-163|
6. Administer oxygen|||||pp 7-18|
7. Initiate and modify weaning procedures|||||pp 143-144|
8. Position patient to minimize hypoxemia||||||
9. Prevent procedure-associated hypoxemia e.g., oxygenate before andafter suctioning and equipment changes|||||pp 64-65|
10. Apply disease-specific ventilator protocols (e.g. ARDS-Net protocol)|||||pp 129-131|
E. Evaluate and Monitor Patient's Objective and Subjective Responses toRespiratory Care|3|7|5|15||
1. Recommend and review a chest radiograph|||||pp 35-45, 155-156, 175-177|
2. Obtain a blood gas sample:|||||pp 167-172, 172-175|
a. by puncture|||||pp 121-122, 167-172, 172-175|
b. from an arterial or pulmonary artery catheter|||||pp 167-172, 172-175|
c. from arterialized capillary blood|||||pp 167-172, 172-175|
3. Perform:||||||
a. transcutaneous monitoring|||||pp 167-172|
b. pulse oximetry||||||
c. blood gas and hemoximetry analyses|||||p 21|
d. capnography|||||pp 50-64|
e. hemodynamic assessment|||||pp 111-119|
4. Interpret results of:||||||
a. blood gases|||||pp 124-126, 126-127, 127-128|
b. hemoximetry e.g., carboxyhemoglobin|||||p 21|
c. hemodynamics|||||pp 111-119|
d. pulse oximetry|||||pp 20-21|
e. capnography|||||pp 50-64, 137-139|
5. Observe for:||||||
a. changes in sputum characteristics|||||pp 33-35|
b. signs of patient-ventilator dysynchrony||||||
6. Measure and record vital signs, monitor cardiac rhythm, and evaluate fluid balance - intake and output|||||pp 139-140|
7. Perform and interpret results of pulmonary function testing:|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
a. spirometry|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197|
b. compliance and airways resistance|||||pp 137-139, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197|
c. lung volumes|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
d. DLco|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
e. exercise|||||pp 119-120, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
f. bronchoprovocation studies|||||pp 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196|
8. Recommend blood tests e.g., hemoglobin, potassium||||||
9. Monitor airway pressures, and adjust and check alarm systems|||||pp 137-139|
10. Measure FIO2 and/or oxygen flow|||||pp 7-18, 20|
11. Auscultate the chest and interpret changes in breath sounds|||||pp 35-45, 50-64|
F. INDEPENDENTLY MODIFY Therapeutic Procedures Based on the Patient’s Response|2|9|7|18||
1. Terminate treatment based on patient's response to therapy|||||pp 86-93, 96-100|
2. Modify treatment techniques:|||||pp 23-27|
a. IPPB|||||pp 86-93|
b. incentive breathing devices|||||pp 93-94|
c. aerosol therapy:|||||pp 27-31, 175-177|
1) modify patient breathing patterns|||||pp 27-31, 175-177|
2) change type of equipment and change aerosol output|||||pp 27-31, 175-177|
3) change dilution of medication|||||pp 27-31, 175-177|
4) adjust temperature of the aerosol|||||pp 27-31, 175-177|
d. oxygen therapy:|||||pp 7-18, 167-172, 172-175, 175-177|
1) change mode of administration, flow, and FIO2|||||pp 7-18, 167-172, 172-175, 175-177|
2) set up or change an O2 blender|||||pp 7-18, 167-172, 172-175, 175-177|
3) set up an O2 concentrator or liquid O2 system|||||pp 175-177, 187-190|
e. specialty gas therapy e.g., He / O2, NO|||||p 19|
1) change mode of administration|||||p 19|
2) adjust flow or gas concentration|||||p 19|
f. bronchial hygiene therapy|||||pp 96-100, 100-102|
1) alter patient position and duration of treatment and techniques|||||pp 96-100, 100-102|
2) coordinate sequence of therapies e.g.,• chest percussion• postural drainage• PEP|||||pp 96-100, 100-102|
g. management of artificial airways|||||pp 64-66|
1) reposition or change endotracheal or tracheostomy tube|||||pp 50-64|
2) change type of humidification equipment|||||pp 23-27|
3) initiate suctioning|||||pp 64-67|
4) inflate and / or deflate the cuff|||||pp 64-67|
5) perform tracheostomy care|||||pp 50-64|
h. suctioning:||||||
1) alter frequency and duration of suctioning|||||pp 64-66|
2) change size and type of catheter|||||pp 64-66|
3) alter negative pressure|||||pp 64-66|
4) instill irrigating solutions|||||pp 179-185|
i. mechanical ventilation:||||||
1) improve patient synchrony|||||pp 145-146, 146-147, 149|
2) enhance oxygenation|||||pp 131-137,145-146, 146-147, 149|
3) improve alveolar ventilation|||||pp 131-137,145-146, 146-147, 149|
4) adjust I : E settings|||||pp 145-146, 146-147, 149|
5) modify ventilator techniques|||||pp 145-146, 146-147, 149|
6) adjust noninvasive positive pressure ventilation|||||pp 129-131|
7) monitor and adjust alarm settings|||||pp 137-139|
8) adjust ventilator settings based on ventilator graphics|||||pp 147-149|
9) change type of ventilator|||||pp 129-131|
10) change patient breathing circuitry|||||p 149|
11) alter mechanical dead space|||||pp 131-137|
12) initiate procedures for weaning|||||pp 143-144|
G. RECOMMEND Modifications in the Respiratory Care Plan Based on thePatient’s Response|3|10|4|17||
1. Recommend:||||||
a. institution of bronchopulmonary hygiene procedures|||||pp 151-153, 153-155, 155-156, 156-158, 158-163|
b. treatment of pneumothorax||||||
c. sedation and/or use of muscle relaxant(s)||||||
d. adjustment of fluid balance||||||
e. adjustment of electrolyte therapy||||||
f. insertion or change of artificial airway||||||
g. weaning from mechanical ventilation|||||pp 143-144|
h. extubation|||||pp 64-67|
i. discontinuing treatment based on patient response||||||
2. Recommend changes in:||||||
a. patient position||||||
b. inhaled drug dosage or concentration|||||pp 179-185|
c. FIO2 and oxygen flow|||||pp 7-18, 167-172, 172-175|
3. Recommend changes in mechanical ventilation to:|||||pp 131-137|
a. improve patient synchrony|||||pp 131-137|
b. enhance oxygenation|||||pp 131-137, 145-146, 146-147, 149|
c. improve alveolar ventilation|||||pp 131-137, 145-146, 146-147, 149|
d. adjust I : E settings|||||pp 131-137|
e. modify ventilator techniques||||||
f. adjust noninvasive positive pressure ventilation|||||pp 129-131|
g. monitor and adjust alarm settings|||||pp 137-139|
h. adjust ventilator settings based on ventilator graphics|||||pp 147-149|
i. change type of ventilator|||||pp 129-131|
j. change patient breathing circuitry|||||p 149|
k. reduce auto-PEEP|||||pp 129-131, 147-149|
l. reduce plateau pressure|||||pp 129-13p|
4. Recommend pharmacologic interventions including use of:|||||pp 179-185|
a. bronchodilators|||||pp 179-185|
b. antiinflammatory drugs e.g.,• leukotriene modifiers• corticosteroids• cromolyn sodium|||||pp 179-185|
c. mucolytics and proteolytics e.g.,• acetylcysteine• RhDNAse• hypertonic saline|||||pp 179-185|
d. cardiovascular drugs e.g., ACLS protocol agents|||||pp 75-77, 79-81|
e. antimicrobials e.g., antibiotics|||||pp 179-185|
f. sedatives|||||pp 179-185|
g. analgesics|||||pp 179-185|
h. paralytic agents|||||pp 179-185|
i. diuretics|||||pp 179-185|
j. surfactants|||||pp 179-185|
k. vaccines e.g., pneumovax, influenza|||||pp 179-185|
H. Determine the Appropriateness of the Prescribed Respiratory Care Plan and Recommend Modifications When Indicated by Data|1|3|0|4||
1. Analyze available information to determine the pathophysiological state|||||p 187|
2. Review:|||||p 187|
a. planned therapy to establish therapeutic plan|||||p 187|
b. interdisciplinary patient and family plan|||||p 187|
3. Determine appropriateness of prescribed therapy and goals for identifiedpathophysiological state|||||p 187|
4. Recommend changes in therapeutic plan when indicated|||||p 187|
5. Perform respiratory care quality assurance|||||p 187|
6. Develop:|||||pp 48, 187|
a. quality improvement program|||||pp 48, 187|
b. respiratory care protocols|||||pp 48, 187|
7. Monitor outcomes of:|||||pp 48, 187|
a. quality improvement programs|||||pp 48, 187|
b. respiratory care protocols|||||pp 48, 187|
8. Apply respiratory care protocols|||||pp 48, 187|
I. Initiate, Conduct, or Modify Respiratory Care Techniques in an Emergency Setting|1|1|1|3||
1. Treat cardiopulmonary emergencies according to:|||||pp 49-50, 75-77, 79-81|
a. BCLS|||||pp 49-50, 75-77, 79-81|
b. ACLS|||||pp 49-50, 75-77, 79-81|
c. Pediatric Advanced Life Support (PALS)|||||pp 49-50, 75-77, 79-81|
d. Neonatal Resuscitation Program (NRP)|||||pp 49-50, 75-77, 79-81|
2. Treat a tension pneumothorax|||||pp 158-163|
3. Participate in:|||||pp 82-83|
a. land / air patient transport|||||pp 82-83|
b. intra-hospital patient transport|||||pp 82-83|
c. disaster management|||||p 83|
d. medical emergency team (MET) e.g., rapid response team|||||pp 79-81|
J. Act as an Assistant to the Physician Performing Special Procedures|1|1|0|2||
1. Intubation|||||pp 50-64|
2. Bronchoscopy|||||pp 69-71|
3. Thoracentesis|||||pp 158-163|
4. Tracheostomy|||||pp50-64|
5. Chest tube insertion|||||pp 71-74, 151-153|
6. Moderate (conscious) sedation|||||pp 184-185|
7. Cardioversion|||||pp 81-82|
8. Ultrasound||||||
K. Initiate and Conduct Pulmonary Rehabilitation and Home Care|1|1|0|2||
1. Monitor and maintain home respiratory care equipment|||||pp 187-190|
2. Explain planned therapy and goals to a patient in understandable terms to achieve optimal therapeutic outcome|||||pp 187-190|
3. Educate a patient and family in health management||||||
4. Interact with a case manager||||||
5. Counsel a patient and family concerning smoking cessation|||||pp 187-190|
6. Instruct patient and family to assure safety and infection control||||||
7. Modify respiratory care procedures for use in home|||||pp 187-190|
Totals|35|74|31|140||
||||||

Similar Documents

Free Essay

Vulnerable Populations

...psychological, or social health” (de Chesney, 2012). There are many vulnerable populations and this paper will concentrate on the elderly. According to Walsh (2009), the Center for Disease Control and Prevention (CDC), states the elderly are considered anyone 65 years old or older. With the increased lifespan of elderly, there have become new demographics of young old (65-74), old (75-84), and oldest old (85 & over), and the frail old (anyone over 65 with physical or cognitive disabilities). The US census bureau estimated in 2011, the population of elderly persons 65 and over living in the U.S. to be 311,501,917. Between 2000 and 2010, the population 65 and over grew at a faster rate than any other population in the United States, 15.1% compared to 9.7% of the rest of the US population. Thirteen percent of the population is elderly; 55.2% are married, 32% live with family members, 51.7% are female, 48.3% are male, 60% are white, 17% are black, 18% are Hispanic, and 5% are other races. Education wise, 10.9% have less than a 9th grade , 10.3% have attended between 9th and 12th grade but did not receive a diploma, 36.4% are high school graduates, 20.6% have some college, and 22.5% have Bachelor’s degree or greater. It is estimated that elderly between the ages of 65-84 are doubling as the baby boomers age, with 85 and over being the fastest growing group due to elderly people living longer (US Census Bureau, 2012). As one ages, there are often cognitive changes and physical disabilities...

Words: 2120 - Pages: 9

Free Essay

Discuss If Nurses Can Safely Care for Mr Robbins Within the Home Environment and at the Same Time Minimise His Risk of Physical and Psychological Injury. Is It Possible to Meet Mr Robbins and His Daughter’s Wishes at the Same Time? Why? Why Not?

...The opportunity to be able to continue living in their own homes and be independent as possible is very important for aging people. This means the elderly people may be reluctant to think of themselves as dependent and in need of care. Likewise, eighty year old Mr Len Robbins desires to retain control over his ageing life in his own home. Mr Robbins has been diagnosed with prostate cancer, pulmonary fibrosis and myocardial infarction. This paper will examine how nurses can provide safe care to Mr Robbins within his home environment. It will also discuss whether nurses can fulfil the wishes of Mr Robbins and his daughter while minimising his risk of physical and psychological injury. The ageing process requires the elderly to adapt to changes in their physical, social, emotional and mental health states (Thygesen et al., 2009). The elderly are always at risk of physical and mental illness (Boehlke, 2009).Therefore, placing the elderly people in a nursing home is not the optimum solution to keeping them safe and healthy; providing a “Hospital in the Home” to Mr Robbins maybe a better choice in order to ensure that he and his daughter’s wishes are fulfilled. A Hospital in the Home’s patients are visited by doctors and nurses at least once a day and is covered by Medicare for a senior Australian. Hospital in the Home can also provide Mr Robbins with needed equipment such as shower stool and toilet chair to minimise his risk of falls and injuries (Boehlke, 2009; De Blok et al., 2010)...

Words: 1570 - Pages: 7

Premium Essay

Physiotherapy: Working Hands on for Elderly in Residential Care

...Physiotherapy: working hands on for elderly in residential care A perception of good health inevitably lies in the eyes of the beholder (Strain, LA 1993). While some strive to maintain their bodies in peak physical condition, health management for the elderly in residential care is treated otherwise. Years of labour and strain is evident in their physical appearance, however it is beneath all this which is key to the vitality of their lives. Physiotherapists, also referred to as physical therapists, are one profession working with the elderly to maintain a state of wellbeing for everyday activity and participation. Through prevention, strengthening and mobility, these fundamental areas in elderly conditioning have more than superficial benefits. Nurses, as well as doctors, occupational therapists and specialists, are also crucial to this client group, ensuring the best possible health is maintained. Physiotherapists are aptly equipped with the skills and knowledge to assess individual patients and prevent avoidable mishaps from occurring. Elderly people over the age of 65 are more likely to experience incidents such as falls due to arthritis, prescribed medications and general impairment (Tinetti, ME 2003). Exercise prescription programs can specifically target areas to achieve maximum range of movement and reduce these risk factors. Researchers at Yale School of Medicine found that falls among the elderly were reduced by 11 percent when clinicians incorporated management...

Words: 1117 - Pages: 5

Premium Essay

Nursing Home Administrator

...Being a nursing home administrator with in a nursing home, excellent communication is a necessity. Communication is how care providers determine the quality of care that is given and needed for the patients. By being a nursing home administrator, it is my job to make sure that the HIPPA rules and regulations are being used by all employees. By making sure that HIPPA rules and regulations are being upheld, the nursing home is providing quality care to the patients. When a change happens at a nursing home there can be confusion and conflict with everyone involved. While following the chain of command can be long and even boring, it is needed to keep the communication process smooth and effective. The chain of command does help reduce the risk of a communication breakdown. If a communication breakdown is developed it can cause commotion in any health care facility which could jeopardize everyone involved. With being the nursing home administrator, the first job that I would need to do is have a full understanding of the new policies and procedures. I would need to know how the policies and procedures were put into place and how exactly this will affect the patient’s in the nursing home. In order to do this I would want to speak with the board members so my concerns could be addressed. In order to address these issues I could meet with the board members face to face, use social media, or by electronic communication. There are advantages to having traditional face to face meetings...

Words: 1238 - Pages: 5

Premium Essay

Elder Abuse

...take care of the elderly. The cost for care has gone up also, making more families opt to keep their loved ones at home instead of sending them to the nursing homes. The fear of elder abuse is higher now because of the cost rise in elder care. Nursing homes are being frowned upon because they do not have enough staff to properly take care of the patients they have. This presents a big problem for society because either choice, nursing homes or in home care can have a negative outcome for our elderly. Abuse is happening more often because we were not prepared in advance to take care of this jump in patients. This paper will look at this issue from a utilitarianism point of view as well as an emotivism point of view. From a utilitarianism point of view the best way to fix this problem would be for more people to pay attention to the elderly. Everyone working together to fix this issue would be the best route. Leaving it to only a few people is not going to work. Laws have been passed and yet we still have elder abuse going on. For the elderly that are being taken care of in their homes there should be more than one family member taking care of the person when at all possible. Each family member could take turns so that no one person gets over loaded and stressed out. That would keep them from taking it out on the elder family member. In a commentary in the Los Angeles Sentinel Meyer (2004) wrote "Elder Abuse is the mistreatment of an elderly person by someone...

Words: 2670 - Pages: 11

Premium Essay

Nursing

...of Vulnerability are the elderly. The elderly are more susceptible to functional deterioration and therefore need special support and medical attention in the health care context.  Caring for elderly people, especially those with medical problems can be nerve-racking, and that can combine with other stressors, such as financial or marital problems, and will further cause caregivers to become neglectful .In the long run caregivers become encouraged to send their old folks to medical facilities or senior homes. Elderly people, like many young people prefer to stay at their own home that is made up of treasured memories; they feel a sense of belonging at their own home than a senior home. In my culture caring for elderly people in their most difficult time of their lives is considered an honor and a blessing and an opportunity for great spiritual growth.  In my culture it is not enough that we only check up on our elders like parents, grandparents, aunts, and uncles, but we act with limitless compassion, are kind, and are patient with them. We always try to remember that when we were helpless children, they were patient with us, gave us their love and preferred us to themselves.  As a nurse, there are instances I forget the confines of the elderly and look at them with distrust and abhorrence, especially when I believe that they sometimes can be demanding, impatient, and rude. I must say that sometimes I also stereotype the elderly with my fellow coworkers...

Words: 373 - Pages: 2

Premium Essay

Robots

...part of everyone’s daily life especially towards the development of robots for the elderly. Frank Tobe, a robotics analyst and publisher of The Robot Reports, explains and describes about the different type of technologies that are beginning to come to the market to help the elderly to live in their homes for as long as possible. Joseph Engelberger, who is a robotics pioneer, created and helped with the invention of the first industrial robot. The need for eldercare technology continues to increase throughout the years. A study from Georgia Tech showed and proved the seniors preferred robotic help for household chores but not for personal needs such as getting help to get dressed up, bathing, and many more. The consequences for having robot-care can vary depending on what type of care the robot is providing to the elders. One consequence would be that robots would be replacing jobs that humans once had. Robots that are used for medical purposes could dramatically change the way we treat the ailments. Many researches are experimenting with robots to perform surgical performances such as a heart surgery. Over the years, robotic engineers are trying to develop nano-robots that could be injected into cancer patients in order to selectively kill cancer cells. For elderly people with impairments such as a spinal cord injury or some sort of paralysis caused by a stroke, robots are able to assist the elderly in a rehabilitation process. Today, there are many problems with organizations trying...

Words: 437 - Pages: 2

Free Essay

Demographic

...7 Demographic Paper The Impact of the Aging Population Your Name HCS/490 Axia College of University of Phoenix 7 The aging population continues to grown as the baby boomers reach retirement age and this affects the healthcare industry tremendously. The need for specialists, more testing, medications, and skilled healthcare is rising along with this population. This causes the cost of healthcare to increase as well as the demand on healthcare workers. This summary will discuss how the aging population affects the area in which I live including: healthcare related challenges, the impact on the healthcare market, marketing needs and services needed by this population, and how these challenges can be addressed. Healthcare in Ohio is being impacted by the aging population. According to Strunk, Ginsburg & Banker (2006), “ As a result of the baby-boom generation—the leading edge of which is now turning age sixty—the proportion of the U.S population older than age sixty-five is projected to grow from 12.4 percent in 2005 to 14.5 percent in 2015 and 18.2 percent in 2025. Although the aging of the baby-boom generation is a key factor in the aging of the population as a whole, increasing life expectancy is also important” (para. 2). To be more specific the aging population in Ohio is expected to go from 13 percent to 20 percent over the next thirty years (ohio.gov, 2010). The increased amount of people that are age 65...

Words: 1576 - Pages: 7

Premium Essay

The Elderly and the Vulnerable

...The elderly population is a growing concern in the healthcare field. According to the US Census Bureau (2011), the elderly encompassed 13% of the population in the United States. The elderly population also grew at a faster rate than any other age group in the United States (US Census Bureau, 2011). The same can be said for Arizona, where are elderly make up 13% of the state population, matching the national average (R&R Partners, 2005). Of this number 39.7% have been classified with a disability. This number is expected to continue to grow as the older population continues choosing warmer climates for retirement. In Pima County our elderly population entails 14.2% of the population, which is greater than the national average. By 2015 Pima county’s elderly population is expected to reach a concerning 185,087 (R&R Partners, 2005). A vulnerable person is characterized by being open and potentially exposed to harm, and a person’s vulnerability status can change due to health, finances or social position Dyer, Franzini, Watson …Pickens, 2008). This is concerning to the health community because of the vulnerabilities the elderly face. A large number of this population will experience changes in hearing, sight speech and mobility which may lead to isolation from the community and depression. Many could experience memory loss or develop dementia causing difficulty in caring for themselves requiring them to seek assisted living facilities or in home care providers. They have a variety...

Words: 1310 - Pages: 6

Premium Essay

Perspective on Healthcare

...Perspective on Health Care Perspective on Health Care Robert L. Brown HCS/212 Health Care Vocabulary Amanda Estes Perspective on Health Care The nursing field has become one of the most dynamic career fields to look into, I find this field challenging and very fulfilling. To take in consideration that you have changed or help save a life is a task within itself. I have become fund of the rehabilitation part of health care, whether working on activities of daily living or physically rehabilitating an injured or repaired limb I find this fascinating and rewarding. I have had the pleasure of assisting many individuals on their road to recovery and with the proper training and discipline the task is easier and pleasant to the patient. The other interest I have is nursing; I have completed a License Practical Nursing program and plan to work towards receiving my Registered Nurse license in the near future. This will give me the opportunity to access and provide valuable medical care to many individuals who rely on the skills of a nurse to provide medication and care; this also allows time for teaching on taking medication proper techniques to prevent further injuries or simple medical knowledge. Government health care programs have been around for many years dating back 100 years with President Teddy Roosevelt, there had been many debates and questions ask how we can provide better and affordable health care to the public. These are a few of the changes that have...

Words: 747 - Pages: 3

Premium Essay

Residential Care Home Care

...Elderly care plays a big part of a general practitioner’s work as evident of the increasing aging population of a country. Study suggests that a good relationship between a general practitioner and an elderly resident are formed through ongoing and regular interaction wherein trust and respect are built up. A responsible general practitioner manages health and social care to make sure the plan is formulated according to patient’s wishes and welfare. It include residents feeling reassured and listened to, understanding their medical issues and being encouraged to take medication or cooperate with treatment; GPs following residents' wishes for treatment and care; and reductions in hospital...

Words: 774 - Pages: 4

Free Essay

Special Populations

...within these populations are cannot advocate for themselves and depend on others for support and services. People who fall into the category of vulnerable populations are children, the elderly, the disabled, and the mentally disabled.   Populations Reviewed For the purposes of this paper, I looked into two different special populations. The first group I reviewed was the elderly. The elderly often face ridicule and stereotyping and this can lead to abuse and neglect. In fact, many elderly people function independently in society but for others, aging cause problems with their ability to make sound decisions, care for their own physical and financial needs, and several other issues. This is why many of the elderly need the assistance of support services. I am really interested in elderly care do to the fact I hear so much in the news about elderly mistreated. I think of my grandparents while hearing this. I feel even though they are elderly doesn’t mean they don’t have feeling. I think I would have so much impact in helping the elderly. I feel I can learn so much from the elderly and yet make sure they are getting the proper care that they need. I was doing research online and came across a website, umkc.edu, while looking on that website; it said that the heterogeneity among the elderly population and within subtypes of the population is often ignored. Increased...

Words: 910 - Pages: 4

Premium Essay

Volunteer

... located at Ira E Woods Ave in Grapevine to learn about the elderly. Although, when I joined the organization, I wasn’t too sure of what to expect so, I decided to visit one of their facility on a lovely weekend for four hours between 11am and 3pm. Apparently, on getting there, most of the residents were just getting up while others were walking towards there lounging area for their lunch. I sat with them to discuss issues within the facility. Interestingly, a lot of valuable information regarding this diverse community was shared. Specifically, the issue with the religion code of conduct between the employees and the management. The board of management has just accommodated the Muslims female employees to use hijab within the facility but unfortunately, some of the residents find it offensive because of their misconceptions. I totally understand how our society view Muslims, especially Muslim women who wear the veil or hijab since the past decade and particularly since the September 11th terrorist attacks, the Muslim community in the United States has experienced an increased level of social and religious scrutiny. The diverse group and people that we work with has shown how easy it can be to stereotype one another based on background, race, culture and belief. I have always thought Nursing home (Rehabilitation centers) were only for the elderly but I later came to realize that it’s not only for the elderly. Perhaps, anybody of any age group can end up in nursing home...

Words: 901 - Pages: 4

Premium Essay

Ethics

...that, health care also the services are provided to people or communities by agents of the health services or professions for the purpose of promoting, maintaining, monitoring, or restoring health. According to the Institute of Medicine, they defines health care quality as the extent to which health services provided to individuals and patient populations improve desired health outcomes. The care should be based on the strongest clinical evidence and provided in a technically and culturally competent manner with good communication and shared decision making. While dementia or senile are often synonymous with the elderly. Senile is a condition in which the brain has decreased, causing a decline in memory of a patient with severe and cannot even take care of you. Dementia or senile is a disease and not alarmed foreign to the Malay community, since time immemorial have been recorded by type as Munshi Abdullah, in his famous book. It usually only pose problems to a family member when the disease came too early from the age norm. If the patient began suffering from dementia when he reached 80 years were normal and not a problem. But if the patient was only 60 years old, is suffering from dementia, so it is very stressful for the family. The health needs of old people are now a matter of concern in all industrialized and developing countries. This concern reflects the growth in the aged population. According to United Nations estimates, old people, that is those 65 years of age and...

Words: 4442 - Pages: 18

Premium Essay

Rehabilitation

...Rehabilitation for elderly When rehabilitation comes to the mind, many people think of getting a treatment for drug abuse or any type of addiction. Rehabilitation not only helps a person recovering from illness or injury, but, also helps to increase their function as much as possible and also provide mental support during rehabilitation. However, there are different purposes of rehabilitation while restoring a person’s state of well-being. Some senior citizens may require a residential care facility and their family members may not be able to stay around them due to their busy lifestyles. In such situation, rehabilitation centers are extremely essential for elderly people, whether they are suffering from various diseases such as terminal illnesses or needs special attention due to their old age. Rehabilitation centers provide facilities to those people, who are sick and unable to perform their everyday life activities independently. It also helps to restore their good health conditions that are sick: physically, mentally, socially, and spiritually. Elderly people definitely need special attention to improve their health, advocate their emotional problems and organize them to make their life easy. An article by unknown says that the numbers of Americans over 65 is expected to nearly double by 2030.” So, we need more health care facilities and workers to take care of the elderly. There is a demand of nurses, aides, therapists to provide proper health care to the elderly. The government...

Words: 1755 - Pages: 8

Popular Essays

Qazw Essay
Riordan Website Redesign Project Essay
Com 155 Final Essay
Parts Emporium Essay
Hamlet’s Struggle with Life and Death Essay
Amazon.Com E-Business Model Essay