DEPARTMENT
OF CARDIORESPIRATORY TECHNOLOGIES
RESPIRATORY
CARE PROGRAM
RESP
102-- CLINICAL AFFILIATIONS
PURPOSE OF COURSE
This
clinical course is the first experience in a clinical setting for Respiratory
Care students. The student will perform routine respiratory therapy skills and
integrate theory taught during the first semester of the program. The student
must be familiar with the pre-requisite information from the major and support
courses to take full advantage of the educational opportunities afforded at our
clinical affiliates.
DRESS CODE
The
student is expected to present a professional appearance while in the affiliate
and should dress and act accordingly. As per guidelines handed out at the end
of the Fall semester, all students are expected to be
dressed in Navy blue scrubs with a CCP shoulder patch attached. A lab coat will
be worn to cover the scrubs outside of the units and will also have a shoulder
patch. A nametag clearly identifying you as a student will be worn. All
appropriate equipment (stethoscope, scissors, watch, pen, etc.) will be taken to clinical. Personal/oral hygiene must conform to local
norms including regular bathing and hair washing. Hair should be short or tied
backs so as to minimize patient discomfort and maximize equipment safety.
Minimal jewelry may be worn but no large earrings and/or rings and bracelets
that may become tangled in equipment and harm the patient. Nails should be
clean and trimmed with only conservative polish colors, if any, worn. Perfumes
and after-shaves must be only lightly scented, if worn, due to the possible
disease states of the patients. Shoes should be chosen which offer good support
as you will be on your feet for extended periods of time. Sneakers may be worn
if they are leather-topped and conservative in color.
EVALUATION
Students
will be evaluated two times during the semester using the attached form. The
form has multiple statements, which are rated by the clinical instructor. To
successfully complete the clinical, all statements must be rated as
"ACCEPTABLE" and all clinical objectives must be satisfactorily
completed. These should be read BEFORE going to the hospital.
CLINICAL
ASSIGNMENTS -- RESP 102--
STUDENT
HOSPITAL HOSPITAL SUPERVISOR
MONDAY:
Pat Rocha Presbyterian Sally
Heuser, RRT
Maureen Wilcox 39th
and Powelton
Roseanne Rappa, RRT
Sin Tran 215-662-9372
Everton Brown
Cynthia Guillard
Frank Hyduk
Instructor:
Lisa Epright, RRT
THRUSDAY:
Sydrick Rabusa
Yifrach Anat 8th and
Ashley
Ernst 215-829-8495
Zoraida Rivera
Hoa Nguyen
Instructor:
Levi Clark, RRT
THURSDAY:
Christine
Kober
Presbyterian Sally Heuser,
RRT
Greg
Jones 39th &
Diane
Hart 215-662-9372
Kelly
Skahan
Jamilah Lorrick
Instructor:
Virgo Kidd, RRT
MONDAY:
Matt
Simmons
Brett Mills Old
Jane
Divergilis 215-456-7890
Kesha Williamson
Kra Noel
Steve Rajan
Instructor:
Kelly Joseph, RRT
COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF CARDIORESPIRATORY
TECHNOLOGIES
POLICY STATEMENT
ABSENCE FROM CLINICAL EXPERIENCE
1. Students may make up due to illness, the total number of hours per semester equal to the number of hours that the course meets weekly.
(Exception: Summer Session Clinical Rotations employ a different formula. Students may make up One eight-hour shift for ever 160 hours of clinical time.)
2. A student who misses an excess of hours (as defined in #l) must arrange a conference with the Clinical Coordinator as soon as possible. Following the conference, one or more of the following decisions will be reached:
a. make up time will be scheduled
b. a conference with the total faculty will be scheduled
c. dismissal from the program
3. Students who miss twice the number of hours above are beyond remedial help and may either be dropped from the program or given permission to repeat depending upon individual circumstances. However, no student may complete, or receive a grade for a clinical practice course in which twice the number of allowed hours have been missed unless the course is repeated.
4. Students must notify the clinical instructor regarding absence in the clinical area PRIOR to the experience.
5. If a student reports to the clinical area more than 30 minutes late, he/she may be directed to leave the area and the time missed will be counted as absentee time.
6. Under no circumstances may the student engage in make-up time without being enrolled as a bona fide student.
COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF CARDIORESPIRATORY
TECHNOLOGIES
RESP 102 CLINICAL RESEARCH ASSIGNMENT
Because pharmacology is important in the treatment of patients with cardiopulmonary disease, the respiratory care practitioner must possess a thorough knowledge of commonly used medications.
This semester a pharmacology course is part of your studies. To ease your integration of this material in the clinical environment, the following drugs should be researched according to the attached format.
Any source may be used for the information as long as the cards are complete, up-to-date, and accurate. Cards are to be completed and taken to your clinical assignment during the third week of clinical.
DRUGS:
Acetylcysteine
Cromolyn Sodium
Ipratroprium Bromide
Albuterol
Flovent
Do a good job on these, as you'll be tested on them in the 102 classroom!
REFERENCE SOURCES:
Physician's Desk Reference
Respiratory Care: A Guide to Clinical Practice
The Pharmacological Basis of Therapeutics
Respiratory
Care Drug Reference
FRONT SIDE
MEDICATION CARDS
YORK HOSPITAL SCHOOL OF RESPIRATORY THERAPY
MEDICATION CARDS
MEDICATION Isuprel ( isoproternol hydrochloride )
ACTION : one of the most pure beta stimulants, relaxes bronchial spasm, facilitates expectoration of pulmonary secretions. Isuprel's bronchodilator action via aerosol can persist for a time as short as 20 minutes, although it often is effective l90 to 120 minutes.
INDICATIONS: the treatment of bronchospasm associated with acute - chronic bronchial asthma, pulmonary emphysema, bronchitis, and bronchiectasis.
CONTRAINDICATIONS: the cardiac stimulant effect of the drug may cause cardiac arrhythmias with tachycardia in patients inclined to these disorders.
REVERSE SIDE
Isuprel (isoproterenol hydrochloride)
ADVERSE REACTIONS: Tachycardia, palpitation, nervousness, nausea, vomiting; may experience some transient throat irritation attributed to the alcohol content.
ADMINISTRATION: Children and adults, 1:200 solutions, 5-15 deep inhalations, up to 5 times daily; adults, 1:100 solutions, 3-7 deep inhalations, administered as an aerosol mist by Mistometer, hand-bulb nebulizer, compressed air or oxygen operated nebulizer, IPPB devices (usual dosage is .25-.5 ml of 1:200 diluted to 5 ml with NSS)
HOW SUPPLIED: Mistometer l5 ml (16.8g) complete nebulizing unit; solution 1:200, bottles of 10 and 60 ml. ; solution 1:100, bottles of 10 ml; as tablets, glossets of 1O and 15 mg., bottles of 50
From Respiratory Care . June 80 Vol. 25 No 6 pg. 661
CCP - RESPIRATORY CARE PROGRAM DAILY
CLINICAL LOG
NAME
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DATE ACTIVITY
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COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF CARDIORESPIRATORY TECHNOLOGIES
RESPIRATORY CARE PROGRAM
CLINICAL BEHAVIORAL EVALUATION FORM
NAME______________________________________DATE______________
COURSE: (circle one)
102 104 221
299 CRITICAL CARE 299 NEO/PEDS
SIGNATURES:_____________________________/HOSPITAL SUPERVISOR
_____________________________/STUDENT
Check appropriate column for each statement using the following key:
U = Unacceptable; I = Improvement Necessary; A = Acceptable
U | I | A
1. Accurately checks patient chart before patient contact
_______________________________________________________________________________|_____|_____
2. Accurately records patient information after patient contact
_______________________________________________________________________________|_____|_____
3. Communicates information to other health care team members clearly and concisely
_______________________________________________________________________________|_____|_____
4. Demonstrates proper care and maintenance of equipment before, during, and after use
_______________________________________________________________________________|_____|_____
5. Demonstrates aseptic technique at all times
_______________________________________________________________________________|_____|_____
6. Demonstrates an ability to appropriately operate equipment and administer therapies required for this clinical rotation.
_______________________________________________________________________________|_____|_____
7. Demonstrates an ability to apply classroom concepts to problem solving in the clinical environment
_______________________________________________________________________________|_____|_____
8. Explains procedures and/or equipment to the patient in understandable terminology
_______________________________________________________________________________|_____|_____
9. Respects the patient/practitioner relationship by varying approach according to individual needs
_______________________________________________________________________________|_____|_____
10. Demonstrates an appreciation of the patient's safety and privacy
_______________________________________________________________________________|_____|_____
U | I | A
11. Respects the confidentiality and legality of the patient's records
_______________________________________________________________________________|_____|_____
12. Attendance and punctuality during this rotation
_______________________________________________________________________________|_____|_____
13. Makes good use of time while in clinical
_______________________________________________________________________________|_____|_____
14. Presents to clinical area with appropriate appearance/hygiene
_______________________________________________________________________________|_____|_____
15. Reacts appropriately to emergency and/or pressure situations
_______________________________________________________________________________|_____|_____
16. Reacts appropriately to suggestions, criticism, and guidance
_______________________________________________________________________________|_____|_____
17. Learns independently via keen, accurate observation
_______________________________________________________________________________|_____|_____
18. Overall rating for this rotation
_______________________________________________________________________________|_____|_____
================================================================================
Use this space for comments by both student and supervisor. All statements graded less than "acceptable" to be explained here. Explanation to be listed by statement number.
COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF CARDIORESPIRATORY TECHNOLOGIES
RESPIRATORY CARE PROGRAM
CLINICAL BEHAVIORAL EVALUATION FORM
NAME______________________________________DATE______________
COURSE: (circle one)
102 104 221
299 CRITICAL CARE 299 NEO/PEDS
SIGNATURES: _____________________________/HOSPITAL SUPERVISOR
_____________________________/STUDENT
Check appropriate column for each statement using the following key:
U = Unacceptable; I = Improvement Necessary; A = Acceptable
U | I | A
1. Accurately checks patient chart before patient contact
_______________________________________________________________________________|_____|_____
2. Accurately records patient information after patient contact
_______________________________________________________________________________|_____|_____
3. Communicates information to other health care team members clearly and concisely
_______________________________________________________________________________|_____|_____
4. Demonstrates proper care and maintenance of equipment before, during, and after use
_______________________________________________________________________________|_____|_____
5. Demonstrates aseptic technique at all times
_______________________________________________________________________________|_____|_____
6. Demonstrates an ability to appropriately operate equipment and administer therapies required for this clinical rotation.
_______________________________________________________________________________|_____|_____
7. Demonstrates an ability to apply classroom concepts to problem solving in the clinical environment
_______________________________________________________________________________|_____|_____
8. Explains procedures and/or equipment to the patient in understandable terminology
_______________________________________________________________________________|_____|_____
9. Respects the patient/practitioner relationship by varying approach according to individual needs
_______________________________________________________________________________|_____|_____
10. Demonstrates an appreciation of the patient's safety and privacy
_______________________________________________________________________________|_____|_____
U | I | A
11. Respects the confidentiality and legality of the patient's records
_______________________________________________________________________________|_____|_____
12. Attendance and punctuality during this rotation
_______________________________________________________________________________|_____|_____
13. Makes good use of time while in clinical
_______________________________________________________________________________|_____|_____
14. Presents to clinical area with appropriate appearance/hygiene
_______________________________________________________________________________|_____|_____
15. Reacts appropriately to emergency and/or pressure situations
_______________________________________________________________________________|_____|_____
16. Reacts appropriately to suggestions, criticism, and guidance
_______________________________________________________________________________|_____|_____
17. Learns independently via keen, accurate observation
_______________________________________________________________________________|_____|_____
18. Overall rating for this rotation
_______________________________________________________________________________|_____|_____
===============================================================================
Use this space for comments by both student and supervisor. All statements graded less than "acceptable" to be explained here. Explanation to be listed by statement number.
The following list of objectives is
intended to be a guide only. There may be additional objectives added to this
list and some may not be covered depending on the clinical preferences of
individual physicians and hospitals.
1. General
1.1 The student will become familiar with physical layout of the hospital. A thorough understanding of the accepted policies and procedures specific to the assigned hospital is mandatory.
1.2 The student will familiarize himself with the equipment specific to the assigned hospital affiliate to include any appropriate operator manuals, if necessary.
1.3 The student will observe departmental employees during normal workday activities. This will further emphsize the policy and procedure of the hospital and allow the student to get a "feel" what he will be doing.
2. Medical Records
2.1 Given any patient chart, the student will identify at least six data related to admission sheet. The data must include patient name, age, sex, and religious affiliation, admitting diagnosis and admitting physician.
2.2 Given any patient chart, the student will identify the history and physical sheet and the standard entries. This must include chief complaint; history of present Illness; past medical history, family history, social history; review of systems; physical exam and impression
2.3 Given any patient chart, the student will identify the laboratory report section and interpret the most recent compete blood count.
2.4 Given any patient chart, the student will identify the radiology report section and those reports dealing with the lungs and thorax.
2.5 Given any patient chart, the student will identify the vital sign record sheet and define the markings used to record the temperature; pulse; respiration and blood pressure.
2.6 Given any patient chart, the student will identify the respiratory therapy record sheet and state the items which constitute a complete entry - date, time of procedure, medication name and dosage, patient reaction, signature and title of practitioner.
2.7 Given any patient chart, the student will identify the physician order sheet and state the items which constitute a complete entry - date; name of procedure, frequency of procedure, medication name and dosage, Signature and title of practitioner.
2.8 Given any patient chart, the student will identify if the following exists: drug allergies, possible contagion, and diagnostic studies.
2.9 The student will discuss the ethics involved with chart entries and medico-legal aspects of accurate entries, erasures, falsification and confidentiality of medical history.
2.10 Given any patient chart, the student will record in the appropriate section correct entries regarding respiratory therapy procedures and objective information re: patient response to therapy.
2.11 The student will give "report" of his assigned patient to the oncoming shift. "Report" is defined by the affiliate normal operating procedure.
3. Equipment
3.1 Medical Gas Cylinders. Given any cylinder of medical gas, the student will:
a. identify its content by at least two methods
b. state the procedure for storage and transportation.
c. connect a pressure-reducing valve and flowmeter
3.2 Medical Gas Analyzers. Given an oxygen analyzer in working condition, the student will:
a. Calibrate the device using two reference concentrations of oxygen
b. Analyze the FI02 for a patient receiving controlled oxygen concentration from a continuous high flow system +/- 2% compared to the same measurements made by the clinical instructor
3.3 Humidifiers and Nebulizers. Given a humidifier, the student will:
a. Identify the safety devices of the humidifier
b. demonstrate the procedure to check the proper operation of the safety devices
c. demonstrate the filling of humidifier or preparation of pre-filled humidifier using aseptic technique
d. demonstrate the connection of humidifiers to various oxygen equipment
3.4 Given a Pneumatic Nebulizer, the student Will:
a. Identify the safety devices of the nebulizer
b. demonstrate the procedure to check the proper operation of the safety device
c. demonstrate the filling of nebulizers or preparation of pre-filled nebulizers using aseptic technique
d. demonstrate the connection of nebulizers to various types of pneumatic power
3.5 Given an ultrasonic nebulizer, the student will demonstrate the filling of the nebulizers of preparation of pre-filled packs using aseptic technique.
3.6 Bag-Mask Resuscitators. Given a variety of manual bag-mask resuscitators, the student will:
a. describe operational characteristics to include pressure relief valve (if appropriate), gas inlet port, exhalation port, type of valve and delivered FI02
b. describe the procedure to modify the bags to deliver a high (>90%) FI02
3.7 Infection Control. The student will demonstrate:
a. entering/leaving an Isolation area including handwashing, gown, mask and glove use and Disposal, and after care of articles used in area
3.8 The student will demonstrate the procedure to use (according to affiliate policy and procedure):
a. cold sterilizing liquid agents
b. gas sterilizing and aeration equipment
c. sterility indicators in equipment packaging
3.9 The student will demonstrate the procedures employed in the routine care of the patient to control cross-contamination by infectious agents including
a. handwashing technique
b. disposal of secretions and needles
c. aseptic insertion of artificial devices within the body
d. care of apparatus used by more than one patient or apparatus or reused by same patient
e. dispensing of medication
4. NON CRITICAL RESPIRATORY CARE
4.1 Oxygen therapy. The student will perform "oxygen rounds" according to the standard practice of the clinical affiliate. "Oxygen rounds" are defined as the collection and distribution of oxygen therapy equipment to hospital storage areas and the keeping of accurate record to charge patient for therapy administered.
4.2 The student will state the indication, contraindications, benefits and side effects of oxygen therapy.
4.3 Given a prescription for basic oxygen therapy, the student will administer the therapy to a patient in the clinical setting. (Cannula/Simple/Mask/Venturi Mask /Partial or Non-Rebreathing Mask.)
4.4 Carbon Dioxide Therapy. When appropriate in the clinical setting, the student will demonstrate two methods to achieve an increased FIC0 2, describe physiological effect of an increased FIC0 2, and list clinical situation for this type of therapy.
4.5 Aerosol Therapy. The student will explain the theory of operation of pneumatic, ultrasonic and hydrodynamic nebulizers.
4.6 The student will exp1ain the theory of air-entrainment a it applies to the determination of oxygen percentage and total gas flow administered to the patient.
4.7 The student will state the indications, contraindications, benefits and side effects of aerosol therapy.
4.11 The student will state indications, contraindications, benefits and side effects of postural drainage and chest physical therapy.
4.12 Intermittent
Positive Pressure Breathing (IPPB). The student will state indications,
contraindications, benefits and side effects of IPPB therapy. (NB: BiPAP can be substituted for IPPB, if more prevalent in the
facility)
4.13 The student will explain the theory of operation of IPPB apparatus specifically the Bird Mark I and Bennett PR-2.
4.14 The student will describe the techniques and precautions of aerosolized medication administration including calculation of dosage, patient monitoring and evaluation of patient response.
4.15 Given a prescription for IPPB therapy, the student will administer that therapy to a patient in the clinical setting.
4.16 Incentive Spirometry. Given a prescription for incentive Spirometry, the student will administer that therapy to a patient in the clinical setting.
4.17 Sputum Induction and Collection. Given a prescription for the induction and/or collection of a sputum specimen, the student will:
a. assemble the necessary equipment and solutions
b. demonstrate the technique of collecting the sample either by natural airway or by Lukens tube
c. demonstrate aseptic technique in handling the specimen.
4.18 Given a specimen of sputum, the Student will describe the significance of:
a. color
b. quantity
c. viscosity
d. odor
e. ease of clearance
4.19 Mechanical Aspirator. The student will state the indications, contraindications, benefits and side effects of mechanical aspiration.
4.21 Nursing Skills. Given a patient assignment dealing with common, well-defined health-problems, the student will perform skills related to vital sign assessment. To be rated as acceptable the student must measure patient pulse, measure patient respiration, and measure patient blood pressure within the limits defined in Course Level Objective #3 RESP 100: Introduction to Health Care Delivery.
4.22 Pulmonary Rehabilitation. Given a prescription for "home care", the student will demonstrate instruction to a patient and/or family for the following procedure :
a. use, operation and maintenance of home IPPB equipment; low flow oxygen equipment (cylinder, liquid, and concentrator humidity and aerosol equipment)
b. mixing, storing and administering medication
c. postural drainage and chest physical therapy
d. breathing retraining exercise including diaphragmatic breathing; relaxation; pursed-lip breathing; ambulating
e. inhalation of bronchospastic prophylactics
Community College of Philadelphia
Clinical Objective Check Off Form
Community College of Philadelphia
Department of Cardiorespiratory
Technologies
Record of Clinical Hours
Name: _________________________________ Hospital _________________________________________
COURSE: (circle one)
102 104 221
299 CRITICAL CARE 299 NEO/PEDS
Clinical Supervisor: Fill in the number of hours the student is present each day and sign weekly. Place an "L" in the appropriate block to indicate lateness. A student is considered "LATE" if not present within 10 minutes of the scheduled start time.
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I attest that this is a true and
accurate statement of the times I attended the clinical area during the
indicated course. I understand that the penalty for falsification of these
records will be a failing grade for this course and immediate dismissal from my
program of study.
__________________________________________
Student signature
Clinical
Patient Evaluation Format
Each student will be expected to complete four (4) patient evaluations
during the clinical rotation. The following outline should be used when writing
your evaluations. All evaluation must be typed and will be graded on a 10-point
scale. Please hand in the evaluations to your Clinical Instructor. Once
he/she grades them, please show them to your 102-classroom instructor as they
are part of your grade.
Patient evaluation process should include, but need not be limited to, information gathered from the patients medical record as well as from patient interviews and your own assessment results. ~ -
Note: proper abbreviations must be used throughout the assessment.
1. Patient information:
Name, age. sex. race.
2. A summary of the patient's chief complaint (CC):
3. An assessment of the patients condition:
Vital Signs
Work of Breathing
Inspection and palpation of the chest
Breath Sounds
Inspection of the extremities
4. A summary of the patient's history (H&P):
Smoking History
Related illness
Occupational history
5. An explanation of any pertinent lab results:
Blood Gas (ABG)
PFT
CBC, Hb, etc.
Chest X-ray results
6. An explanation of the current Plan of Care:
Include all medications the patient is receiving and Why?
7. Look for pertinent lab and subjective evaluation notes that will verify that the current plan of care is working. These might include:
Improved breath sounds
after treatments
Improved CXR
Improved Peak Flow or
PFT results
ABG changes