| | Searching Current Courses For Fall 2016 |
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Course: |
RCA 232
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Title: | Advanced Monitoring |
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Long Title: | Advanced Monitoring |
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Course Description: | Develop the necessary skills required of Respiratory Care professionals to include monitoring and assessment of the patient requiring intensive care using both non-invasive and invasive data. Topics include: introduction to hemodynamic values and interpretation of the results; characteristics and indications of both bronchoscopy and sleep disorders; and introduction to research. |
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Min Credit: | 2 |
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Max Credit: | |
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Course Notes: | Entered new course 9/29/10 s@ |
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Origin Notes: | Pickens |
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STANDARD COMPETENCIES:
I. Non-invasive Monitoring
a. Determine methods of measuring tissue oxygenation in a compromised patient using various calculations
b. Determine methods of measuring carbon dioxide elimination through use of capnograph
c. Differentiate between various capnograph waveforms and clinical significance of each abnormal waveform
II. Hemodynamic Values
a. Differentiate between normal values, method of calculation and significance of the following hemodynamic values as they relate to cardiac output:
i. Cardiac index
ii. Ejection fraction
iii. Stroke volume
iv. End-diastolic volume
v. Cardiac work
vi. Ventricular stroke work
vii. Systemic vascular resistance
viii. Pulmonary vascular resistance
b. Differentiate how the various hemodynamic values are affected by pulmonary compromise
III. Hemodynamic Monitoring
a. Summarize proper procedure for inserting an arterial line
b. Determine indications and contraindications for insertion of an arterial line
c. Interpret lab and hemodynamic results taken from an arterial line and discuss clinical significance
d. Summarize proper procedure for inserting a central venous catheter
e. Determine indications and contraindications for insertion of a central venous catheter
f. Interpret lab and hemodynamic results taken from a central venous catheter and discuss clinical significance
g. Summarize proper procedure for inserting a pulmonary artery catheter
h. Determine indications and contraindications for insertion of a pulmonary artery catheter
i. Interpret lab and hemodynamic results taken from a pulmonary artery catheter
j. Identify proper placement of a central venous and pulmonary artery catheter on a chest radiograph
k. Summarize risk factors to the patient with an indwelling hemodynamic catheter
IV. Bronchoscopy
a. Summarize proper procedure for performing a bronchoscopy
b. Summarize how to prepare the patient for a bronchoscopy procedure on and inpatient or outpatient basis
c. Interpret the clinical significance of bronchoalveolar lavage (BAL) results taken from a bronchoscopy
V. Sleep Studies
a. Differentiate between obstructive, central and mixed sleep apnea
b. Identify patients at risk for sleep apnea
c. Predict complications of patients with untreated sleep apnea
d. Identify parameters measured by polysomnograph
VI. Research Methods
a. Explain the importance of research to clinical practice in respiratory care
b. Carry out simple research projects
c. Demonstrate proper formatting for formal scientific poster presentation
TOPICAL OUTLINE:
Hemodynamics and Non-Invasive Monitoring
1. Define cardiac output and venous return
2. Recognize the following regarding cardiac output:
a. method of calculation
b. range of normal values
c. effect of sympathetic nervous stimulation
3. Recognize the following regarding the distribution of blood flow
a. effect of metabolism and reduced oxygen availability on the regulation of blood flow through organs
b. percent of total blood volume in venous system
c. effect of blood loss (hypovolemia) on circulatory function
d. basal distribution of blood flow to organs vs., distribution during cardiac failure
e. effect of mechanical ventilation
4. Discuss the various hemodynamic values to include:
a. cardiac index
b. ejection fraction
c. stroke volume
d. end-diastolic volume
e. cardiac work
f. ventricular stroke work
5. Recognize the following regarding preload:
a. definition
b. values used to measure preload of the left and right ventricles
c. factors affecting
d. clinical value of ventricular function curves
e. effect of mechanical ventilation
6. Recognize the following regarding afterload:
a. definition
b. factors affecting
c. how it is measured
d. effect of vasodilators
e. how to calculate systemic and pulmonary vascular resistance
f. effect of mechanical ventilation
7. Identify the following regarding contractility:
a. definition
b. factors affecting g
c. how it is assessed
8. Recognize the technique for obtaining cardiac output via the
following invasive methods
a. dye dilution
b. thermodilution
c. Fick
9. Identify the methods, normal values, and significance of measuring lung volumes in the intensive care unit
10. Recognize the value of monitoring pressure, volume, and flow tracings in mechanically ventilated patients.
11. Introduce the difference between capnometry and capnography.
12. Discuss the clinical significance of capnography and how it is monitored in the intensive care unit.
13. Identify basic flow patterns on the capnograph and discuss the clinical significance of abnormal tracings commonly seen with various disease processes.
14. Recognize how the following parameters can be used to evaluate tissue oxygen delivery and utilization:
a. Oxygen delivery and availability
b. Oxygen consumption
c. Mixed venous oxygen tension
d. Venous saturation
e. Arterial to mixed venous oxygen content difference
f. Oxygen extraction ratio
g. Blood lactate
Hemodynamic Monitoring
1. Recognize the following regarding arterial cannulation
a. indications
b. cannulation
c. possible complications
d. normal pressures and their significance
e. pressure waveforms
f. significance of respiratory variation in the pressure waveform
g. method of direct aortic pressure measurement and its significance
2. Identify the following regarding central venous pressure (CVP) monitoring:
a. significance
b. factors affecting measurement
c. insertion sites
d. types of catheters
e. correct technique for pressure measurement
f. parts of the CVP waveform
g. effect of respiratory motion on the CVP waveform
h. normal value for CVP
i. relationship to left ventricular function
3. Recognize the following regarding pulmonary artery pressure monitoring:
a. synonyms for the catheter
b. indications and complications
c. catheter description
d. sizes used for adults and children
e. position of distal and proximal catheter lumens
f. average amount of air required to fill the catheter balloon
h. two synonyms for pulmonary capillary wedge pressure (PCWP) and the normal value for PCWP and pulmonary artery pressure (PAP)
i. relationship between PADP (pulmonary artery diastolic pressure) & PCWP
j. significance of PAP and PCWP measurements
k. importance and verification of Zone II catheter placement
l. factors which affect the measurement of PCWP
m. technique for wedging the balloon
n. effect of PEEP on PCWP measurements
Bronchoscopy
1. Define the basic terms used in endoscopy.
2. Identify basic technical data about flexible fiberoptic bronchoscopes as they relate to:
a. their size relative to the patients being examined.
b. the airway generations that can be examined.
c. The accessory equipment needed: light sources, biopsy forceps, brushes, needles, laser probes, and specialty forceps.
3. Discuss the five most common indications for bronchoscopy and identify which indications are diagnostic applications and which are therapeutic applications.
4. Discuss the uses of bronchoalveolar lavage, brushings (both sterile and nonsterile,) and needle biopsies.
5. Discuss the complications of flexible bronchoscopy and understand the relative risks involved in the procedure.
6. List the contraindications to performing a bronchoscopy.
7. List the essential equipment needed in order to perform a bronchoscopy safely.
8. Describe how to prepare a patient, step-by-step, for an outpatient bronchoscopy, including
a. Explaining the procedure.
b. Instructing the patient on what to do and what not to do in the 6 hours before the procedure.
c. Obtaining informed consent.
d. Nebulizing lidocaine (Xylocaine)
e. Starting an intravenous port for medication.
f. Preparing the nostril for insertion of the bronchoscope
g. Preparing the suction device and the in-line trap.
h. Administration of “conscious sedation” medications.
i. Safety
j. Handling specimens obtained during the procedure.
k. Monitoring the patient during and after the procedure.
l. Discharge criteria.
m. Sending the specimens to the laboratory.
n. Charting the bronchoscopy procedure.
Sleep Studies
1. Discuss the definition of obstructive, central, and mixed sleep apnea.
2. Discuss the implications of sleep apnea on patient’s overall health.
3. Introduce the normal sleep stages and characteristics of each sleep stage.
4. Discuss the clinical features and risk factors for patients with obstructive sleep apnea (OSA) using various surveying and clinical measurements.
a. Epworth Sleepiness Scale
b. Berlin Questionnaire
5. Discuss the parameters typically monitored during a polysomnogram
a. EEG
b. Airflow
c. Effort
d. SaO2
Research
1. Introduction and importance of the basic research methods.
2. Preparing a basic research study.
a. Surveys / questionnaires
b. Research reviews
c. Independent versus dependent variables.
3. Poster presentations and presenting original research that will be displayed at state conference by student if selected.
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