2. HS-TGM-12. Students will demonstrate understanding of advanced technical skills in respiratory care – Respiratory Therapy. a. Identify normal and abnormal respiratory effort. b. Demonstrate correct placement of cannula and mask for oxygen therapy. c. Describe croup tent usage and maintenance. d. Correctly apply pulse oximeter for measurement of oxygen saturation and recognize the difference between normal and abnormal readings. e. Assist clients with respiratory management devices. f. Demonstrate techniques for suctioning based on facility protocol. g. Describe and demonstrate care for a tracheostomy based on facility guidelines within their scope of practice.

3. Scope of Practice for Respiratory Therapists Management of patients with respiratory diseases and disorders may require a variety of devices and equipment. It is important for healthcare workers involved in caring for patients with respiratory disorders to understand how to monitor, recognize and report problems in respiratory effort. Additionally, the healthcare worker must be able to recognize types of respiratory care devices and understand the use of and how to safely manage devices.

4. How do body systems and structures operate to maintain normal functioning of the respiratory system? How are patients with disorders or diseases of the respiratory system managed to meet their respiratory care needs? What is the role of respiratory therapists, nurses and patient care technicians in providing care for patients with respiratory diseases or disorders? How is oxygen therapy provided in a safe and therapeutic manners?

5. Students should know: The differences between normal and abnormal respiratory effort Croup tent usage and maintenance Types, use and care of various respiratory devices Safety issues related to respiratory therapy How to monitor and provide care for patients with respiratory system diseases or disorders

6. Students should be able to demonstrate: Setting up for oxygen administration via Nasal Cannula, Oxygen Mask, Venturi Mask and Non-Rebreather Mask Use of nasopharyngeal and oropharyngeal airways Pulse oximetry measurement, normal and abnormal values Suctioning the airway using a Yankauer catheter Assisting with artificial airway care Use of Ambu Bag

7. Describe your breathing in terms of work of breathing (how easy/hard is it) on a sheet of paper. Pass out drinking straws to each student in class. Instruct them that they are going to be involved in an activity to simulate breathing difficulties. Tell them that they will be breathing through the straw while pinching their nose closed. Students should be sitting down at this time. Begin the timer and time them for one minute. Ask students to describe their breathing and how they felt during this exercise. Now ask them to do the same exercise while jogging in place. Time them for a minute. Now describe in writing how their breathing felt during this part of the exercise.

8. Think about what it might be like to fight for every breath you take. How would having breathing problems affect everyday living (sleep, eating, activities, going to the bathroom, mowing the grass, washing clothes, working, etc.)? ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ______________________________________________

9. Use the following acronym and recall the structures through which air passes during inhalation N___________________ P ___________________ L ___________________ T ___________________ B ___________________ Br __________________ A ___________________ What gas is inhaled? _____________________ What gas is exhaled? _____________________ The right lung has _____ lobes The left lung has _____ lobes 1 breath in and 1 breath out=1 respiration

10. Accessory Muscle which separates the thoracic and abdominal cavities and flattens during inspiration is called ___________________. This muscle contracts and pulls down during inspiration, enlarging the thoracic cavity which allows the lungs to expand. During expiration, this muscle relaxes, forcing the air out of the lungs. What other muscle helps with the process of breathing?

11. Lungs protected by bony framework Name the structures of the bony framework using the acronym below S R V Review: How many pairs of ribs do we have? Which vertebrae is referred to above?

13. Important for respiratory and cardiovascular systems to work together to meet the oxygen needs of the body In the respiratory system, structures must function properly to allow exchange of O2 and CO2 What is the role of the cardiovascular system? Blood must circulate to and from the heart Exchange of O2 and CO2 must be able to take place between capillaries and cells

14. Nervous System plays an important role Diseases of and injury to the nervous system can affect respiratory muscles Breathing may be difficult Brain damage can affect respiratory rate Respirations increase when oxygen level is low Which part of the brain controls respirations? _______________________ Too much ____________ and too little __________________ will cause the brain to think something’s wrong and increase the respiratory rate.

16. Aging also affects the respiratory system: Decreased function because of weaker muscles Lung tissue loses elasticity Exercise- increases need Muscles need O2 to work Drugs Some may depress the respiratory center in brain and cause respiratory depression which can lead to respiratory arrest Narcotics given to patients for pain control

17. Smoking Causes lung cancer and COPD & risk factor for Disease of Coronary Arteries Allergies Sensitivity to substances in which the body reacts when exposed runny nose, itchy eyes, wheezing, congestion and swelling in the airway which can become severe Exposure to Pollutants Harmful substances in air or water like asbestos, toxic fumes which can be at work, school, or home

18. Nutrition Needs to be adequate for production of red blood cells which carry O2 Vitamins are important to produce the cells such as vitamin C, B12, Folic Acid Alcohol Depresses brain function and can depress cough reflex in excess Gag reflex can also become depressed

20. Hypoxia Cells do not have enough oxygen Brain reacts to low oxygen person may become Restless Disoriented Dizzy Drowsy Personality change Tachycardia Abnormal respirations Bradypnea Slow breathing- <12/min Tachypnea Rapid respirations >25 Apnea Absence of respirations Dyspnea difficulty breathing-may be labored or painful Orthopnea breathe normally when in sitting position

21. Cheyne-Stokes Respirations increase in rate and depth and then become shallow and slow, periods of apnea may occur also Kussmaul’s Respirations Deep and Rapid Seen in Diabetic Ketoacidosis* and Renal Failure Hypoventilation Slow, shallow, & sometimes irregular Pneumonia, disease of alveoli (Emphysema) Nervous system disorder affecting respiratory system Hyperventilation Rapid and deeper than normal respirations Can be caused by Asthma

22. Responsibilities include Patient assessment Disease management Diagnostic evaluation Management Education Rehabilitation Care of patients The scope of practice includes the application of technology and the use of protocols across all care sites including. They are not just in hospitals anymore….

23. Diagnostic Activities include: Obtain and analyze physiological specimens Interpret physiological data Perform tests and studies of the cardiopulmonary system Perform neurophysiological studies Perform sleep disorder studies

24. Therapy includes but is not limited to: The application and monitoring of medical gases and environmental control systems Mechanical ventilator management Insertion and care of artificial airways Bronchopulmonary hygiene Administration of Pharmacological agents Cardiopulmonary rehabilitation Hemodynamic cardiovascular support Sleep support

25. Nasal Cannula and Mask Use-demo at bedside Croup Tent-handout Pulse Oximeter-demo/handout MDI-handout/demonstration Incentive Spirometry-demonstration Peak Flow Meter-demonstration/return demo Suctioning-handout/demo at bedside (Yankaeur’s) Nasopharyngeal and Oropharyngeal Airway-demo Trach Care http://www.youtube.com/watch?v=Wimw7bz0fLo Ambu bag use review (CPR)