PROCEDURE (TASK): ROUTINE VENTILATOR CHECK. 5. Verifies current ventilator Insures correspondence between physician's
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1 PROCEDURE (TASK): ROUTINE VENTILATOR CHECK I. KEY PERFORMANCE ELEMENTS Procedural Element (Step): Description of Performance: 5. Verifies current ventilator Insures correspondence between physician's settings with physician's orders and pre-set values. orders. Identifies discrepancies. Contacts physician regarding discrepant values. Readjusts discrepant values to correlate with physician's orders. (as appropriate) Correlates recent arterial blood gas to ordered ventilator settings. 7. Properly refills humidifier. Fills with sterile distilled water to indicated level. Checks for proper seal/leaks. 8. Checks airway temperature; Waits sufficient time after humidifier refill for adjusts if necessary. warm-up. Insures airway temperature of C. Checks/confirms airway temperature controlled alarm functions. 9. Checks circuit integrity for Drains tubing away from patient into disposal. leaks/obstructions and Checks/minimizes traction on artificial airway position. (repositions circuit). 10. Inspects and assesses patient Refer to proficiency evaluations: status (physical assessment, PATIENT ASSESSMENT vital signs, airway). AIRWAY CARE - CUFF MANAGEMENT ASPIRATION OF SECRETION SINGLE POINT COMPLIANCE Records pertinent observations. Notes recent trends in peak and static pressure, compliance and airway resistance, respiratory rate, spontaneous tidal volume, minute ventilation, pulse oximetry, capnography, and hemodynamic values 11. Correlates pre-set values Measures expired tidal volumes, compares with those monitored to pre-set value. (VT, f, F I O 2, etc.) Measures/records ventilator rate and patient spontaneous rate. Measure F I O 2, compares to pre-set value. Accounts for discrepancies in values. 12. Insures proper ventilator Identifies discrepancies in parameters of function (troubleshoots). ventilation/oxygenation. Differentiates between patient and mechanical problems. Solves problem or provides interim corrective measures. Disconnects ventilator/provides manual support if in doubt. 16. Records pertinent data in Updates flowsheets. chart and department records. Confirms (by signature) all entries. Notes patient status. Proficiency Eval. #1 (Routine Ventilator Check) - 1
2 II. REQUISITE PERFORMANCE VARIABLES: The student is expected to demonstrate proficiency in regularly checking ventilator function/patient status with the following patient groups and selected mechanical ventilators: Ventilator Bennett 7200 Adult STAR Hamilton Veolar or Amadeus Bird 8400 Emerson Post-op or IMV III. ADDITIONAL EVALUATION CRITERIA: Flow sheet entries must be complete and accurate as determined by the evaluator. IV. ORAL REVIEW QUESTIONS 1. Identify the likely causes and appropriate action necessary when the following observations are noted on a routine ventilator check: A. Patient Behaviors: V. SCENARIO QUESTIONS - tachypnea, tachycardia - restlessness, agitation - confusion, disorientation - somnolence, obtundation - dyspnea - headache - twitching, tetany, convulsions - asterixis 1. Data for a 100-lb COPD patient on ventilatory support are: Ventilator Settings Blood Gases Mode SIMV ph 7.35 Vt 700 ml PCO 2 60 torr Rate 8/min HCO 3 35 meq/l F I O PaO 2 58 torr What changes would you recommend at this time? 2. Over a two-hour period, you note that a patient's peak and plateau pressures have both been steadily increasing, but the difference between the two remains about the same. What is the best explanation for this observation? 3. While listening to a patient's breath sounds during mechanical ventilation, you notice an absence of breathy sounds over the entire right hemithorax. Peak pressures have increased from 25 to 50 cwp in the last 30 minutes. Percussion on the right is hyperresonant. What should you do at this time? Proficiency Eval. #1 (Routine Ventilator Check) - 2
3 V. SCENARIO QUESTIONS (cont.): 4. During mechanical ventilation on IMV of 4 breaths/min and Vt of 800 ml, a patient has a respiratory rate of breaths/minute and spontaneous Vt ranges from 175 to 325 ml. The patient is using accessory muscles to breathe. Arterial blood gas results are within the normal range. What would be an appropriate intervention in light of these findings? 5. A patient is being ventilated in the assist-control mode. The flow rate is set at 30 LPM. Vt is 1000 ml. The machine rate is set at 10 breaths/min, but the actual assisted rate is 20 breaths/min. You notice that the peak pressure has been rising progressively over the last several breaths. Pressure does not go back to zero at the end of exhalation and seems to be rising. The pressure limit alarm starts sounding. To correct this situation, what would you do? 6. A 150 lb. (68 kg) patient on an SIMV rate of 6 and Tidal Volume of 750 ml has a spontaneous respiratory rate of 20 and spontaneous tidal volume of 250 ml. What is his approximate VA? 7. On the ventilator being checked, describe methods of changing I:E without changing minute ventilation. Proficiency Eval. #1 (Routine Ventilator Check) - 3
4 STUDENT: COURSE: KALAMAZOO VALLEY COMMUNITY COLLEGE RESPIRATORY THERAPY PROGRAM PROFICIENCY EVALUATION PROCEDURE (TASK): ROUTINE VENTILATOR CHECK THERAPEUTIC PROCEDURE: NON THERAPEUTIC PROCEDURE CLINICAL NEW PATIENT REPEAT PROCEDURE EQUIPMENT UTILIZED: COLLEGE LABORATORY PEER APPLICATION MANIKIN/ANALOG STEPS IN PROCEDURE OR TASK: EQUIPMENT AND PATIENT PREPARATION 1. Selects, gathers, and assembles appropriate equipment. Insures asepsis 2. Verifies, interprets and evaluates physician's order 3. Identifies patient, self, and department 4. Explains procedure and confirms patient understanding IMPLEMENTATION AND ASSESSMENT 5. Verirfies current ventilator settings with physician's order 6. Checks humidifier function and water level 7. Properly refills humidifier if required 8. Checks airway temperature and adjusts if necessary 9. Checks circuit integrity of leaks, obstruction, and position 10. Assesses patient status (physical assessment, vital signs, airway) 11. Correlates pre-set values with those monitored (V t, f, FIO 2, etc.) 12. Insures proper ventilator function 13. Verifies all alarm functions/settings 14. Reassures patient FOLLOW-UP 15. Maintains and processes equipment, insures asepsis 16. Records pertinent data in chart and departmental records 17. Notifies appropriate personnel ADDITIONAL EVALUATION CRITERIA 18. all review questions correctly Proficiency Eval. #1 (Routine Ventilator Check) - 4
5 STUDENT'S COMPREHENSION OF COGNITIVE OBJECTIVES RELATED TO THE PROCEDURE - ROUTINE VENTILATOR CHECK: Upon completion the student will be able to answer oral review questions and discuss clinical scenarios related to the following cognitive objectives: 1. Analyze ABG results and make appropriate recommendations regarding the parameters required for a patient on mechanical ventilation. 2. Evaluate adverse systemic effects caused by mechanical ventilation and take appropriate steps to minimize those effects. 3. Calculate I:E ratio, dynamic compliance, static compliance, airway resistance, and loss of volume due to tubing compliance given pertinent data. 4. Explain the operation of each control for this particular make of ventilator as it would be utilized in a specific clinical situation. 5. Explain all safety, monitoring, and alarm systems for this particular ventilator. Specify Evaluator Data Skill evaluation Oral Review Deficiencies: Ability to perform applicable steps in Specify applicable Please sign your name and procedure as listed on the front of Knowledge of the skill steps that were state your affiliate name. form without error or omission. cognitive omitted or done objectives listed erroneously. Also above. note any errors in discussing cognitive objectives. Please give enough detail to allow the student to work on specific Date Unsatisfactory remediation.... Proficiency Eval. #1 (Routine Ventilator Check) - 5
6 STUDENT: COURSE: KALAMAZOO VALLEY COMMUNITY COLLEGE RESPIRATORY THERAPY PROGRAM PROFICIENCY EVALUATION PROCEDURE (TASK): ROUTINE VENTILATOR CHECK THERAPEUTIC PROCEDURE: NON THERAPEUTIC PROCEDURE CLINICAL NEW PATIENT REPEAT PROCEDURE EQUIPMENT UTILIZED: COLLEGE LABORATORY PEER APPLICATION MANIKIN/ANALOG STEPS IN PROCEDURE OR TASK: EQUIPMENT AND PATIENT PREPARATION 1. Selects, gathers, and assembles appropriate equipment. Insures asepsis 2. Verifies, interprets and evaluates physician's order 3. Identifies patient, self, and department 4. Explains procedure and confirms patient understanding IMPLEMENTATION AND ASSESSMENT 5. Verirfies current ventilator settings with physician's order 6. Checks humidifier function and water level 7. Properly refills humidifier if required 8. Checks airway temperature and adjusts if necessary 9. Checks circuit integrity of leaks, obstruction, and position 10. Assesses patient status (physical assessment, vital signs, airway) 11. Correlates pre-set values with those monitored (V t, f, FIO 2, etc.) 12. Insures proper ventilator function 13. Verifies all alarm functions/settings 14. Reassures patient FOLLOW-UP 15. Maintains and processes equipment, insures asepsis 16. Records pertinent data in chart and departmental records 17. Notifies appropriate personnel ADDITIONAL EVALUATION CRITERIA 18. all review questions correctly Proficiency Eval. #1 (Routine Ventilator Check) - 6
7 STUDENT'S COMPREHENSION OF COGNITIVE OBJECTIVES RELATED TO THE PROCEDURE - ROUTINE VENTILATOR CHECK: Upon completion the student will be able to answer oral review questions and discuss clinical scenarios related to the following cognitive objectives: 1. Analyze ABG results and make appropriate recommendations regarding the parameters required for a patient on mechanical ventilation. 2. Evaluate adverse systemic effects caused by mechanical ventilation and take appropriate steps to minimize those effects. 3. Calculate I:E ratio, dynamic compliance, static compliance, airway resistance, and loss of volume due to tubing compliance given pertinent data. 4. Explain the operation of each control for this particular make of ventilator as it would be utilized in a specific clinical situation. 5. Explain all safety, monitoring, and alarm systems for this particular ventilator. Specify Evaluator Data Skill evaluation Oral Review Deficiencies: Ability to perform applicable steps in Specify applicable Please sign your name and procedure as listed on the front of Knowledge of the skill steps that were state your affiliate name. form without error or omission. cognitive omitted or done objectives listed erroneously. Also above. note any errors in discussing cognitive objectives. Please give enough detail to allow the student to work on specific Date Unsatisfactory remediation.... Proficiency Eval. #1 (Routine Ventilator Check) - 7
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