RT 246 - Comprehensive Clinical Education

1. Demonstrate the ability to identify heart arrhythmias and measurments from pulmonary artery catheters.
   1. Demonstrate the ability to identify the following abnormal ECG patterns:
      1. Sinus bradycardia
      2. Sinus tachycardia
      3. Premature atrial contractions
      4. Atrial tachycardia
      5. Atrial flutter
      6. Atrial fibrillation
      7. Junctional rhythms
      8. Premature ventricular complexes
      9. Ventricular tachycardia
      10. Ventricular fibrillation
      11. Atrioventricular blocks
      12. Asystole
   2. Explain the functions of an indwelling systemic arterial catheter.
   3. Describe the complications associated with an indwelling arterial catheter and the precautions to avoid those complications.
   4. Demonstrate the proper technique for withdrawing blood from an arterial catheter.
   5. Identify the various parts and explain the functions of a Swan-Ganz or pulmonary artery catheter.
   6. Identify the various pressure waveforms, including wedge pressure, as the pulmonary catheter passes through the chambers of the heart and is positioned in the pulmonary artery.
   7. State the normal values for the following measurements made with the pulmonary artery catheter:
      1. Right atrial pressures
      2. Right ventricle pressures
      3. Pulmonary artery pressures
      4. Mean pulmonary artery pressures
      5. Pulmonary capillary wedge pressures
      6. SVO2
   8. Demonstrate the proper technique for obtaining the above measurements.
   9. Demonstrate the proper technique for withdrawing a mixed venous blood sample from a pulmonary artery catheter.
   10. Display the appropriate professional mannerisms, as described in the clinical performance evaluation, while performing the clinical duties associated with this unit.
2. Demonstrate the ability to manage positive pressure equipment to treat patiencts in the critcal care setting.
   1. Demonstrate the proper setup and application to patients to pneumatic/electric mechanical ventilators.
   2. Demonstrate the ability to troubleshoot signs of malfunction and make appropriate corrections to the ventilators listed above.
   3. Make appropriate recommendations or modifications in ventilators settings, utilizing the following information:
      1. The physiologic equations from RT 226  
      2. Arterial blood gases
      3. Chest x-rays
      4. The hemodynamic measurements from RT 246, Section I, Unit I
      5. Physical assessment
      6. Patient history
      7. Progress notes
      8. Electrolytes
      9. CBC
      10. Other lab data
   4. Relate the following information to your patient's ability to tolerate ventilator discontinuance:
      1. VD/VT
      2. A-a DO2
      3. VC
      4. NIF
      5. Qs/Qt
      6. VE
      7. RR
   5. Demonstrate proper techniques for administering
      1. IMV
      2. CPAP
      3. PSV
      4. PCV
   6. Display the appropriate professional mannerisms, as described in the clinical performance evaluation, while performing the clinical duties associated with this unit.
3. Demonstrate the ability to identify classes of drugs.
   1. Identify the generic and/or trade name for the following classes of drugs:
      1. Sympathomimetic bronchodilator
      2. Anticholinergic bronchodilator
      3. Xanthine
      4. Mucolytic
      5. Dilutants
      6. Corticosteroid
      7. Antiasthmatics
      8. Narcotic analgesics
      9. Cardiac glycosides
      10. Antiarrhythmic
      11. Cardiac stimulants
      12. Vasopressor
      13. Vasodilator
      14. Neuromuscular blocking agents
   2. State the indications for the above mentioned drugs.
   3. Explain the effects of the above mentioned drugs.
   4. State the side effects of the above mentioned drugs.
   5. State the proper therapeutic dosage of the above mentioned aerosolized drugs.
   6. Display the appropriate professional mannerisms, as described in the clinical performance evaluation, while performing the clinical duties associated with this unit.
4. Demonstrate the ability to recognize indications for ECMO.
   1. Describe the following methods of extracorporeal oxygenation:
      1. Venoarterial (VA)
      2. Venovenous (VV
   2. Explain advantages and disadvantages of each method described above.
   3. Identify and explain the function of the components in an extracorporeal oxygenation circuit.
   4. Identify acceptable aerterial blood gas values for the post-op cardiovascular patient.
   5. Make appropriate recommendations in the ventilator management of the post-op cardiovascular patient.
   6. Recognize the clinical signs and symptoms of common complications of cardiosvascular surger.
   7. Display the appropriate professional mannerisms, as described in the clinical performance evaluation, while performing the clinical duties associated with this unit.
5. Demonstrate the ability to recognize hypoxia and mechanical venitlation use with the infant.
   1. Identify the clinical signs of hypoxia in the neonate.
   2. Explain the hazards of O2 therapy as they relate to the neonate.
   3. Demonstrate the proper procedure for setup of the following O2 devices:
      1. Nasal cannula
      2. Oxyhood
   4. Demonstrate the proper procedure for changing the above devices.
   5. Demonstrate the proper procedure for setup and calibration of the following infant
   6. List and explain the various mechanisms of heat loss in the newborn and methods to avoid each.
   7. Explain the importance of maintaining the newborn in a neutral thermal environment as it relates to both:
      1. Heat stress
      2. Cold stress
   8. Explain the hazards of the following methods of suctioning the neonate’s airway:
      1. Oropharyngeal
      2. Endotracheal
   9. Demonstrate the proper procedure for suctioning the neonate’s airway via the above methods.
   10. Demonstrate proper procedure for manually ventilating the infant via:
       1. Bag and mask
       2. Bag and E-T tube
   11. Demonstrate proper procedure for providing the following respiratory care to the infant:
       1. Aerosol therapy
       2. Chest physical therapy
   12. Demonstrate proper procedure for obtaining arterial and/or capillary blood from the infant for analysis.
   13. Describe the hazards of the above procedures.
   14. Demonstrate proper procedure for setup of pneumatic/electric infant ventilators.
   15. Demonstrate proper procedure for monitoring the ventilators listed above.
   16. Demonstrate proper procedure for changing the circuits on the ventilators listed above.
   17. After a thorough assessment of the infant, make appropriate recommendations in the management of infants on:
       1. Mechanical ventilation
       2. CPAP
   18. List and explain the scoring of the five categories of the APGAR evaluation system.
   19. Relate the infant’s APGAR score to the need for resuscitation and also the degree of the resuscitative efforts.
   20. Display the appropriate professional mannerisms, as described in the clinical performance evaluation, while performing the clinical duties associated with this unit.