RT 135 - Diagnostics and Special Procedures

Credits: 4
Instructional Contact Hours: 4

Presents the theory and application of skills required to perform arterial and mixed venous blood sampling and analysis, basic pulmonary function testing, and to interpret the results of and make recommendations for care based on these diagnostic procedures. Emphasizes the respiratory therapist's role in chest and lateral neck x-ray evaluation, bronchoscopy, and chest tube drainage.

Prerequisite(s): RT 117, RT 118, RT 121, RT 126, and RT 131 each with a minimum grade of “C”
Corequisite(s): RT 132, RT 146, RT 149
Lecture Hours: 54 Lab Hours: 12
Meets MTA Requirement: None
Pass/NoCredit: No

Outcomes and Objectives

Demonstrate an understanding of acid-base balance.
1. Compare and contrast the role of body buffer systems, lungs and kidneys, in normal acid - base homeostasis.
2. Apply the Henderson - Hasselbalch Equation to the determination of plasma pH.
3. Employ the following to differentiate among compensated and uncompensated status of acid - base imbalance:
4. Compare the four primary states of acid - base imbalance according to underlying causes, and mechanisms of compensation and correction.
5. Explain the interrelationships between renal regulation of electrolytes (sodium, potassium, chloride) and acid - base states.
6. Describe the measurement of standard bicarbonate and base excess.
7. Identify mixed acid - base imbalances.
8. Identify acute on chronic acid - base imbalances.
9. Define ventilatory and respiratory insufficiency and failure.
10. Identify typical blood gas values for specific acute and chronic disease states.
11. Estimate changes in PaO2, PaCO2, and pH as a result of changes in therapy.
12. Make appropriate recommendations for modifications in the respiratory care plan based on ABG results.
Demonstrate an understanding of arterial blood gases.
1. Discuss the clinical importance of blood gas analysis.
2. List in order the most desirable sites for arterial puncture and discuss why each is more desirable than the next.
3. Describe and demonstrate the modified Allen’s Test and state the clinical application.
4. Select appropriate equipment for the obtaining of each type of sample (arterial puncture and indwelling catheter), and arterial samples from various types of patients.
5. Demonstrate the ability to select an appropriate site and draw an arterial blood sample from the arterial lab arm, employing proper technique.
6. Demonstrate the ability to draw blood from an indwelling catheter.
7. Discuss the potential hazards of arterial puncture and of inappropriate arterial puncture technique.
8. Discuss the feelings of the patient having an arterial puncture, and mannerisms to reassure the patient.
9. Describe other sources for obtaining arterialized blood sample from ICU patients and neonates, other than an arterial puncture.
10. Describe the technique for obtaining arterialized capillary sample from an infant; state the average size of the sample; demonstrate handling of the sample until it is analyzed.
11. Discuss the variations in values between an arterial sample and an arterialized capillary sample.
12. State the type of heparin to use with arterial samples and discuss why other types are not utilized.
13. Discuss the possible causes and results of pre-analytic error in blood gas samples.
14. Demonstrate the appropriate handling of an arterial blood sample after it is obtained until it is analyzed.
15. Describe the function of the Sanz, Severinghaus, and Clark electrodes and the various parts of the blood gas analyzer.
16. Demonstrate the ability to change the electrodes and the electrode membranes.
17. Demonstrate the ability to calibrate the blood gas analyzer; compute the partial pressures of the calibration gases.
18. Demonstrate the ability to analyze a normal size sample, micro sample, and gas sample.
19. Perform maintenance and demonstrate proper storage procedures of the blood gas analyzers.
20. Describe the process of co-oximetry and discuss the clinical significance of carbon monoxide in the blood.
Demonstrate an understanding of pulmonary function.
1. Explain each of the following terms:
  1. Tidal volume (Vt)
  2. Inspiratory reserve volume (IRV)
  3. Expiratory reserve volume (ERV)
  4. Residual volume (RV)
  5. Inspiratory capacity (IC)
  6. Functional residual capacity (FRC)
  7. Vital capacity (VC)
  8. Total lung capacity (TLC)
2. Identify each of the above on a simple spirogram.
3. Describe the technique for measuring each of the volumes and capacities.
4. Explain the significance of each of the volumes and capacities.
5. Explain how predicted values for each of the above are determined.
6. Give normal ranges for Vt and VE in the adult.
7. Explain the significance of the RV/TLC
8. Calculate FRC using the
9. Explain the limitation of the above 7 techniques.
10. Calculate RV/TLC ratios
11. Given the appropriate information, compute lung volumes and/or capacities.
12. Explain each of the following terms:
  1. Forced vital capacity (FVC)
  2. Forced Expiratory Volume (FEV₁)
  3. FEV₁/FVC or FEV_1%
  4. FEF_200-1200
  5. FEF_{25% - 75%}
  6. PEFR
  7. Flow-volume loop
  8. MVV
  9. Compliance
  10. Airway resistance
  11. MIP
  12. MEP
13. Describe the technique for measuring each of the above.
14. Give normal ranges for each in a healthy adult.
15. Explain the significance of each of the above measurements.
16. Assuming more than one reproducible FVC Maneuver, what is the basis for selecting the FEF 25%-75% to be reported.
17. Identify abnormal flow-volume loops.
18. Discuss the normal and abnormal values and show the mathematical relationship between:
  1. CL
  2. CT
  3. CLT
19. Give examples of diseases that cause:
  1. Increased CL
  2. Decreased CL
  3. Decreased CT
  4. Increased RAW
20. Define and explain how each of the following is used:
  1. Trans Pulmonary Pressure
  2. Trans Airway Pressure
  3. Trans Thoracic Pressure
Demonstrate an understanding of pulmonary function test equipment.
1. Explain the function of the following equipment used in pulmonary function testing:
  1. Spirometers (volume displacement and pneumotachometers)
  2. Peak flow meters
  3. Plethysmographs
2. Demonstrate the ability to select, properly set up for use, monitor, correct malfunctions and maintain while in use, the following equipment.
  1. Spirometers
  2. Peak flow meters
3. State the limits of flow for the accuracy and care of the respirometers.
4. Discuss the uses of the respirometer and peak flow meter in lab and clinical setting; discuss situations in which the use of each is inappropriate.
5. Demonstrate the ability to perform simple spirometry on a simulated patient.
6. Demonstrate the ability to appropriately coach and monitor a patient during the performance or simple spirometry.
7. Discuss potential hazards/limitations of the use of the above equipment.
Demonstrate an understanding of pulmonary function test results.
1. Explain each of the following terms:
  1. SBN2 Washout
  2. Closing volume (CV)
  3. Nitrogen washout test (7 minute)
  4. Lung scans
2. Explain the four phases of the SBN2
3. Describe the technique for obtaining the above measurements.
4. Explain the significance of each of the tests.
5. State the following values for the index of distribution of inspired gases (IDI):
  1. Ideal
  2. Normal
  3. Abnormal
6. Explain the significance of any technical problems associated with any of the above tests.
7. State the normal V/Q ratio.
8. Explain any contraindications for perfusion lung scans.
9. Explain why radioactive xenon is used for assessing regional ventilation.
10. Explain the term DLco
11. Describe techniques for measuring DLco
12. Give normal values for DLco and DL02
13. Explain the significance of DLco
14. Explain why carbon monoxide is used to measure diffusion instead of oxygen.
15. State those factors that will influence the observed Dlco and how they will affect it.
16. Define obstructive and restrictive disease.
17. Identify types of obstructive and restrictive diseases.
18. Describe a typical PFT pattern for patients with obstructive lung disease.
19. Describe a typical PFT pattern for patients with a restrictive lung disease.
20. Describe a typical PFT pattern for patients with combined obstructive and restrictive lung disease.
21. Given data from Pulmonary Function Tests, interpret the results.
Demonstrate an understanding of pulmonary stress test equipment
1. Explain the function of the following equipment used in pulmonary function testing:
  1. Spirometers (volume displacement and pneumotachometers)
  2. Peak flow meters
  3. Plethysmographs
2. Demonstrate the ability to select, properly set up for use, monitor, correct malfunctions and maintain while in use, the following equipment.
3. State the limits of flow for the accuracy and care of the respirometer.
4. Discuss the uses of the respirometer and peak flow meter in lab and clinical settings; discuss situations in which the use of each is inappropriate.
5. Demonstrate the ability to perform simple spirometry on a simulated patient.
6. Demonstrate the ability to appropriately coach and monitor a patient during the performance or simple spirometry.
7. Discuss potential hazards/limitations of the use of the above equipment.
Demonstrate an understanding of pulmonary stress tests.
1. Describe the preliminary test procedures for an exercise test.
2. Describe the equipment needed for exercise testing.
3. Describe the exercise testing procedure.
4. Identify the physiological variables that should be monitored during exercise testing.
5. Describe precautionary measures taken during exercise testing.
6. State the normal values for:
7. Explain the relationship between the following parameters and Vo2:
  1. VE
  2. VD/VT
  3. Vco2
  4. R
8. Explain the changes seen in the above parameters (Objective 7) when the anaerobic threshold is reached.
Demonstrate an understanding of chest tubes.
1. Describe the types of pneumothoraces, hemothorax, pleural effusion, and sucking chest wound.
2. Discuss the indications for chest tubes and the potential hazards.
3. Describe the insertion and placement of chest tubes.
4. Describe the functions of the types of vacuum systems for chest tubes, care, potential hazards, and the management of the patients with each.
5. Discuss the methods of evaluating the effectiveness of chest tubes and vacuum systems.
6. Discuss the modifications and/or applicability of adjunct therapies to meet therapeutic goals.
7. Recognize the need for and recommend the insertion of chest tubes.
Demonstrate an understanding of diagnostic imaging.
1. Locate the prominent and basic anatomical structures and any radiopaque foreign objects; identify each.
2. Relate obvious anatomical abnormalities to disease states.
3. Evaluate the placement of the film and patient during the x-ray exposure.
4. Discuss the varying densities as indicators of pulmonary, cardiac, and/or thoracic disease or trauma states.
5. Describe the adequacy of placement of artificial airways as shown on x-rays.
6. Relate the x-rays and x-ray findings to other patient data to compile a patient profile.
7. Discuss safety to the patient and the therapist concerning x-rays.
8. Inspect and describe findings of lateral neck and chest x-rays.
9. Recognize the need for and recommend chest and lateral neck x-ray.
Demonstrate an understanding of broncoscopies.
1. Discuss the indications and techniques for bronchoscopy.
2. Assemble and maintain equipment and discuss the manner in which respiratory therapy assists in bronchoscopy.
3. Assist the physician with bronchoscopy.