RET1264C - Fundamentals of Respiratory Care II

4 hours Lecture, 4 credit(s)

Lower-Division College Credit

Prerequisite(s): RET 1026C

AA Elective: No

Academic Dean’s Contact Information

LAKELAND DEAN’S OFFICE: LLC 2255 PHONE: (863) 297-1024
WINTER HAVEN DEAN’S OFFICE: WSC 101 PHONE: (863) 297-1020

Course Description:
This course provides a continuation of Fundamentals of Respiratory Care I (RET 1026C). The curriculum discusses airway management and mechanical ventilation.

Polk State College Mission and Program Outcomes

Polk State College, a quality driven institution transforms lives through the power of education by providing access to affordable associate and baccalaureate degree programs, career certificates, and workforce employment programs delivered by diverse, qualified faculty and staff. In line with this purpose, Polk State’s Associate in Science and baccalaureate degree programs develop competence in career areas. This course focuses on the development of competencies related to the following program outcomes:

To provide the student with a sound basis in the scientific principles which form the foundation of respiratory care practice.
To develop within the student a clear idea of his/her role, responsibilities, ethics and professional conduct to the patient, the physician and other members of the health care team.
To acquaint the student with the equipment, medical gases, and medications which are utilized by the respiratory care profession.
To provide the student with an opportunity to master skills and techniques associated with the safe practice of respiratory care.
To promote and aid students in developing good study habits which will be a resource for continued personal and professional growth.

Course Objectives:

The student will be able to:

Discuss, identify and apply proper theory and techniques for the installation, maintenance and removal of artificial airways on adult, pediatric and neonatal patients to a proficiency of 78 percent on a written examination and to 100 percent on a laboratory practical examination.
List and describe the indications for the implementation of mechanical ventilation on adult, pediatric and neonatal patients to a proficiency of 78 percent on a written examination and 100 percent on a laboratory practical examination.
Describe and implement techniques used for proper management of the patient-ventilator system to a proficiency of 78 percent on a written examination and 100 percent on a laboratory practical examination.
Describe and implement techniques for weaning and removal of mechanical ventilation support on adult, pediatric and neonatal patients to proficiency of 78 percent on a written examination and 100 percent on a laboratory practical examination.
Develop a patient care plan for artificial airway management and/or mechanical ventilation to a proficiency of 100 percent in a laboratory setting using the Human Patient Simulator (HPS).

Course Content:

I. Airway Management
    A. Types of Artificial Airways
        1. Nasopharyngeal Airways
        2. Oropharyngeal Airways
        3. Intraesophageal Devices
        4. Intratracheal Devices
            a. endotracheal tubes
            b. tracheostomy devices
    B. Indications for Artificial Airways
        1. Maintenance of ventilation
        2. Protection of airway
        3. Control of secretions
        4. Attachment to mechanical ventilation
    C. Installation of Intraesophageal and Intratracheal devices
        1. Installation and use of the Esophageal Obturator Airway (EOA)
        2. Installation and use of the Combi-Tube
        3. Installation and use of the Laryngeal Mask Airway (LMA)
        4. Installation and use of the Endotracheal Tube (ET tube)
        5. Installation and use of Tracheostomy devices
    D. Complications and Hazards of Artificial Airways
        1. Acute Complications
            a. Infection
            b. Direct trauma
            c. Bleeding and hemorrhage
            d. Improper cuff maintenance
            e. Air leak syndromes
         2. Long-Term Complications
            a. Tracheomalacia
            b. Subglottic stenosis
            c. Tracheal stenosis
            d. Cuff erosion
            e. Vocal cord damage
     E. Discontinuance of Artificial Airways
         1. Procedures for extubation
         2. Monitoring following removal
         3. Pharmacological Interventions

II. Mechanical Ventilation
     A. Specific Indications for Mechanical Ventilation
         1. Apnea
         2. Acute Respiratory Failure
         3. Impending Respiratory Failure
         4. Oxygenation (Refractory)
         5. Maintenance of Sustained Hypocapnia
     B. Pathophysiology Requiring Mechanical Ventilation
         1. Respiratory implications
         2. Non-respiratory implications
         3. Clinical Practice Guidelines
         4. Therapist Driven Protocols
     C. Major Ventilation Categories
         1. Control functions
             a. open loop
             b. closed loop
         2. Microprocessor
         3. Ventilation Domains
             a. positive pressure
             b. negative pressure
     D. Ventilator Classification
         1. Pressure cycled
         2. Volume cycled
         3. Time cycled
         4. Flow cycled
         5. Other classification
     E. Modes of Ventilation
         1. Control mode (pressure or volume) (CMV)
         2. Assist Control (pressure or volume) (A/CMV)
         3. Synchronized Intermittent Mandatory Ventilation (SIMV)
         4. Pressure Support Ventilation (PSV)
         5. Pressure Control Ventilation (PCV)
         6. Pressure Control Inverse Ratio Control (PCIRV)
         7. Extended Mandatory Minute Ventilation (EMMV)
         8. Airway Pressure Release Ventilation (APRV)
         9. Continuous Positive Airway Pressure (CPAP)
        10. Bi-Level Positive Pressure Ventilation (BiPAP@)
        11. Non-Invasive Positive Pressure Ventilation (NIPPV)
        12. Others as they evolve
     F. Patient Commitment to Mechanical Ventilation
         1. Rationale for ventilator commitment
             a. specific disease processes
             b. ventilatory parameters; VC, VT, and NIF (MIP)
                  i. prognosis
                 ii. ethical considerations
         2. Initial settings based on:
             a. pathophysiology including arterial blood gases
             b. patients’ age, gender, height and weight
         3. Establishing Patient-Ventilator Continuity
             a. selection of proper flow
             b. selection of proper I:E ratio (normal v. inverse)
                  i. recording baseline parameters
                 ii. pharmacological interventions
         4. Monitoring the ventilated patient
             a. use of established protocols
             b. monitoring of laboratory values including ABG’s
                  i. use of the team approach
                 ii. periodic monitoring of the patient-ventilator system
                iii. use of Clinical Practice Guidelines
                iv. use of Therapist Driven Protocols
         5. Airway Pressure Therapy
             a. Positive End Expiratory Pressure (PEEP)
             b. Continuous Positive Airway Pressure (CPAP)
             c. Bi-Level Positive Airway Pressure (BiPAP@)
                i. Pressure Support Ventilation (PSV)
         6. Ventilator Weaning and Discontinuance
             a. selecting the best weaning method
             b. selecting the best weaning mode
            c. establishing minimum criteria for weaning
             d. recognizing a “failure to wean” situation
             e. post extubation/weaning support
             f. ethical and legal considerations
     G. Maintaining the Mechanical Ventilator
         1. Pressure testing and/or use of the Extended Self Test (EST)
             a. prior to use on a patient
             b. according to established
         2. Preventive maintenance and cleaning
         3. Circuit changes
         4. Additions to the ventilator circuit
             a. Heat and Moisture Exchangers (HME)
             b. End tidal CO2 monitors
             c. Closed suction catheter systems
         5. Infection control
         6. Electrical and fire hazards
         7. Medical-legal considerations
     H. Brand-Names of Ventilators
The number of companies both inside the United States and in other countries has grown tremendously over the previous decade. Students of Respiratory Care should become familiar with these names and model numbers, e.g. Puritan Bennett 840 or Bennett 7200 or Bear 1000 to enhance and broaden their knowledge base and awareness of the technology that drives today’s mechanical ventilator systems. It is highly unlikely that you will be asked specific questions on board exams about specific ventilators. The trend has been from machines that only performed those tasks to which they were directed, to current and future technology where mechanical ventilators will act according to pre-programmed logic. It is a wide and wonderful area of Respiratory Care.

Textbook and Other Requirements

Textbook information is provided in the course syllabus, at the campus bookstore, on the campus bookstore website (www.polk.bncollege.com), or via the “Shop Textbook” button on the PASSPORT schedule of classes.

The Gordon Rule

This is not a Gordon Rule course.

Student Help

The professor is available for help during posted hours and by appointment during other non-class hours. Students are encouraged to seek assistance from the professor. To further the educational process, the campus Learning Resources Centers, comprised of the Teaching/Learning and Computing Center (TLCC) JDA Student Success Center, and library, are available for student use. Each resource provides qualified staff and up-to-date equipment and facilities to promote students’ academic success. The TLCCs and JDA Student Success Center provide tutoring services, computing resources, and other instructional support. The library provides information resources, individual and group study space, research assistance, information literacy instruction, and computing resources. Each facility provides free wireless access to the Internet. Polk State College Library, Student Success Center, and TLCC hours of operation and tutoring schedules are posted at each facility and on the College website.

Withdrawing From a Course

Students may officially withdraw from course(s) during any given term, provided they follow the appropriate policy and procedure. Following the conclusion of the Drop/Add Period, a student may officially withdraw without academic penalty from any credit course, provided he or she has submitted the appropriate forms to the Student Services Office no later than the published deadline. The published deadline reflects approximately (but no more than) 70% of the term, based upon the course’s scheduled duration. It is the student’s responsibility to submit these withdrawal forms; failure to do so may result in a grade of F in the course. Under the Forgiveness Policy, a student is allowed only three attempts in any one course: one initial enrollment and two repeats. A student is not allowed to withdraw from a third course attempt. Limited admission programs may have specific guidelines regarding course withdrawal that vary from this policy. Individuals should refer to the student handbook for that program for more information. If a student stops attending class, the grade earned, usually an F, is assigned and posted. Prior to withdrawing from a course, the student should consult with the Financial Aid Office to determine what impact, if any, withdrawal from the course will have on his or her financial aid status. A student cannot use course withdrawal to avoid academic dishonesty penalties. A student who has been penalized for academic dishonesty in a course is not eligible to withdraw from the course.

Repeating a Course

Under the Forgiveness Policy, a student is allowed only three attempts in any one college credit course: one initial enrollment and two repeats. Under certain circumstances, a student may petition to repeat a credit course beyond the three attempts. Limited admission programs may have specific guidelines regarding repeating a course that vary from this policy. Individuals should refer to the student handbook for that program for more information. The student should be aware that repeating a course may result in a higher course cost. A course cannot be repeated unless the previously earned grade is a D, F, or W (the Polk State College Catalog provides further details regarding this process). Prior to repeating a course, the student should consult with the Financial Aid Office to determine what impact, if any, repeating the course will have on his or her financial aid status.

Academic Dishonesty

Each student is responsible for his or her work. It is assumed that each student is honest and will abide by this standard; however, in the event that there is an indication or suspicion of cheating/plagiarism, the situation shall be dealt with in accordance with the published College policy. Copies of this policy are available in the Student Services Office. Students should also refer to the course syllabus for more specific information.

Information Technology Access/Use Policy

All individuals who employ the information technology resources provided by Polk State College (this includes, but is not limited to, telephones, computers, the Polk State College Local Area and Wide Area Networks, and the Internet) must use these resources for academic purposes only. Use of these resources is a privilege, not a right. Inappropriate use can result in revocation or suspension of this privilege.

Equal Access/Opportunity

Polk State College is an equal access/equal opportunity institution committed to excellence through diversity in education and employment. The College complies with all state and federal laws granting rights to students, employees, and applicants for employment or admission to the College. The College prohibits unlawful discrimination on the basis of race, color, national origin, creed, ethnicity, sex, age, religion, sexual orientation, marital status, veteran status, genetic information or disability in any of its employment policies or practices, educational programs, or activities. For questions or concerns, please contact: Valparisa Baker, Director, Equity & Diversity (Title IX Coordinator), 999 Avenue H NE, Winter Haven, FL 33881-4299, Office: WAD 227, 863.292.3602 Ext. 5378, vbaker@polk.edu.

Equal Opportunity For Students With Disabilities

The College complies with The Americans with Disabilities Act and provides equal educational opportunity for qualified individuals. A student with a disability who requires special accommodations or auxiliary aids under The Americans with Disabilities Act (ADA) should contact the Student Services Office on either campus and speak with a Disability Services Advisor or the Coordinator of Disability Services. Note: Limited admission programs may have performance restrictions that apply. Restrictions (where applicable) are outlined in each program’s student handbook.

Evaluative Criteria:

Multiple choice tests, take-home and scheduled in class, quizzes, equipment/procedure check-offs, individual projects and assignments, group activities and professional behaviors.

Assignments and/or projects that may be assigned are to be submitted on the designated date, during the class period. No assignments or projects will be accepted after the class has adjourned, unless arrangements have been made between the student and the instructor. Students failing to submit assignments on time and not following procedures will get a zero (0).

Lecture = 40%
                        4 unit exams
                        Quizzes
                        Group activities /projects as assigned
                        Individual homework as assigned
Lab = 50%
                        2 Lab exams
                        Quizzes
                        Group activities/projects as assigned
                        Individual homework as assigned
Professional Behavior = 10%
                        Classroom professionalism
                      Social Activities
Total of 100%

Grading Scale:
92.5 – 100                  A
88.5 – 92.4                 B+
83.5 – 88.4                 B
80.5 – 83.4                 C+
77.5 -80.4                   C
70.5- 77.4                   D+
65.5-70.4                    D
Below 65.4                  F

Attendance:

Regular attendance in the classroom and laboratory sessions is mandatory. When three (3) unexcused absences are accumulated, the student may be issued a written warning. If an additional absence occurs, the student may be dropped from the program in accordance with the attendance policies outlined in the general college catalog. In no case will a student receive a passing grade for a course if more than twenty-percent (20%) of scheduled lectures is missed.

Work Missed:

No Make-ups will be given for missed exams, quizzes, assignments, or projects unless the condition falls under extended medical, military leave, or family emergency. If any of these work items are missed, the grade assigned will be a zero (0). Students who need to be on extended medical, military leave and/or family emergency must submit copies of official documents to the program manager.

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