1. Welcome to RT 210: Introduction to Applied Respiratory Therapeutics
Instructor: Ms. K. Walker, BS, RRT
Introduction to RT210

2. Respiratory Therapy Organizations
Associations
AARC – American Assn. for Respiratory Care
Promotes Profession
Respiratory Care and AARC magazines
Clinical Practice Guidelines (CPG’s)
Governmental representation
State Society for Respiratory Care (FSRC)
Education
Newsletters

3. Respiratory Therapy Organizations
Associations (cont)
NBRC – National Board for Respiratory Care
Testing – National exams accepted by most states for licensure
Certified Respiratory Therapist (CRT)
Registered Respiratory Therapist (RRT)
CoARC – Committee on Accreditation for Respiratory Care
Accreditation of RT schools

4. Respiratory Therapy Organizations
Groups that affect healthcare
Insurance Companies
Government Medicare
Consumer Groups Ex: AARP

5. Hospital Organization
Admitting
Billing and Accounts
Radiology / X-rays
Nursing
Laboratory (culture, urinalysis, blood counts)
Education
Engineering / Repair and maintenance

6. Hospital Organization
Housekeeping
Nuclear Medicine
Dietary
Pharmacy
Physical Therapy

7. Respiratory Therapy Department Organization
Medical Director
Responsible for clinical function of department
Administrative Director
Supervisors
Secretary
Equipment Personnel
Education Coordinator
Therapist/Registered & Certified

8. Hospital Administration
Board of Directors
Medical Director
Department Directors & Managers

9. Triage (order of care) CPR CMV ICU Care ER Postoperative care
O2 and aerosol therapy
IPPB
CPT and IS
Diagnostic studies

10. Diagnostic Therapy vs. Clinical Therapy
Principals of code blue

11. Medical Terminology and Abbreviations
Root Words + Combining Form
Prefixes: Begin Word
Suffixes: After Root
Combine Suffixes, Prefixes And Roots

12. Medical Terminology and Abbreviations
Root Combining Form
Gastr + o = stomach
Cardi + o = heart
Derm + o = skin
Pneum + o = air
Pleur + o = lung lining
Trach + e = trachea
Abdomin + o = abdomen
Aden + o = glands
Hem + a/o = blood
Cost + o = ribs
Cyt + o = cells

13. Medical Terminology and Abbreviations
Root Combining Form
Vas + o = vessel
Bi + o = life
Thorax + a = chest
Bronch + o = bronchus
Myo = muscle
Myco = fungus
Cyan +o = blue
Febrile = fever
Aerobic = in the presence of O2

14. Medical Terminology and Abbreviations
Prefixes: Begin Word
A-, An- negative
AB away
Di two
Ex out of
Intra inside
Infra beneath
Inter between
Macro large
Mal abnormal
Mega large
Micro small
Neo new
Ortho to correct
Sub below
Trans through
Contra against
Hyper above
Hypo below
Tachy fast
Brady slow

15. Medical Terminology and Abbreviations
Suffixes: After Root
Algia pain
–ectomy removal
–gen agent
–oma tumor
–penia lack
–ostomy opening
–otomy cutting
–itis inflammation
–ology study
–gram tracing
–graph record
–pnea breathing

16. Medical Terminology and Abbreviations
Combine Suffixes, Prefixes And Roots 
Tracheostomy tracheal opening
Tracheotomy tracheal surgery
Adenoma gland tumor
Pleuralgia pleural pain
Bronchitis inflammation of the bronchi
Tachypnea fast breathing
Bradycardia heart less than 60 beats/min
Hypertrophy an increase in size
Atrophy wasting away

17. Medical Terminology and Abbreviations
Directional Terms
Left: To the subject’s left … not YOUR left
Right: To the subject’s right … not YOUR right
Lateral: Toward the side
Medial: Towards the middle
Anterior: Toward the front of the body
Posterior: Toward the back of the body
Superior: Toward the top of the body
Inferior: Toward the bottom of the body
Dorsal: Along, or toward, the vertebral surface of the body
Ventral: Along, or toward, the belly surface of the body
Caudad (Caudal): Toward the tail
Cephalad: Toward the head
Proximal: nearer the trunk
Distal: farther from the trunk

18. Medical Terminology and Abbreviations
A = alveolar
a = arterial
ATPD = ambient temperature and pressure, dry
ATPS = ambient temperature and pressure, saturated
BTPD = body temperature and pressure, dry
BTPS = body temperature and pressure, saturated
ERV = expiratory reserve volume
E = exhaled gas
f = frequency
pH = hydrogen ion concentration
P = gas pressure

19. Medical Terminology and Abbreviations
BID = 2 times a day
TID = 3 times a day
QID = 4 times a day
Qh = every hour
VT = tidal volume
STAT = immediately
WBC = white blood count
RBC = red blood count
C¯ = with
s¯ = without
D/C = discontinue or discharge

20. Medical Terminology and Abbreviations
BCLC p. 188 (Table 11-1).

22. Patient Relationships
"The Nuremberg Declaration"
Patient has rights to have informed consent
Reasons for therapy
Consequences of refusing therapy
If therapy is administered and patient has refused, may be liable for assault

23. Patient Relationships
Improved communications help prevent problems
Respect patient
Explain in layman's language
Show kindness to patient & visitors - privacy
Improved records
Clarify orders when necessary
Accurately chart
No white out
One line through error, initial
If it isn’t charted it isn’t done
Neat/legible so it can be read

24. Patient Relationships
Insurance
Covered by school
Covered by hospital

25. Confidentiality
No information about patient to anyone other than patient (or to parent regarding minor patient).
Avoid discussions in cafeteria, elevator, hall, public areas, or patients’ rooms, etc.
In case studies, we don't use patient name, instead use initials, age, description, etc

26. Hospital Relationships
All members of a team
Work within chains of command
Avoid discussions of other personnel
Do not say anything to anyone that you do not want repeated.
Discuss appropriate information on what to talk about

27. Metric System Basic Rules for English Measures Linear Weight Volume
12 inches = 1 foot
3 feet = 1 yard
Weight
16 ounces = 1 pound
Volume
32 fluid ounces = 1 quart
4 quarts = 1 gallon

28. Metric System Prefixes for the Metric System
Kilo * or 1.0 * 103(k)
Hecto * or 1.0 * 102(h)
Deka - 10 * or 1.0 * 101 (da)
Deci * or 1.0 * (d)
Centi * or 1.0 * (c)
Milli – 0.001, or 1.0 * (m)
Micro – or 1.0 * 10 –6 (μ)

32. Lesson: Measurement, Terminology, and Ethics

33. Lesson: Measurement, Terminology, and Ethics

35. Kangaroos Hop Down Under Dirty Coal Mines
Kids Have Dropped Over Dead Converting Metrics
Kangaroos Hop Down Under Dirty Coal Mines

36. Conversion from Metric to English
Linear - 1 inch = 2.54 cm
Volume - 1 gallon = 3.8 L
Weight - 1 kilo = 2.2 lb
Temperature (normal oral 98.6° F or 37° C)
F = (9/5 * C) + 32
C = 5/9 * (F - 32)
K = C + 273
1 cm H2O =0.74 mm Hg
1 mm Hg = 1.36 cm H2O

38. Conversions
Linear inch = cm
Volume gallon = 3.8 L
Weight kilo = 2.2 lb

40. Temperature Conversions
F = (C * 1.8) + 32
C = (F -32) /1.8
K = C + 273

41. Ethical and Legal Implications of Practice
Private Law - deals with definition, regulation, and enforcement of rights in cases between citizen and citizen or between citizen and organizations. There are two types of private law. They are torts and contract law. (Talk only about torts).
Tort - a legal wrong committed upon a person or property independent of contract

42. Ethical and Legal Implications of Practice
Intentional tort –
Assault - willful attempt or threat to inflict injury on another.
Battery - intentional touching of another person without consent
Libel - false or malicious writing that is intended to defame or dishonor another
Slander - spoken form of defamation

43. Ethical and Legal Implications of Practice
Negligent tort – Malpractice - carelessness or failure to act with due care on the part of the professional
Malfeasance-execution of an unlawful or improper act
Negligence-reckless disregard for the safety of another

44. Basic Principles of Health Care Ethics
Reciprocal patient rights
Autonomous choice
Not to be harmed
Fair and equitable treatment
Autonomy-patient personal liberty and their right to decide their own course of treatment –Informed consent: educate the patient so that they are able to make their own course of treatment
Veracity-binds healthcare workers to tell the truth

45. Basic Principles of Health Care Ethics
Reciprocal patient rights (cont)
Benevolent deception-truth is withheld from the patient for their own good
Non-malfeasance: obligates healthcare worker to avoid harming patient and try to prevent harm where possible
Beneficence-healthcare workers go beyond doing no harm and actively contribute to the health and well being of their patients
Confidentiality-don’t talk about the patient in areas where others can hear. Use the report room to discuss patient information.

46. Charting POMR-Problem Oriented Medical Record Has 4 basic parts
Database
Contains information of a routine nature
General health history
Physical exam results
Results of diagnostic tests
Problem List: Something that interferes with a patient’s physical or psychological health or ability to function

47. Charting Has 4 basic parts (cont)
Plan - Course of action to correct problems from list
Progress notes
Contains findings (subjective and objective), assessment plans, and plans for orders

48. Charting Format used is SOAP
Subjective-information obtained from the patient, relatives, or similar source
Objective-information based on caregivers observations of the patient, physical exam, or diagnostic or laboratory tests
Assessment-refers to the analysis of the patient’s problem
Plan-plan of action to be taken to resolve the problem

49. Charting Components of a chart Admission Record
States time and date the patient was admitted to the facility
Patient birthday, address, SSN, telephone number, next of kin, insurance information
Physician Orders: All orders must contain the date, time, and physician signatures
Progress notes: Every time the patient is visited by the doctor, the patient’s progress is recorded

50. Charting Components of a chart (cont) History and Physical Examination
The patient history is obtained from the patient or relatives upon admission
The initial physical is performed by the attending physician: it is a head to toe assessment of the major organ systems
Nursing Data: Includes nursing notes and nursing assessment records

51. Charting
Graphic Record: Contains pulse, temperature, respirations, blood pressure, urine output, oral intake, daily weights
Laboratory Reports: CBC, ABG, etc.
Radiology: x-rays, CT scans, MRI, PET, and ultrasound
Operative Data: Includes operative consents, operation reports, and anesthesia and post anesthesia records

52. Charting
Medication Administration Record: Provides a chronology of the medication given to the patient, quantity, dosage, route, and date & time of administration
Ancillary Services: Reserved for RT, OT, PT, ST
Discharge Plan
Denotes patient condition and date and time of discharge
Any prescribed medication(s) and patient teaching for medication administration are documented here

53. Preparing for the Patient Encounter
Role of the RT in Patient Assessment
Assist physician in determining initial diagnosis
Assess patient’s response to therapy

54. Preparing for the Patient Encounter
Stages of Patient Clinical Interaction
Preinteraction Stage
Review patient’s chart to identify important facts stated in medical history
Introductory Stage
Introduce yourself to the patient stating your name, department, and purpose of the visit
Confirm patient identity using his/her wrist ID bracelet

55. Preparing for the Patient Encounter
Stages of Patient Clinical Interaction (cont)
Initial Assessment Stage
This stage is done to identify the current health status of the patient. A brief interview and physical examination are appropriate
Don’t assume the patient’s condition has changed since the initial workup by the physician at admission
Treatment and Monitoring Stage
Provide treatment and monitor patient’s response
Follow-up Stage
Take a minute to ask the patient about how s/he feels and if you can do anything else before you leave
Also let the patient know when you will return

56. Preparing for the Patient Encounter
Communicating the Assessment Findings
Record details of the patient encounter in the chart
If the patient had complications to the treatment, verbally communicate this to the patient’s nurse and physician if the complications are serious
When the patient’s condition takes a turn for the worse, you should stay with the patient until help arrives

57. Preparing for the Patient Encounter
Use of Space
Social space (4-12 ft)
initial introduction
First step in establishing rapport
Personal space (18in -4ft)
Intimate Space (0-18in)

58. Preparing for the Patient Encounter
Territoriality
Patients often lay claim to items in their room that are placed bedside even though the items belong to the hospital. For this reason never take a bedside item from Patient A and give to Patient B without obtaining Patient A’s permission
Respecting the territorial rights of patients is an excellent way to let patients know you value them and that you are considerate of their needs

59. Preparing for the Patient Encounter
Confidentiality
All patient records are confidential. What you read in the chart and what you discuss with the patient must be shared only with other healthcare workers who need to know the information to perform their job appropriately
Discuss patients in areas outside private reports rooms must not be done

60. Preparing for the Patient Encounter
Express Genuine Concern
Face the patient squarely
Use eye contact appropriately
Maintain an open posture
Consider appropriate use of touch
Be an active listener
Universal Precautions

61. The Interview Principles of Communication
Each patient has a unique background that includes level of education, cultural heritage, religious beliefs, previous experiences, and self concept. All these factors play a key role in determining the patient’s response to you and your questions during the interview
Verbal and nonverbal messages make up each interview
Nonverbal messages can say more than actual words
Excellent skills at listening are essential for the interview

62. The Interview Structuring the Interview
Project a sense of undivided interest in the patient during the interview
Introduce yourself in a professional manner to begin the interview
Be professional in your appearance and mannerisms during the interview
Interview using a relaxed conversational style that communicates empathy

63. The Interview
Questions and Statements Used to Facilitate Conversational Interviewing
Open ended questions encourage patients to describe events as they see them and promote better understanding of their problem (e.g., How have you been feeling lately?)
Direct questions are better for the brief interview such as when following up on the effects of therapy (e.g., Did the oxygen help?)
Indirect questions are used to clarify issues (e.g., Are you saying you can breathe better now that you are not taking the heart medication?)
Introduction to RT210

64. The Interview
Questions and Statements Used to Facilitate Conversational Interviewing (cont)
Neutral questions and phrases avoid leading the patient toward a desired answer
Reflecting phrases show interest and let the patient know you are listening
Communicating empathy during the interview provides more information to patients, suggesting you care about them.

65. The Interview Alternate Sources for a patient History
Family members present during the interview can be helpful in providing information that the patient does not know or remember