what are the primary goals of a therapist driven protocol (TDP)
-deliver individualized diagnostic/therapy’s
cost effective care, optimize outcome, decrease hospital stay
how do TDPs improve patient outcomes and hospital efficiency
-allows therapist to make decisions based on signs/symptoms to improve efficiency& reduce delays
what clinical authority do TDPs give to respiratory therapist
-gather clinical information related to pt respiratory status
-assess clinical data collected
-start, increase or decrease or discontinue respiratory therapies
list the essential components of the knowledge base required for a successful TDP program
-anatomic alternation of lungs
-pathophysiologic mechanism activated
-clinical manifestation that develop
-treatment modalities used to correct problem
what assessment skills must a respiratory therapist demonstrate when working under TDPS
-gather clinical information
-analyze data
-choose optimal treatment
-document and evaluate process
essential cornerstones for a successful TDP program
-oxygen therapy protocol
-bronchopulmonary hygiene therapy protocol
-lung expansion therapy protocol
-aerosolized medication therapy protocol
what are the main indication for initiating oxygen therapy
-PaO2 <60mmHg on room air
-SaO2 <90% on room air
-acute hypoxia is suspect
which device should be used first when starting oxygen therapy in most cases
start low-nasal cannula
when is it appropriate to escalate oxygen delivery to non rebreather mask or CPAP
emergency based or specific orders
why is oxygen therapy started at the lowest effective concentration whenever possible
provide just enough O2 to maintain adequate tissue oxygenation w/out causing potential O2 toxicity
what are the main indications for initiating airway clearance therapy
secretions: coarse crackles
-cough effectiveness
-mucus plug
why is it important to start with the least invasive method first
minimizes pt discomfort and reduces risk of complications
give 3 examples of non invasive airway clearance techniques
-chest physiotherapy & postural drainage
-high frequency chest wall oscillation
-flutter valves
-intrapulmonary percussive ventilation
when is nasotracheal and endotracheal suctioning indicated
-when noninvasive methods fail
-secretions are too deep to mobilize
what adventitious lung sound typically triggers the airway clearance protocol
-coarse crackles
what are the primary indications for lung expansion therapy
atelectasis-fine crackles
-post operative abdominal thoracic surgery
-shallow breathing
-surgery for pt with chronic lung disease
which patient population is at highest risk for atelectasis
chronic lung disease that have surgery due to previous preexisting reduced lung function
list 3 devices used for lung expansion therapy from least to most invasive
-incentive spirometer
-intermittent positive pressure breathing
-PEEP, CPAP, EPAP
what lung sounds suggest the presence of atelectasis
fine crackles
why is incentive spirometry used as first line treatment for postoperative patients
least invasive
-provide visual feedback to pt
-prevent alveolar collapse
-simple to use
which respiratory condition typically require aerosolized medication
-bronchoconstriction-wheezing
-retained secretions-mucus plugging
-stridor-upper airway inflammation
what medications are indicated for bronchospasm and wheezing
bronchodilators
when is racemic epinephrine recommended
when moderate stridor is present
how should mild stridor be treated differently than moderate stridor
mild-cool aresol
mod-racemic epinephrine
