Control Comp #3 (Med Records Review, NC, SM-NRB-PRB Masks, AEM Mask, HFNC Optiflow-Vapotherm, Bubbler)

Question 1

Medical Records Review/Documents (Comp 3)
(20 Steps)

Answer 1

PROCEDURAL STEPS
1. Confirms correct patient medical record
2. Ensures compliance with HIPPA regulations regarding personal health information
ASSESSMENT AND IMPLEMENTATION
3-12. Locates and evaluates:
-Patient demographics
-Chief complaint/diagnosis
-History of present illness
-Smoking history (packs years)
-Past medical history
-Allergies
-Current Medications
-Psycho/social history
-Occupational history and exposures
-Family history
13. Locates and evaluates the physician’s orders or protocols
14. Review physical examination results
15. Reviews results of current diagnostic procedures, including CXR, EKG, PFT, ABGs, labs
16. Reads and evaluates most recent progress notes
DOCUMENTATION
17. Identifies the proper section to chart respiratory services
18. Charts the respiratory care procedure according to facility policy
19. Signs note with appropriate credential and has preceptor/instructor countersign
20. Returns chart to proper location or closes the record and logs off the computer

Question 2

Medical Records Review/Documents
(Steps 1-2)

Answer 2

PROCEDURAL STEPS

1. Confirms correct patient medical record
2. Ensures compliance with HIPPA regulations regarding personal health information

Question 3

Medical Records Review/Documents
(Steps 3-12)

Answer 3

ASSESSMENT AND IMPLEMENTATION
3-12. Locates and evaluates:

3. Patient demographics
4. Chief complaint/diagnosis
5. History of present illness
6. Smoking history (packs years)
7. Past medical history
8. Allergies
9. Current Medications
10. Psycho/social history
11. Occupational history and exposures
12. Family history

Question 4

Medical Records Review/Documents
(Steps 13-16)

Answer 4

ASSESSMENT AND IMPLEMENTATION

13. Locates and evaluates the physician’s orders or protocols
14. Review physical examination results
15. Reviews results of current diagnostic procedures, including CXR, EKG, PFT, ABGs, labs
16. Reads and evaluates most recent progress notes

Question 5

Medical Records Review/Documents
(Steps 17-20)

Answer 5

DOCUMENTATION

17. Identifies the proper section to chart respiratory services
18. Charts the respiratory care procedure according to facility policy
19. Signs note with appropriate credential and has preceptor/instructor countersign
20. Returns chart to proper location or closes the record and logs off the computer

Question 6

Oxygen Devices: Nasal Cannula (Comp 3)
(15 Steps) LOW FLOW Device

Answer 6

PROCEDURAL STEPS
1. Gathers and assembles appropriate equipment
2. Checks physician orders
3. Verifies facilities protocol
4. Introduces self and department and identifies patient
5. Utilizes and maintains standard precaution as required
6. Explains purpose of O2 therapy
7. Assesses patient before and after oxygen therapy (HR, RR, SpO2, and Color)
8. Assembles humidifier (if indicated) and attaches flowmeter (Checks equipment function)
9. Adjusts the flowmeter to appropriate level before placing on patient and verify flow t/o device
10. Places the device properly and comfortably on the patient
11. Instructs patient in oxygen safety precautions and reinforces patient instruction in us of oxygen therapy
12. Correctly cares for equipment following procedure
13. Thanks patient and ensures safety and needs
14. Disposes of PPE; washes/gel hands
15. Documents

Question 7

Oxygen Devices: Nasal Cannula
(Steps 1-7)

Answer 7

1. Gathers and assembles appropriate equipment
2. Checks physician orders
3. Verifies facilities protocol
4. Introduces self and department and identifies patient
5. Utilizes and maintains standard precaution as required
6. Explains purpose of O2 therapy
7. Assesses patient before and after oxygen therapy (HR, RR, SpO2, and Color)

Question 8

Oxygen Devices: Nasal Cannula
(Steps 8-12)

Answer 8

8. Assembles humidifier (if indicated) and attaches flowmeter (Checks equipment function)
9. Adjusts the flowmeter to appropriate level before placing on patient and verify flow t/o device
10. Places the device properly and comfortably on the patient
11. Instructs patient in oxygen safety precautions and reinforces patient instruction in us of oxygen therapy
12. Correctly cares for equipment following procedure

Question 9

Oxygen Devices: Nasal Cannula
(Steps 13-15)

Answer 9

13. Thanks patient and ensures safety and needs
14. Disposes of PPE; washes/gel hands
15. Documents

Question 10

Oxygen Devices: Nasal Cannula Normal
FiO2 Range
Flow Rate

Answer 10

FiO2 = 24% - 44% Variable stability
Flow = 1/4 - 6 L/min Adult

2 - 4 L/min with 28% O2 is what is norm for Nasal Cannula at the hospital setting

If flow rate is greater than 4 L/min or Patient complains of dryness, you will utilize a humidifier.

Question 11

Humidification - Bubbler (Comp 3)
(15 Steps)

Answer 11

PROCEDURE STEPS
1. Verifies protocol
2. Gathers and assembles appropriate equipment
3. Utilizes and maintains standard precautions as required
4. Introduces self and department and identifies patient
5. Explains procedure to patient and confirms patient’s understanding
6. Handles prefilled equipment aseptically and attaches humidifier to flowmeter
7. Attaches oxygen tubing to humidifier
8. Turns flowmeter on to ordered or assessed liter flow
9. Checks Pop-off valve
10. Verifies gas flow through the humidifier and oxygen device
11. Positions oxygen device properly on patient
12. Cleans area
13. Ensures the patient’s safety, comfort, and needs, Thanks patient
14. Disposes of PPE; washes/gels hands
15. Documents

Question 12

Humidification - Bubbler
(Steps 1-5)

Answer 12

1. Verifies protocol
2. Gathers and assembles appropriate equipment
3. Utilizes and maintains standard precautions as required
4. Introduces self and department and identifies patient
5. Explains procedure to patient and confirms patient’s understanding

Question 13

Humidification - Bubbler
(Steps 6-12)

Answer 13

6. Handles prefilled equipment aseptically and attaches humidifier to flowmeter
7. Attaches oxygen tubing to humidifier
8. Turns flowmeter on to ordered or assessed liter flow
9. Checks Pop-off valve
10. Verifies gas flow through the humidifier and oxygen device
11. Positions oxygen device properly on patient
12. Cleans area

Question 14

Humidification - Bubbler
(Steps 13-15)

Answer 14

13. Ensures the patient’s safety, comfort, and needs, Thanks patient
14. Disposes of PPE; washes/gels hands
15. Documents

Question 15

Humidification - Bubbler
When to use
Pop off Test

Answer 15

If flow rate is GREATER than 4 L/min or Patient complains of dryness, you will utilize a humidifier.

The Pop off test is conducted to ensure patient is getting flow from the bubbler. Cover the hose opening and listen for a loud noise. Once you get it let go.

Question 16

Oxygen Devices: Simple, Partial Breathing, Non-Breathing Masks (Comp 3)
(14 Steps) LOW FLOW Devices

Answer 16

PROCEDURAL STEPS
1. Verifies facilities protocol
2. Scans chart for diagnosis and any other pertinent data
3. Gathers and assembles appropriate equipment
4. Utilizes and maintains standard precautions as required
5. Introduces self and department and identifies patient
6. Explains purpose of O2 Therapy
7. Assesses patient before and after oxygen therapy
8. Adjust the flowmeter to the appropriate level before placing on patient and verify flow t/o device
9. Verifies flow through the device
10. Places the device properly and comfortably on the patient
11. Correctly cares for equipment following procedure
12. Thanks patient and ensures safety and needs
13. Disposes of PPE; washes/gel hands
14. Documents

Question 17

Oxygen Devices: Simple, Partial Breathing, Non-Breathing Masks
(Steps 1-7)

Answer 17

1. Verifies facilities protocol
2. Scans chart for diagnosis and any other pertinent data
3. Gathers and assembles appropriate equipment
4. Utilizes and maintains standard precautions as required
5. Introduces self and department and identifies patient
6. Explains purpose of O2 Therapy
7. Assesses patient before and after oxygen therapy

Question 18

Oxygen Devices: Simple, Partial Breathing, Non-Breathing Masks
(Steps 8-11)

Answer 18

8. Adjust the flowmeter to the appropriate level before placing on patient and verify flow t/o device
9. Verifies flow through the device
10. Places the device properly and comfortably on the patient
11. Correctly cares for equipment following procedure

Question 19

Oxygen Devices: Simple, Partial Breathing, Non-Breathing Masks
(Steps 12-14)

Answer 19

12. Thanks patient and ensures safety and needs
13. Disposes of PPE; washes/gel hands
14. Documents

Question 20

Oxygen Devices: Simple Mask
FiO2 Range
Flow Rate

Answer 20

FiO2 = 35% - 50% Variable stability
Flow = 5 - 10 L/min

Flow rate of 5 L/min minimum so that CO2 gas can get flushed out of the mask.

Question 21

Oxygen Devices: Partial Breathing Mask
FiO2 Range
Flow Rate

Answer 21

FiO2 = 40% - 70% Variable stability
Flow = Minimum of 10 L/min

Flow rate of must be at least 10 L/min to prevent the bag from collapsing during inspiration

Question 22

Oxygen Devices: Non-Breathing Mask
FiO2 Range
Flow Rate

Answer 22

FiO2 = 60% - 80% Variable stability
Flow = Minimum of 10 L/min

Flow rate of must be at least 10 L/min to prevent the bag from collapsing during inspiration

Question 23

Oxygen Devices: Venturi Mask (Comp 3)
(14 Steps) HIGH FLOW Device

Answer 23

PROCEDURAL STEPS
1. Verifies facilities protocol
2. Scans chart for diagnosis and any other pertinent information
3. Gathers and assembles appropriate equipment
4. Utilizes and maintains standard precaution as required
5. Introduces self and department and identifies patient
6. Explains purpose of O2 therapy
7. Assesses patient before and after oxygen therapy
8. Adjusts the flowmeter to appropriate level before placing on patient and verify flow t/o device
9. Place the device properly on patient
10. Confirms FiO2 and patient comfort
11. Correctly cares for equipment following the procedure
12. Thanks patient and ensures safety and needs
13. Disposes of PPE; washes/gel hands
14. Documents

Question 24

Oxygen Devices: Venturi Mask
(Steps 1-7)

Answer 24

1. Verifies facilities protocol
2. Scans chart for diagnosis and any other pertinent information
3. Gathers and assembles appropriate equipment
4. Utilizes and maintains standard precaution as required
5. Introduces self and department and identifies patient
6. Explains purpose of O2 therapy
7. Assesses patient before and after oxygen therapy

Question 25

Oxygen Devices: Venturi Mask (Steps 8-11)

Answer 25

8. Adjusts the flowmeter to appropriate level before placing on patient and verify flow t/o device 9. Place the device properly on patient 10. Confirms FiO2 and patient comfort 11. Correctly cares for equipment following the procedure

Question 26

Oxygen Devices: Venturi Mask (Steps 12-14)

Answer 26

12. Thanks patient and ensures safety and needs 13. Disposes of PPE; washes/gel hands 14. Documents

Question 27

Oxygen Devices: Venturi Mask (AEM) FiO2 Range Flow Rate

Answer 27

FiO2 = 24% - 50% Fixed stability Flow = Varies; should provide output flow >60 L/min

Question 28

Oxygen Devices: HFNC: Optiflow (Comp 3) (16 Steps/Condensed Version) HIGH FLOW Device

Answer 28

PROCEDURE STEPS 1. Check physician's orders/Verify facilities protocols 2. Scan patient chart for pertinent data 3. Gather equipment 4. Perform Standard Precautions 5. Introduce Self/Dep and Verify Identity of Pt 6. Explain purpose of visit/procedure 7. Assess Vitals prior to and after therapy 8. Plug in air (Yellow) and Oxygen (Green) cords to wall 9. Put heater pot on heater and plug heater pot and turn on 10. Attach circuit (tubes) to heater pot and flow meter. Then plug in heater wires to the circuit. Spike water bag 11. Select appropriate prongs for Pt and attach to circuit. Make sure not to occlude more than 50% of Pts nares. 12. Set appropriate liter flow (5-60 LPM) and FiO2 (21% to 100%). VERIFY FLOW 13. Put cannula on Pt. and use safety strap or clip. REASSESS VITALS on Pt 14. Ensure Pt's comfort, safety and needs are met. Clean up area 15. Dispose of PPE, Wash/Gel hands 16. Record/Report

Question 29

Oxygen Devices: HFNC: Optiflow (Steps 1-7)

Answer 29

1. Check physician's orders/Verify facilities protocols 2. Scan patient chart for pertinent data 3. Gather equipment 4. Perform Standard Precautions 5. Introduce Self/Dep and Verify Identity of Pt 6. Explain purpose of visit/procedure 7. Assess Vitals prior to and after therapy

Question 30

Oxygen Devices: HFNC: Optiflow (Steps 8-13)

Answer 30

8. Plug in air (Yellow) and Oxygen (Green) cords to wall 9. Put heater pot on heater and plug heater pot and turn on 10. Attach circuit (tubes) to heater pot and flow meter. Then plug in heater wires to the circuit. Spike water bag 11. Select appropriate prongs for Pt and attach to circuit. Make sure not to occlude more than 50% of Pts nares. 12. Set appropriate liter flow (5-60 LPM) and FiO2 (21% to 100%). VERIFY FLOW 13. Put cannula on Pt. and use safety strap or clip. REASSESS VITALS on Pt

Question 31

Oxygen Devices: HFNC: Optiflow (Steps 14-16)

Answer 31

14. Ensure Pt's comfort, safety and needs are met. Clean up area 15. Dispose of PPE, Wash/Gel hands 16. Record/Report

Question 32

Oxygen Devices: HFNC: Optiflow FiO2 Range Flow Rate

Answer 32

FiO2 = 21% - 100% Fixed stability Flow = 5 - 60 L/min The flowmeter on the optiflow can go up to 70 L/min

Question 33

Oxygen Devices: HFNC: Vapotherm (Comp 3) (31 Steps) Part 1of 2 (Steps 1-16)

Answer 33

PROCEDURE STEPS 1. Verifies physician's orders 2. Scans chart for any other pertinent data and notes 3. Gathers and assembles equipment (Precision flow unit set-up, water bag, high or low flow disposable patient circuit kit, nasal cannula) 4. Washes hands and applies appropriate PPE 5. Identifies patient, introduces self to family/patient 6. Explains purpose of therapy and confirms family/patient understanding 7. Assesses patient before therapy 8. Ensure O2 sensor in place 9. Check air/oxygen high pressure hoses are in place and plugged into wall 10. Install cartridge into disposable water path 11. Secure delivery tube into bottom of disposable water path 12. Slide open unit door & slide disposable patient circuit into place 13. Hang sterile water above unit, remove spike with alcohol pad and insert spike into port of sterile water 14. Plug in power cord, allow unit to "self-test" & identify any error codes 15. Rotate setting control know to light up display panel 16. Press run / Standby button to initiate gas flow, pump & heater

Question 34

Oxygen Devices: HFNC: Vapotherm (Comp 3) (31 Steps) Part 2of 2 (Steps 17-31)

Answer 34

17. Identify unit is in "run mode" & that all numeric displays are on & status LED is green 18. Press & release setting control knob 19. Identify flashing value & change it by rotating the setting control knob 20. Repeat these steps to adjust flow, & FiO2 21. Identify that FiO2 & flow settings are within range of gas source 22. Ensure patient placement: High Flow Cartridge: 8-40 lpm Adult NC (or) 5-20 lpm Pediatric NC Low Flow Cartridge: 1-8 lpm Premature, Neonate, Infant & Intermediate NC 23. Ensure FiO2, flow & temperature are set 24. Allow unit to reach set temperature & attach cannula 25. Places cannula on patient and observe to ensure proper placement & settings; cannula occludes no more than 50% of nares 26. Knows flow rate ranges per cannula & cartridge 27. TROUBLE SHOOTING: Identifies alarms and is able to competently correct each; can point out "alarm mute button"; can differentiate between medium and low priority alarm. Unit shutdown: Press run/standby button to put unit into standby mode; clamp the water inlet tube & disconnect it by pulling out the spike; open sliding door, remove the disposable water path with the cartridge & delivery tube attached by sliding it upwards out of the docking station; unplug unit (note: there is no ON/OFF button, keep plugged into wall outlet to keep battery fully charged 28. Reassess patient; thanks patient/family and ensure comfort 29. Cleans up area: main unit, including docking station for disposable water path, should be wiped down with alcohol wipes; ensure transparent sensor ports are clean 30. Disposes of PPE; washes/gel hands 31. Documents

Question 35

Oxygen Devices: HFNC: Optiflow (Comp 3) (23 Steps) Part 1of 2 (Steps 1-12)

Answer 35

PROCEDURAL STEPS 1.Verifies physician's orders/protocol 2. Scans chart for any other pertinent data and notes 3. Gathers and assembles equipment (blender unit with heater, appropriately sized disposable patient circuit, cannula, and sterile water bag 4. Washes hands and applies appropriate PPE 5. Identifies patient, introduces self and department to patient/family 6. Explains purpose of therapy and confirms family/patient understanding 7. Assesses patient before therapy 8. Check air/oxygen high pressure hoses are in place and plugged into wall and ensure O2 sensor in place 9. Place non-heated tubing on one side of the water chamber and attach it to the blender and place heated circuit on other side of water chamber 10. Plug temperature probe into the circuit and plug in heater wires and connect water bag. 11. Select invasive temperature setting, set liter flow appropriately and FiO2 12. Places cannula on patient and observe to ensure proper placement & settings; cannula occludes no more than 50% of nares

Question 36

Oxygen Devices: HFNC: Optiflow (Comp 3) (23 Steps) Part 2of 2 (Steps 13-23)

Answer 36

13. Place strap with breakaway around patient's neck 14. Place strap that is connected to the prongs around the patient's head adjusting it above the ears, on the crown, place the prongs in the patient's nares and adjust the strap for a comfortable fit; not tight 15. Tighten the strap around the patient's neck to support the weight of the circuit 16. Insert the adult cannula into the adult heated circuit 17. Adjust liter flow and FiO2 on the blender unit. Turn on heater using the invasive mode 18. Trach patients--place strap around patient's neck, attach end with the blue cover to the patient's trach and other end to the circuit. (in-line suction device may be used for patients with increased secretions 19. Sets alarms +/- 5% to accommodate fluctuations 20. reassess patient and ensures comfort 21. Thanks patient/family 22. Disposes of PPE; washes/gels hands 23. Documents