Clinical Objectives

CLINICAL OBJECTIVES

2012 GRADS

Index of rotations

**For a quick link to the desired rotation objectives, place curser over rotation name and follow instructions.

Adult ICU

Asthma Education

Community Care

Emergency

Hyperbaric Oxygen Therapy

Neonatal ICU

Operating Room

Pediatric Wards

Pediatric ICU

Pulmonary Functions

Sleep

Wards

AICU I and II

Rotation overview:
In the AICU clinical rotation students will practice skills and demonstrate knowledge required to conduct care of critically ill adult patients in the ICU setting. Students are expected to work with their preceptors to gain experience with the outlined clinical objectives, as well as practice and achieve competency with related CBO’s. Clinical experience may vary somewhat based on the type of ICU, and volume of patients, therefore two 4 week rotations are scheduled at different clinical sites to optimize exposure to the complete list of clinical objectives and related CBOs. Although the same list of clinical objectives applies to rotation 1 and 2, students will be expected to perform in the 2nd rotation with more independance, and assume responsibility for a larger volume of patients and skill sets.
Schedule / ·  12 hour shifts which may include nights and weekends.
·  See Site Schedules
Pre Rotation / ·  Clinical Simulation Week prior to 1st AICU rotation only
·  Pre rotational exam prior to 1st AICU rotation only (80% to pass). The break down for the exam is under AICU Clinical Simulation.
·  See schedule in Clinical Simulation
Site orientation / ·  Orientation will be provided by the NAIT clinical instructor except for Red Deer which will be provided by that sites RTs/preceptpors.
Workbook/
Assignment / ·  Workbook 1 must be done in time for review on AICU 1 common day
·  Workbook 2 must be done in time for review on AICU 2 common day
·  Some questions may require presentation on common day
·  Workbooks will not be marked but are meant as a self study tool and guide for review on common day
Common Day / ·  Common class day will be scheduled in the 3rd week of each AICU rotation
·  See Common Day Schedule for date, time and location of common day
Exam / ·  Post rotation exam 1 will be written at the end of AICU 1 (60% to pass)
·  Post rotation exam 2 will be written at the end of AICU 2 (60% to pass)
·  Exams will be graded and count towards the final RET602 mark
·  Exam dates will be scheduled by NAIT clinical site faculty
Clinical Performance Evaluation / ·  One mid rotation evaluation required for each rotation
·  One end point evaluation required for each rotation

Clinical Objectives

Upon completion of the AICU Clinical Rotation, the student will be able to:

Professionalism

·  Adhere to dress code, and maintain professional appearance

·  Report to shifts on time

·  Demonstrate respect towards patients, health care staff and preceptors

·  Maintain patient privacy and confidentiality

·  Advocate patient care and safety

·  Demonstrate compassionate care

·  Practice within ethical guidelines

·  Adhere to scope of practice limitations

·  Integrate with an interdisciplinary approach to patient care

·  Demonstrate flexibility and adaptability when working with others

·  Manage and resolve conflicts constructively

·  Demonstrate accountability for actions

Communication

·  Clearly and concisely discuss procedures and care with patients and families,

·  Use medical terminology in the appropriate context

·  Demonstrate appropriate nonverbal communication skills

·  Provide effective patient reports (shift end, interdisciplinary rounds etc…)

·  Effectively engage in consultation and collaboration with other disciplines

·  Report pertinent data to staff in a timely and accurate manner

·  Maintain detailed and accurate documentation (hard copy, electronic records)

·  Effectively access medical records and information systems

Knowledge

·  Recall relevant information from previously taught subject matter

·  Acquire and recall information from past clinical experience with preceptors and/or faculty

·  Demonstrate an understanding of relevant basic concepts

·  Effectively apply learned concepts to practice

Critical Thinking

·  Demonstrate sound decision making skills

·  Demonstrate problem solving skills

·  Provide rationale for procedures and changes in therapy

·  Analyze and correlate clinical information

·  Integrate input from other health disciplines with own critical judgment

·  Develop effective patient care plans

·  Demonstrate effective critical evaluation skills of patients, care plans and equipment

·  Adapt therapy to changes in patient status

·  Use self evaluation effectively to improved performance

Efficiency

·  Follow direction appropriately from preceptors

·  Complete tasks and assigned workload in a timely manner without prompting

·  Apply a systematic approach to completing tasks and workload

·  Prioritize tasks and patient care effectively

·  Demonstrate effective workload planning skills

·  Complete tasks in a reliable and safe manner

·  Performs manual skills safely and according to skills guidelines and hospital protocols

·  Recognize own limitations and need to ask for help

Initiative

·  Clearly outline relevant past experience, abilities, limitations and/or previous clinical responsibilities

·  Discuss goals for improved clinical performance

·  Seek, and react positively to, constructive feedback

·  Take responsibility for errors and establish strategies to improve

·  Attempt to complete tasks and assigned workload in a timely manner without prompting

·  Assist others (RTs and other health disciplines) with random tasks

·  Seek new clinical experiences and challenges

·  Seek repeated clinical experience for improved performance

·  Ask questions frequently

·  Use “down time” constructively for learning

Health, Safety and Infection Control

·  Demonstrate effective coping skills with stressful situations

·  Use personal protective equipment appropriately

·  Comply with all infection control standards

·  Adhere to policy and guidelines on biohazard waste management

·  Use patient care equipment and supplies appropriately and safely

·  Discuss isolation protocols for significant organism precautions

·  Evaluate technique of gown/glove/mask

·  Clean and disinfect equipment

·  List methods of transmission for different common pathogens

Patient Care

1.  Patient Assessment

·  Outline information that should be obtained from patient’s chart

·  Describe factors affecting patient care plan through a body systems review

·  Apply patient assessment results to available RT protocols

·  Identify basic structures and ETT placement on CXR

·  Associate abnormal CXR findings with patient’s past medical history, current status, and with previous films

·  Analyze patient plan through the evaluation of patient results in diagnostic imaging databases

·  Discuss the indications, function, and troubleshooting of chest tube drainage

2.  Blood Sampling

·  Establish need for obtaining analysis of arterial blood

·  Interpret ABG based on PMHX and current condition

·  Suggest corrective action, and discuss issues around the corrections of ABGs

·  Calculate the correct minute ventilation for a target PaCO2 based on ABG results

·  Evaluate/suggest arterial gas orders

·  Discuss implications of acidosis or alkalosis on patient’s condition and pharmacological therapy

·  Discuss the controversy of correcting metabolic acidosis with alkaline agents

·  Discuss blood gas results from mixed venous sites (PAC) and central venous sites (central lines) and implications for mechanical ventilation and cardiovascular pharmacological management

3.  Pulmonary Diagnostics

·  Outline indications for ETCO2 use

·  Discuss theory of operation of ETCO2

·  Discuss indications for therapeutic and diagnostic bronchoscopy in the AICU

·  Evaluate success of bronchoscopy post procedure

·  Apply ETCO2 readings to an evaluation of patient deadspace

·  Discuss use of ETCO2 when determining optimal PEEP

·  Describe theoretic course of action with deteriorating patient status during bronchoscopy

4.  Cardiac Monitoring

·  Evaluate patient dysrhythmias and suggest course of action

·  Discuss the clinical relevance of pulmonary artery catheter readings (i.e. (CVP, PAP, PAOP, PVR, SVR, Cardiac Output)

·  Describe how disease processes, PPV, and patient condition influence pulmonary artery catheter (PAC) readings

·  Evaluate PAC values and correlate with patient’s current condition and past medical history

·  Discuss patient specific PAC values and implications for mechanical ventilation and cardiovascular pharmacological management

5.  Basic Respiratory Care and Medical Gas Therapy

·  Discuss oxygen therapy post-extubation, based on requirements when mechanically ventilated

·  Discuss theory of operation of High Flow Cold Nebulizer to provide humidified oxygen therapy

·  Describe oxygen toxicity in terms of etiology, pathophysiology, effects, prevention and treatment

·  Discuss complications of tracheal suctioning

·  Outline indications for sputum collection

·  Discuss how contamination may affect results of sputum analysis

·  Describe how sputum collection results may affect patient care plan

·  Describe indications for xylocaine (and/or short acting boluses of sedative) pre-suctioning

·  Discuss controversies regarding use of instillations

6.  Airway Management

·  Describe indications for use of an oropharyngeal airway (OPA)

·  List indications for intubation

·  Discuss how the position of the ETT is assessed post intubation

·  Describe complications of intubation and corrective action for these

·  Describe extubation parameters measured prior to extubation

·  Evaluate patients for extubation

·  Describe complications of extubation and corrective action for these

·  Discuss theory of cuff pressure monitoring

·  Discuss complications of cuff management

·  Discuss indications for tracheostomy

·  Describe the function and maintenance of Evac tubes

·  Describe the function of various tracheostomy tube adjuncts including: flange, cuff, fenestration, inner cannulae, obturator and plug

·  Describe how to utilize various devices used for difficult intubations

·  Discuss implications of re-taping an ETT on the development of Ventilator Associated Pneumonia (VAP)

·  Describe a comprehensive plan to prevent ventilator associated pneumonia (VAP)

·  Discuss complications of tracheostomy including the procedure and surgical technique

·  Discuss theory behind trach weaning

·  Evaluate patients for trach downsizing

·  Evaluate patients for plugging trials

·  Discuss complications of a trach change and course of action for these

7.  Mechanical Ventilation

·  Describe the effects of positive pressure ventilation on the various body systems including: CNS, CVS, Respiratory, GI, GU, and MSK

·  Describe the concepts of barotrauma (including volutrauma, atelectrauma, shearing forces) including etiology, pathophysiology, effects, prevention and treatment

·  Describe the concept of permissive hypercapnea,

·  Describe the components of the ventilator circuit and their function

·  Discuss how resistance and compliance is measured, evaluated and the implications for mechanical ventilation

·  Discuss theory behind initial ventilatory parameters selected for particular patients

·  Evaluate ventilatory monitoring for precision, accuracy and completeness

·  Describe how to optimally set the following parameters based on your particular patient’s disease/condition, ventilator parameter analysis, ventilator waveform analysis, and patient assessment/diagnostic results:

-  Vt in VC

-  Pressure Limit in PC

-  Peak Inspiratory Flow in VC with a set insp flow and set flow waveform

-  Ti in a PC or Volume Targeted Mode

-  Inspiratory Rise Time or Slope

-  Trigger

-  Cycling Mechanism (I.E. ESENS)

-  PEEP

-  Mode

·  Evaluate the following ventilator mechanics: CSTAT, AutoPEEP, PPLAT, RAW; and suggest course of action

·  Evaluate the following calculations and describe possible course of action

-  Alveolar to arterial oxygen gradient

-  Deadspace

-  A-V Difference

-  Oxygen Exchange Ratio

-  P/F Ratio

-  Classic Shunt Equation

-  Oxygen Consumption

-  Oxygen Delivery

·  Contrast and discuss a patient readiness to wean with patient readiness for extubation

-  Discuss the use of various weaning and extubation tests including; RSBI, NIF, Leak around the ETT, VC, P 0.1, and other indices

-  Discuss the concepts of “off loading” a patient’s work of breathing, and strength/endurance training as applied to weaning ventilation

-  Evaluate weaning trials

·  Discuss indications for Non-Invasive Mechanical Ventilation (NIMV)

·  Describe the following modes; A/C , SIMV, PS, Volume Targeted, VS, MMV, TC, APRV, PAV, ILV, HFO, in terms of the following:

-  indications

-  theory of operation

-  parameter interfacing

-  differences with each ventilator (including the Drager Evita, PB 840, Servo I)

·  Describe how all adjuncts (e.g. ATC, etc) function on the ventilators listed above

·  Discuss alternative weaning strategies, used at different sites, when patients are difficult to wean

·  Discuss complications for NIMV

·  Describe how to utilize patient assessment results and diagnostics to optimize NIMV

·  Comprehensively describe how to utilize ventilator (and other airway pressure/flow analysis devices as they become more mainstream) waveforms (scalars and loops) to analyze and optimize mechanical ventilation

·  Discuss the theory behind the use of airway recruitment maneuvers (ARMS), indications, and effects

8.  Cardiopulmonary Resuscitation

·  Describe the RT’s role in a code situation

·  Evaluate the effectiveness of chest compressions in a code situation

·  Discuss the use of manual ventilations in a code situation

9.  Pharmaceuticals

·  Compare MDI versus SVN administration to a mechanically ventilated patient in terms of: technique, efficacy, and infection control

·  Evaluate MDI and SVN technique for efficacy, and for infection control

·  Describe the classification, indications, mode of action, routes of administration, therapeutic effects, side effects, and dosages of the following medications:

Respiratory

-  acetylcysteine (Mucomyst and *Parvolex)

-  epoprostenol (Flolan / Prostacyclin)

-  fluticasone (Flovent), budesonide (Pulmicort) and other inhaled corticosteroids

-  heliox

-  ipatropium bromide (Atrovent)

-  isoflourane

-  methylprednisolone (Solu-medrol)

-  nitric oxide

-  prednisone

-  racemic epinephrine (Vaponefrin)

-  salbutamol (Ventolin) and other short acting beta agonists

-  sodium bicarbonate

-  tobramycin (inhaled)

·  Describe the classification, indications, therapeutic effects, and side effects of the following medications:

CNS

1

-  diazepam (Valium)