Ch. 9: Protocol and the RT Role

Question 1

Therapist-driven protocols (TDP)

• deliver individualized diagnostic and therapeutic respiratory care to patients
• assist physician with evaluating patients’ respiratory care needs
• opitiimze allocation of respiratory care services
• determine the indication for therapy
• determine appropriate modalities for high-quality, cost-effective care that improves patient outcomes and decreases length of stay
• empower RT to allocate care using sign and symptom based algorithms for treatment.

Answer 1

Therapist-driven protocols (TDP)

• deliver individualized diagnostic and therapeutic respiratory care to patients
• assist physician with evaluating patients’ respiratory care needs
• opitiimze allocation of respiratory care services
• determine the indication for therapy
• determine appropriate modalities for high-quality, cost-effective care that improves patient outcomes and decreases length of stay
• empower RT to allocate care using sign and symptom based algorithms for treatment.

Question 2

What authorities does the TDP give to therapists?

Answer 2

• gather clinical information related to patient’s respiratory status
• make an assessment of clinical data collected
• start, increase, decrease, or discontinue certain therapies

Note: TDP improves outcomes and lowers cost.

Question 3

Vital Signs TDP

Answer 3

Sign: Rapid breathing, high blood presse, high pulse

Assessment: Respiratory distress

Treatment: Treat underlying cause

Question 4

Sign: Wheezing

Answer 4

Assessment: Bronchospasm

Treatment: Bronchodilator

Question 5

Sign: Inspriatory Stridor

Answer 5

Assessment: Layngeal edema

Treatment: racemic epniephrine

Question 6

Sign: coarse crackles

Answer 6

Assessment: secretions in large airway

Treatment: bronchial hygiene treatment

Question 7

Sign: fine and medium crackles

Answer 7

Assessment: secretions in distal airway

Treatment:

• treat underlying cause (e.g. CHF)
• hyperinflation

Question 8

Cough Effectiveness Indicators

Answer 8

Strong cough: good ability to mobilize secretions, no treatment needed

Weak cough: poor ability to mobilize secretons

• Treatment: bronchial hygiene

Question 9

Abnormal secretion indicators

Amount: > 25mL/24 hr.

White/Translucent

Yellow or opaque sputum

green sputum

brown sputum

red sputum

frothy secretions

Answer 9

Amount: > 25mL/24 hr: excessive bronchial secretions, bronchial hygiene treatment.

White/Translucent: normal; none

Yellow or opaque sputum: acute airway infection; treat underlying cause

green sputum: old, retained secetions and infections; bonchial hygiene treatment

brown sputum: old blood; bronchial hygiene treatment

red sputum: freh blood; notify physician

frothy secretions: pulmonary edema; notify physician, treat underlying causes (CHF); hyperinflation

Question 10

Abnormal Lung Parenchyma Indicators

sign: bronchial breath sound

Answer 10

Assessment: atelectsis

Treatment: hyperinflation, oxygen treatment

Question 11

Abnormal Lung Parenchyma Indicators

sign: dull percussion note

Answer 11

Assessment: infiltrates or effusion

Treatment: treat underlying cause

Question 12

Abnormal Lung Parenchyma Indicators

sign: opacity of chest radiograph

Answer 12

Assessment: fibrosis

Treatment: no specific treatment

Question 13

Abnormal Lung Parenchyma Indicators

sign: restrictive pulmonary function test values

Answer 13

Assessment: consolidation

Treatment: no specific, effective respiratory care treatment

Question 14

Abnormal Lung Parenchyma Indicators

sign: depressed diaphragm on x-ray

Answer 14

Assessment: air trapping and hyperinflation

Treatment: treat underlying cause