RT 210 Exam 1 – Flashcards
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Who was the 1st scientist in 1865 to suggest that many diseases were caused by microorganisms?
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Louis Pastuer
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Today, respiratory care educational programs in the U.S. are accredited by what organization?
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Committee on Accreditation for Respiratory Care (CoARC)
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Due to the aging of the majority of the population, all of the following will be the focus of the Respiratory Therapist of the future, EXCEPT:..
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Verifying insurance information
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Respiratory care education programs are reviewed by which committee to ensure quality?
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Committee for Accreditation of Respiratory Care (CoARC)
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Which of the following is/are characteristics of a respiratory care professional?
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- Participates in continuing education activities - Obtains professional credentials - Adheres to a code of ethics - Completes an accredited education program
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What system has the federal gov't developed to evaluate the quality of care given to Medicare beneficiaries?
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Peer review organizations (PROs)
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A health professional who withholds the truth from a patient, saying it is for his or her own good, is engaged in what practice?
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Benevolent deception
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What ethical principle can be used to justify the plan that might occur in drawing blood from a patient for a diagnostic test?
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Double effect
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A physician who participates in active euthanasia is committing what type of malpractice?
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Criminal
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Who introduced the use of soft rubber endotracheal tubes around 1930?
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Ivan McGill
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According to the AARC's "2015 & Beyond" project, all of the following are included in the 7 major competencies required by Respiratory Therapists by the Year 2015, EXCEPT;..
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Bronchoscopy
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Who is professionally responsible for the clinical function of the respiratory care department?
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Medical director
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For the CRT credential, what does the letter "T" stand for?
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Therapist
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Responsibility for the technical direction of a respiratory care department lies with whom?
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Department manager
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What term is used to describe the work done by a researcher who reviews numerous studies on a single topic & gives more weight to the more rigorous ones before making recommendations?
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Meta-analysis
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Which of the following are necessary to validate a claim of profession negligence?
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- The practitioner owned a Duty to the patient - The practitioner was Derelict with that duty - The breach of duty was the Direct cause of damages - Damages or harm came to the patient (The 4 D's of Negligence)
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A respiratory therapist who engages in a questionable business practice is committing what type of malpractice?
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Ethical
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HIPPA primarily is referred to as the Privacy Rule & is concerned with PHI. What does the letters PHI stand for?
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Protected health information
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What legal doctrine holds superiors responsible for the actions of their workers?
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Respondeat superior
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When a decision-making tool isn't helpful in a certain situation, how is the RT to make a decision?
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Base it on their intuitional abilities
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Hippocrates
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"Father of Medicine" - Believed air contained essential substance distributed to body via heart - DO NO HARM
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Aristotle
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1st great Biologist
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Erasistratus
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Developed pneumatic theory of respiration in Egypt
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Galen
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Anatomist who believed air had substance vital to life
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Leonardo de Vinci
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Determined sub-atmospeheric pressures inflated lungs
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Andreas Vesalius
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Performed human dissections & experimented w/ resuscitation
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Joseph Black
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Describes properties of CO2
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Joseph Priestley
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Describes his discovery of oxygen - "dephlogisticated air" - Dephlogisticated air: oxidation
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Lazzaro Spallazani
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Describes tissue respiration
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Jacques Charles
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Describes relationship between gas temperature & volume - "Charles Law"
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John Dalton
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Describes his law of partial pressures
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Joseph Louis Gay-Lussac
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Describes relationship between gas temperature & pressure
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Thomas Graham
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Describes law of diffusion for gases - "Graham's Law"
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Louis Pasteur
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Advanced his "germ theory" & suggests that some diseases were result of microorganisms
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William Roentgen
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Discovers X-Rays
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Which scientist describes his law of diffusion of gases in the 19th century?
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Thomas Graham
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Development of Respiratory Care Profession
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- 1940s: Technicians hauled O2 cylinders & apply O2 delivery devices - Beginning of RT's!
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Formal education programs of inhalation therapist were established what year?
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1960 - Developed a sophisticated mechanical ventilators in the 1960s expanded the role of RT's
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Positive pressure ventilation
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Forcing air in lungs
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Negative pressure ventilation
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Natural (breathing) - Iron lung
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RT's are responsible for what?
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- For arterial blood gas & pulmonary function laboratories - Measure how much gas is in blood - Pulmonary function lab: testing of lung volumes, breathing.
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When did designation "Respiratory Therapist" become standard?
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1974
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How long after initially applying positive pressure breathing devices to patients did the 1st sophisticated mechanical ventilator become available, expanding the role of RT's?
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10 years
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Karl von Linde
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Developed large-scale production of O2 - O2 is considered a drug
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Clark electrode
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1st developed - Allows measurement of arterial PO2
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Pulse oximeter was invented when?..
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1980s
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Aerosol Medications
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Aerosolized epinephrine used to treat asthma - Levalbuteral introduced in yr. 2000 (bronchodilator) - Original Levalbuteral was introduced before yr. 2000
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Philip Drinker
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Invented the Iron Lung - Used for Polio victims
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Positive pressure ventilators
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- Dragor Pulmotor - Bennett TV-2P - Bird Mask 7 - Ohio 560 - Engstrom 300
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Volume-Cycled ventilators
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- Bennett MA-1 - Ohio 560 - Engstrom 300
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Ventilator-Associated Pneumonia (VAP)
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- Death is a potential risk of VAP - Non-invasive ventilation may be used to avoid VAP - There are very costly consequences when a patient acquires VAP
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William MacEwen
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Successfully applied 1st endotracheal tube in patient
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John Hutchinson
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Developed 1st water-sealed spirometer - Relationship between height & lung volume - Drum
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American Association of Respiratory Care (AARC)
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- Founded in 1982 - Advocates for profession to legislative & regulatory bodies, insurance industry, & public
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State of licensure for RT's began when?..
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1980
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National Board for Respiratory CAre (NBRC)
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- Offers certification & registry examination for RT's - State licensure based on RT's passing entry level exam - Minimum educational requirements & competence of practice (AS degree)
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In what year did it become a requirement for RT's to be licensed by the state in which they practice?
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1980
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Which of the following sets the minimum educational requirements & the method of determining competence to practice RC?
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NBRC
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Medical Director
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- He/She is a M.D. - Responsible for clinical function of department - Must possess both management & clinical skills - Education of medical & nursing staffs regarding RT's - Plays a role in RT's continuing their education
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Responsibilities of the Medical Director of RC include all of the following, EXCEPT;..
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Organizing the weekly work schedule
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Committee on Accreditation for Respiratory Care (CoARC)
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- Approves educational programs
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Technical Direction
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- Manager of department usually provides technical direction - They oversee policies, procedures, & equipment used to provide safe & effective patient care
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Respiratory Care Protocols
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- Enhance appropriate allocation of RC - Plans that are written, that allow autonomy - Guidelines to deliver care only when indicated, by correct method; discontinued when no longer needed
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According to respiratory care protocols, what is the minimum frequency for assessing patients for a change in clinical status?
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Every 4 hours
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The Joint Commission
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- Evaluates hospital practices - Calls for continuous quality improvement (CQI) - CQI is an ongoing process to detect & correct factors hindering quality care
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Goals for a RC CQI Plan
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1) Provide a mouthed for ongoing monitoring of both quality & appropriate of RC 2) Ensure that respiratory care methods & procedures are cost-effective 3) Ensure that respiratory care methods & procedures are effective 4) Identify, rank, & resolve patient care related problems
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Competence or "Checks"
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Used to test skills & knowledge through use of clinical simulations
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Peer Review Organizations (PROs)
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Federal gov't established elaborate system of PRO's to evaluate quality of care given to Medicare beneficiaries - NBRC, AARC, TJC, CoARC
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All of the following are the goals of disease management, EXCEPT;..
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Keep track of medication usage
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Evidence-Based Medicine
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- Represents important concept regarding quality RC - Clinical Practice Guidelines (CPG's): developed by AARC represent recommendations based on expert review of evidence
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The goal of evidence-based medicine is to?..
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Use results from research for clinical practice
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4 stages of evidence-based medicine
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1) Single case studies (simplest, least rigorous) 2) Case series (collection of patients w/ similar clinical features) 3) Cohort studies (comparing 2 grps., greater evidence) 4) Randomized controlled trails (ideal, most rigorous evidence
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Key outcomes of evidence-based medicine
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- Survival - Discharge from ICU - Organ system failures
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Meta-Analysis
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Identifies, analyzes, & summaries body of literature for specific topic being studied - Comprised of different studies that have already been done - To come up w/ some sort of solution
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What type of study holds the most scientific rigor?
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Randomized controlled trials
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Code of Ethics
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- Primarily concerned w/ " How should we act?" - Essential part of any profession claiming to be self-regulating - Moral obligations impose ethical duties on therapies
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Autonomy
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Principle acknowledges patients personal liberty & their right to decide their own course of treatment
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What does the principle of autonomy allow patients to do?
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To allow the patient to decide their own course of treatment
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Veracity
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Principle binds health care provider & patient to be truthful - Withholding truth from patient for their own good - TRUTH, is the best policy
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Nonmaleficence
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Problems occur when treatment has series side effects or "double effect" - Means that professionals deliberately avoid inflicting potential or actual harm (emotional harm, physical harm) on clients
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Beneficence
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One's duty to benefit or promote the good of others - Raises "do-no harm" requirement to higher level - Dilemmas in this domain have led to development of "advanced directives"
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Confidentiality
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HIPPA - Requires health care workers to respect patient's right to privacy - Certain situations, health care providers are permitted to share patient's medical history w/ others - Risks of inadvertent disclosure of patient's protected health information (PHI) has increased exponentially w/ advent of social networking sites
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Which poses the newest, most contemporary risk of violating the patient's right of confidentiality?
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Healthcare worker's use of social networking sites
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Justice
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- Fair distribution of care - Rationing of health care services calls for "distributive justice" - Compensatory justice calls for recovery of damages incurred from medical malpractice
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Role Duty
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Practitioners have duty to understand limits of role & to practice w/ fidelity
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Formalism
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Viewpoint relies on rules & principles - Act: justifiable if it upholds applied rules or principles
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Consequentialism
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Commonly uses principle of utility - aims to promote greatest general good - Act: Judged to be right or wrong based of consequence
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Mixed Approaches to moral reasoning
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Rule utilitarianism approach: Variation of consequentialism
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Which ethical viewpoint emphasizes the moral character of each individual?
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Virtue Ethics
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Intuitionism
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Ethical viewpoint holds there are certain self-evident truths, usually based on moral maxims - Treat others "fairly" - BE CONFIDENT W/ YOUR DECISION.
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Public Law
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1) Criminal Law: deals w/ acts against welfare & safety of public. - Protects citizens from others who might seek to take unfair advantages - Impacting another person [ex. youth in asia] 2) Administrative Law: Consists of regulations set by gov't agencies
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Which system of law consists of the regulations set by gov't agencies?
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Administrative Law
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Tort Law
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Civil wrong committed against individual or property for which kurt provides remedy
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4 D's of Negligence
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1) The practitioner owes a Duty to the patient 2) The partitioner was Derelict w/ that duty 3) The breach of duty was the Direct cause of damages 4) Damage or harm came to the patient
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What can a RT do to minimize the risk of being involved in a law suit?
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Be aware of, & conform to all legal aspects of licensure & the standards of care
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Health Insurance Portability & Accountability Act of 1996 (HIPPA)
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Established standards for privacy of individually identifiable health information - Protecting individuals' health information - Not impeding exchange of information needed to provide quality health care
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What is the basic goal of HIPPA?
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Balance between protecting individuals' health information & providing quality health care
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Professional Licensure Issues
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- Respiratory Care Practice Act (Licensure Statute) - Therapist driven protocols - Understand causes of discipline
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Patient Safety Continuum
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- Requires TEAMWORK - Good posture minimizes risk injury when moving patient for heavy equipment - RT's should use their legs w/ straight spine to lift patients & heavy objects
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Ambulation
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- WALKING - can reduce length of hospital stay
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Extended bed rest can result in which of the following?
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Atelectasis (collapse of alveoli)
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High currents that pass through the chest can cause all of the following, EXCEPT;..
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Atelectasis
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Electrical Safety
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Use 3 prongs - Red plugs ONLY!
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Most shock hazards are caused by what?
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Inadequate grounding
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Fire Hazards
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- About 13,000 fires were reports in health care facilities - # dropped by 2,000 - Most hospital fires start in the kitchen - Fires in areas where oxygen is being used are especially dangerous - Hospital fires are more serious because evacuations of critically ill patients is difficult
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Oxygen
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- Is NOT flammable - Accelerates rate of combustion - Supports combustion
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What makes hospitals fires more serious than those at other non-medical facilities?
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The evacuation of critically ill patients is difficult
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Conditions must exist for fire to start?..
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- Flammable material must be present - Oxygen must be present - Flammable material must be heated above its ignition temp.
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P.A.S.S. - fire extinguisher training
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P - Pull pin A - Aim nozzle S - Squeeze handle S - Sweep nozzle across base of fire
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R.A.C.E. - core fire plan
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R - Rescue patients in immediate area of fire A - Alert other personnel to fire C - Contain the fire; shut doors to prevent spreading of fire E - Evacuate other patients & personnel
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National Fire Protection Association (NFPA)
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Regulates storage of medical gases - Monitored by TJC
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What is the role of the RT when it comes to the patients direct environment?
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To position the equipment, tubing, & treatments out of the way as much as possible
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5 components of Communication
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- Sender - Message - Channel - Receiver - Feedback
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Communication
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Communication tool: Patients' chart - Poor communication can: 1) Interfere working well w/ others 2) Limit satisfy your employment 3) Limit your ability to treat patients
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Stages of Space
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- Social: Introduction 4ft.-12ft. - Personal: Interview 18in-4ft. - Intimate: Physical exam 0-18in
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By allowing the patient to reflect their feelings, you are:
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Providing them the opportunity to express & reflect on the emotions
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Sources of Conflict
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1) Poor communication 2) Structural problems 3) Personal behavior 4) Role conflict
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5 strategies for handling conflict
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1) Competing 2) Accommodating 3) Avoiding 4) Collaborating 5) Compromising
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General Rules for Record Keeping
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- Entries should be printed or handwritten - Don't use ditto marks ( " " " " ) - Don't erase - Document patient complaints - Record each patients interaction & sign entry - Don't leave blanks - Standard abbreviations only, NEVER abbreviate drugs.
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Documentation Flow sheets are designed to..
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- Briefly report data - Decrease time spent in documentation - TJC published a "DO NOT USE" abbreviation list developed to reduce potential errors.
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Problem-Oriented Medical Record (POMR)
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- Documentation format used by some health care institutions - Uses SOAP format
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4 parts of POMR
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1) Database 2) Problem list 3) Plan 4) Progress notes
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S.O.A.P. format
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S - Subjective (patient's complaints) O - Objective (results of physical exam, lab tests, ABG's, chest radiograph, etc.) A - Assessment (what's the problem?) P - Plan ( How is problem to be treated?)
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When documenting notes in POMR, what format should be followed?
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SOAP format
