PROCEDURE (TASK): CONTINUOUS DISTENDING PRESSURE THERAPY (CPAP) (NEONATAL/PEDIATRICS)
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1 PROCEDURE (TASK): CONTINUOUS DISTENDING PRESSURE THERAPY (CPAP) (NEONATAL/PEDIATRICS) I. KEY PERFORMANCE ELEMENTS Procedural Element (Step): Description of Satisfactory Performance: 5. Obtains baseline physiological Collects/calculates (where available) profile pertinent data on adequacy of oxygenation and cardiovascular performance, to include: PaO2, P(A-a)O2 Oxygenation Index, SaO2 Shunt estimate (table) Blood pressure, cardiac rate 6. Performs operational check Connects system to test lung or analog. of equipment function/alarms Adjusts pressure to level specified. safety systems. Checks system for leaks. Adjusts flow or sensitivity. Confirms sensitivity (if demand valve). Confirms pressure level. Confirms safety relief function. Confirms disconnect or low pressure alarm indicator. 9. Insures appropriate pressure Adjusts flow (in continuous flow systems) level (adequate flow/ Confirms ventilator cycling/demand valve sensitivity) function by observing manometer/ spontaneous breath indicators. Adjusts flow or sensitivity to minimize work, while maintaining appropriate pressure level. 10. Adjusts alarms/indicators. Adjusts low pressure alarm to level below pressure selected. 11. Observes patient response/ Observes patient for subjective signs of assesses cardiopulmonary discomfort, anxiety. status. Observes changes in subjective signs of hypoxemia or hypercapnea. Determines (subjectively) changes in the work of breathing (accessory muscle use/retractions, rate of breathing, etc.). Observes changes in heart rate or rhythm. Measures blood pressure, SaO2, notes changes from baseline. Auscultates thorax. 12. Collects pertinent Repeats step #5. physiological data. Notes/interprets changes from baseline measurements. 13. Readjusts distending pressure Provides for satisfactory oxygenation to optimum level. without cardiovascular depression and a minimal likelihood of oxygen toxicity. Proficiency Eval. #4/Continuous Distending Pressure Therapy (Neonatal/Pediatrics) - 91
2 14. Provides for appropriate Follows oxygenation status by collection/ monitoring/management. recording of appropriate objective data. Follows maintenance of adequate perfusion by collection/recording of appropriate objective data. Makes recommendations on level/ continuance of therapy based upon patient status/progress. II. REQUISITE PERFORMANCE VARIABLES: PEDIATRIC/NEONATAL CPAP/PEEP. The student is expected to demonstrate proficiency in the application/management of continuous distending pressure applied to either the spontaneously breathing pediatric/neonatal (CPAP) or pediatric/neonatal patients receiving mechanical ventilation (PEEP). Applicable systems may include the following: CPAP A. Demand flow/threshold resistor examples: SERVO 900C B. Continuous flow/flow resistor examples: Sechrist C. "in-house" system not attached to mechanical ventilation III. ADDITIONAL EVALUATION CRITERIA: None IV. ORAL REVIEW QUESTIONS A. PEDIATRIC/NEONATAL CPAP/PEEP 1. What are the clinical indications, desirable and undesirable physiological effects, contraindications and hazards of continuous distending pressure therapy in pediatric or neonatal patients? 2. Describe the mechanism by which PEEP/CPAP is developed and maintained with the system being employed. Explain any/all alarm functions/ indicators. 3. State methods of recognizing hyperinflation in the neonatal population. 4. State various application devices used for neonatal CPAP and give benefits/risks for each. 5. What signs of infant, respiratory distress would indicate a potential need for CPAP? 6. Describe the mechanism by which PEEP/CPAP is developed and maintained with the system being employed. Explain any/all alarm functions. 7. List the hazards and complications of infant CPAP. 8. What would determine whether you should use a nasopharyngeal tube, nasal prongs, or a face mask to deliver CPAP to an infant? 9. List at least three goals of CPAP therapy. Proficiency Eval. #4/Continuous Distending Pressure Therapy (Neonatal/Pediatrics) - 92
3 V. SCENARIO QUESTIONS 1. The oximetry saturation readings of an infant receiving CPAP via nasal prongs with an FIO2 of 40% drop substantially during frequent episodes of crying. What action would you recommend in this situation? 2. An infant with respiratory distress syndrome is placed on 5 cm H2O nasal CPAP at an FIO2 of 50%. After five minutes, grunting, retractions, and cyanosis are still present. A peripheral ABG cannot be obtained, so blood gas analysis will have to await umbilical artery catherization. What action would you recommend in this situation? 3. Assuming other elements of the patient's clinical assessment support discontinuation, which of the following infants is the best candidate for removal from CPAP? a. CPAP 8 cwp - FIO2 60% - PO2 58 torr b. CPAP 6 cwp - FIO2 50% - PO2 62 torr c. CPAP 3 cwp - FIO2 40% - PO2 55 torr d. CPAP 7 cwp - FIO2 40% - PO2 61 torr e. CPAP 3 cwp - FIO2 60% - PO2 54 torr Proficiency Eval. #4/Continuous Distending Pressure Therapy (Neonatal/Pediatrics) - 93
4 STUDENT: COURSE: KALAMAZOO VALLEY COMMUNITY COLLEGE RESPIRATORY THERAPY PROGRAM PROFICIENCY EVALUATION PROCEDURE (TASK): CONTINUOUS DISTENDING PRESSURE THERAPY (CPAP) THERAPEUTIC PROCEDURE: NON THERAPEUTIC PROCEDURE CLINICAL COLLEGE LABORATORY NEW PATIENT EQUIPMENT UTILIZED: REPEAT PROCEDURE PEER APPLICATION MANIKIN/ANALOG STEPS IN PROCEDURE OR TASK: EQUIPMENT AND PATIENT PREPARATION 1. Selects, gathers, and assembles appropriate equipment. Insures asepsis 2. Verifies, interprets and evaluates physician's order 3. Identifies patient, self, and department 4. Explains procedure and confirms patient understanding IMPLEMENTATION AND ASSESSMENT 5. Obtains baseline physiologic data 6. Performs operational check of equipment function/alarms/safety systems 7. Selects/inserts appropriate airway appliance 8. Initiates distending pressure (PEEP/CPAP) 9. Insures appropriate pressure level (adequate flow/sensitivity) 10. Adjusts alarms 11. Observes patient response/assesses cardiopulmonary status 12. Collects pertinent physiological data 13. Readjusts distending pressure to optimal level 14. Reassesses patient response/cardiopulmonary status 15. Reassures patient FOLLOW-UP 16. Provides for appropriate monitoring/management 17. Records pertinent data in chart and departmental records 18. Notifies appropriate personnel Proficiency Eval. #4/Continuous Distending Pressure Therapy (Neonatal/Pediatrics) - 94
5 STUDENT'S COMPREHENSION OF COGNITIVE OBJECTIVES RELATED TO THE PROCEDURE: CONTINUOUS DISTENDING PRESSURE Upon completion the student will be able to answer oral review questions and discuss clinical scenarios related to the following cognitive objectives: 1. Identify the goals of CPAP and describe how CPAP increases FRC. 2. List the clinical indications, contraindications, and hazards of CPAP therapy in pediatric or neonatal patients. 3. Explain the method by which PEEP/CPAP is developed and maintained with the system used in this performance 4. List and recognize the signs of hyperinflation in the neonatal population. 5. List the possible delivery systems for CPAP (e.g., NPCPAP, nasal prongs, etc.) and give specific clinical situations where each may be appropriate. 6. Explain how a neonatal patient is weaned from CPAP. Specify Evaluator Data Skill evaluation Oral Review Deficiencies: Ability to perform applicable steps in Specify applicable Please sign your name and procedure as listed on the front of Knowledge of the skill steps that were state your affiliate name. form without error or omission. cognitive omitted or done objectives listed erroneously. Also above. note any errors in discussing cognitive objectives. Please give enough detail to allow the student to work on specific Date Satisfactory Unsatisfactory Satisfactory remediation. Satisfactory Satisfactory Proficiency Eval. #4/Continuous Distending Pressure Therapy (Neonatal/Pediatrics) - 95
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