Respiratory Therapy Questions
By an allied health world contributing writer
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How are lung and breathing disorders diagnosed?While it is not the job of the RT to diagnose patients, after an individual works in this profession long enough, they develop this skill. Typically a respiratory therapist uses their stethoscope to determine what the problem is based on how they are breathing. How the patients’ lungs sound can provide very useful information. Asking a variety of questions and reviewing other test results like x-rays, CTs, and EKGs is also helpful. The doctor is the expert who is able to actually diagnose even when an RT has a pretty good idea of what the problem is.
How do RTs handle Code Blues?For Code Blue emergency situations, a respiratory therapist initially makes sure the patient is breathing. If the patient isn’t breathing or gasping for air, the RT uses an Ambu-bag and mask to assist the patient or breath for him. Typically an RT assistant or nurse will then manage the Ambu-bag while the RT opens the airway box and set up for intubation. Then, the RT sets up a ventilator. Also at a code blue an RT may do an ABG as appropriate, and an EKG at some point. Along with these skills, the RT also works with the RN and physician in trying to figure out what is wrong with the patient and how to effectively resolve it.
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How are ventilators managed?Patients are put on ventilators for a number of reasons. Sometimes patients are put on ventilators for short term, such as in post-op heart patients, and other times patients are put on ventilators for long- term periods. Respiratory therapists setup ventilators based on physician’s orders and are responsible for making sure the ventilator is in sync with the patient’s breathing. The RT is responsible for checking the ventilator to ensure there are no changes with the patient or the machine. The ventilator should be working with the patient rather than the other way around. In the Intensive Care Unit, ventilators are typically checked every two to three hours. Respiratory therapists also participate in patient care plans and make adjustments accordingly in collaboration with the physician. The goal is to wean the patient as quickly as possible, but not before the underlying condition that led to the ventilator is resolved. With some patients this can be easy, but for others (especially COPD patients) this can be very tricky.
Ventilator care in the home is very involved due to educating the patient, family, caregiver, and nurses appropriately. There are several pieces of equipment that require education for the patient and caregiver. The patient and family or caregivers must be familiarized with every piece of equipment and taught how to suction, and how to identify a crisis situation.
What are the main types of medical equipment used in this field?
- Intubation equipment such as a laryngoscope and bag valve mask.
- Endotracheal tubes (ET tubes) which are placed in the airway (trachea) so breathing can be assisted.
- Tracheostomy tubes which are placed in the trachea via an incision made below the vocal cords. This tube provides a connection for a ventilator and a way of suctioning the airway for long term care patients.
- CPAP/Bilevel therapy provides one or two levels of pressure to maintain the patient’s airway.
- Nebulizer therapy is the most commonly ordered treatment for pulmonary diseases.
- Ventilators provide life-sustaining therapy that may be short or long term.
- Suction catheters are typically set up at the patient’s bedside to allow RTs to suction secretions from the lungs and mouth.
- Arterial blood gas kits include a heparinized syringe and needle used for puncturing the artery. The arterial blood that is obtained reflects the condition of the lungs by measuring oxygen and carbon dioxide levels.
- Pulse Oximeters are devices that measure the saturation of oxygen in the blood (hemoglobin).
- Capnometers are devices that detect the amount of carbon dioxide in exhaled air. It is used for making sure the endotube is in the trachea rather than the stomach and can also be used continuously with mechanical ventilation to ensure that the patient is adequately exchanging air
What sort of questions are patients asked when they’re being “interviewed” about their symptoms?When a patient comes in with breathing issues, there are a series of questions the respiratory therapist asks them to better understand what is going on. Some of these questions include:
- Are you short of breath (although this may be obvious)
- How long have you felt this way?
- Have you had a cold?
- Have you been coughing anything up?
- Do you have chest pain? If so, is it constant (sign of cardiac issues) or do you just feel it with deep inhalation (sign of respiratory issues)?
- If you have chest pain, on a scale of 1-10, with 10 being the worse pain you have ever experienced, how would you rate your pain?
- Have you ever felt like this before?
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