Course Outline of Record

Item	Value
Curriculum Committee Approval Date	04/17/2019
Top Code	121000 - Respiratory Care/Therapy
Units	1 Total Units
Hours	18 Total Hours (Lecture Hours 18)
Total Outside of Class Hours	0
Course Credit Status	Credit: Degree Applicable (D)
Material Fee	No
Basic Skills	Not Basic Skills (N)
Repeatable	No
Grading Policy	Standard Letter (S)

Course Description

Techniques and operation of respiratory home care and pulmonary rehabilitation. Includes special equipment set-up, patient and family education, patient evaluation, and care of the ventilator dependent patient at home. Also includes regulations of home care and third party reimbursement. PREREQUISITE: RSPC A190. Transfer Credit: CSU.

Course Level Student Learning Outcome(s)

1. Describe and apply the techniques and equipment utilized in the pulmonary patient home care and rehabilitation setting.

Course Objectives

• 1. List the members and function of members of a pulmonary rehabilitation team.
• 2. Describe current reimbursement conditions for respiratory care practitioners in home health services.
• 3. Describe the goals of pulmonary rehabilitation.
• 4. State medicare definitions for home medical equipment.
• 5. State the advantages and disadvantages to home care compared to hospital care.
• 6. Describe requirements for a patient to be a successful rehabilitation candidate.
• 7. List typical problems presented by the pulmonary patient and describe measures to control or reverse them.
• 8. State factors that might limit progress for a patient in pulmonary rehabilitation.
• 9. List purposes for conduction a patient interview.
• 10. List three simple methods to assess the degree of impairment in a patients pulmonary mechanics.
• 11. Describe the rationale for exercise testing of the pulmonary rehabilitation patient.
• 12. State the parameters measured during an exercise stress test.
• 13. Distinguish between normal and abnormal physiological responses to exercise in the pulmonary patient.
• 14. Describe the concept of interval training.
• 15. List in order the physiological parameters that change the most in the trained pulmonary patient.
• 16. Describe the difference between respiratory muscle weakness and respiratory muscle failure.
• 17. State the factors which indicate respiratory muscle weakness.
• 18. Describe the following types of respiratory muscle training: resistive, isocapneic breathing, diaphragmatic, pursed lip, and pacing.
• 19. Describe the concept and use of the following bronchial clearance devices: P.E.P. therapy and flutter valve.
• 20. Describe the sources of stress.
• 21. List the pulmonary and cardiovascular responses to stress.
• 22. Describe the different types of relaxation techniques.
• 23. Describe healthy ways to cope with stress.
• 24. List benefits for patient education.
• 25. State the guidelines which should be followed when creating patient educational materials.
• 26. Create an instructional media intended for patient use using one of the themes listed: Cleaning home respiratory equipment, travel tips for patients with breathing problems, proper use of metered dose inhalers, or sources of indoor air pollution.
• 27. Describe the concept of delayed billing and its effects.
• 28. Describe manufacturer support for medical equipment (service, repair).
• 29. List factors that add to the cost of medical equipment retail sales.
• 30. Describe the role of the medical equipment manufacturers, distributors, dealers and customers.
• 31. Describe medicare payment for home oxygen equipment.
• 32. Describe the set up, advantages, and disadvantages of home each type of home oxygen delivery system.
• 33. State the advantages and disadvantages of oxygen conserving devices.
• 34. State reasons why home continuous aerosol therapy is not practical.
• 35. List advantages and disadvantages to unit dose format medications.
• 36. Describe bubble humidifiers and why they are not usually provided in low flow oxygen at home.
• 37. Compare the advantages of high humidity generators to continuous aerosol for home use.
• 38. State three recommended methods for cleaning and disinfecting respiratory care equipment at home.
• 39. Describe the advantages and disadvantages of nasal masks and "pillows".
• 40. Describe different types and use of negative pressure ventilators.
• 41. List emergency equipment required for patients on home ventilator systems.
• 42. Compare the advantages and disadvantages of different types of negative pressure ventilators.
• 43. Compare common features found on home positive pressure ventilators.
• 44. Describe the possibilities for illegal/unethical behavior in health care scenarios.
• 45. Describe how current federal law seeks to control fraud and abuse in the health care system.

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Lecture Content

Unit One -Introduction to rehabilitation     Definition of rehabilitation     Definition of rehabilitation     The rehabilitation team     Functions     Patient assessment     Course of treatment     Patient/family input and concerns     Implementation     Follow up      Members and their roles     II.    Structure of rehabilitation programs     In-patient programs     Diagnostic work up     Recommendations     Implementation     Out-patient programs     Referral     Implementation     Problems encountered     Reimbursement     Private insurance     Types     Managed Care     Health Maintenance Organizations (HMO)     Preferred Provider Networks (PPO)    Medicare     Historical perspective     Current legislation     Other funding sources     Medi-Cal Optima     Medical services for indigents     Home health care     Part A services     Home health agencies     Health occupations     Reimbursement     Home infusion services     Part B services     Home medical equipment (HME) / Durable Medical Equipment (DME)     Health occupations     Reimbursement     Home infusion services     Ethics and legal considerations etc. Unit 2 - Pulmonary rehabilitation benefits and goals     Epidemiology of pulmonary problems     Chronic Obstructive Pulmonary Disease (COPD)     Pneumonia     Emphysema     Asthma     Financial impact on pulmonary disease     Asthma     COPD     Cost cutting measures     Diagnostic related groups (DRG)     Out-patient care     Goals of pulmonary rehabilitation     Control or reverse current problems     Shortness of breath     Decreased chest wall mobility     Decreased level of bronchial hygiene     Decreased exercise tolerance and physical work capacity    Prevent the re-occurrence of pulmonary problems     Optimize medication regime     Institute exercise and breathing retraining program     Institute bronchial clearance measures     PEP therapy     Postural Drainage and percussion     Flutter valve     Huff cough    Impediments to rehabilitation    Patient problems     Stages of grief     Coping mechanisms     Rehabilitation team problems Unit 3 - Patient assessment and interview process    The patient interview     Confirm the diagnosis     Obtain list of symptoms     Determine the patient reaction to disease     Development of rapport     Review of systems    Nervous system     Cardiovascular system     Gastrointestinal system     Metabolic conditions     Locomotor system     Evaluation of respiratory mechanics     Observation of breathing patterns     Use of diaphragm     Use of accessory muscles     Observation of body position     Measure dyspnea index     Index definition     Application index     Evaluation of laboratory data     Arterial blood gases     pH     Oxygenation     Carbon dioxide     Pulmonary function tests (PFT)     spirometry     lung volume measurement      Auscultation     Breath sounds     Adventitious sounds     Disorders of the spoken voice   nb  Bronchophony     Egophony Unit 4 - Exercise testing and training    Exercise testing     Benefits     Protocols     Naughton     Balke     Bruce     Jones     Parameters measured and anticipated changes     Heart rate/target heart rate     Respiratory rate     Blood pressure     Oxygen consumption     VO2     Metabolics     Oxygenation levels     PaO2     SpO2     Respiratory quotient     a-v O2 difference     Time     Exercise training concepts     Long slow distance training     Interval training     Exercise training techniques     Stationary bike       Time     Resistance     Walking     Time     Distance     Swimming     Time     Endurance     Benefits of exercise     Endurance     Physical work capacity     VO2     a-v O2 difference     Vital sign changes     Arterial bl ood gases     Breathing retraining     Muscle weakness vs muscle failure     Respiratory muscle weakness     Respiratory muscle failure     Manifestations of respiratory muscle weakness     Limited exercise tolerance     Altered breathing pattern     Weak cough effort     Changes in blood gases     Treatment of respiratory muscle weakness     Restore balance between supply and demand     Increase strength and endurance     resistive devices     diaphragmatic breathing     isocapneic breathing     pursed lip breathing     pacing     Improved nutrition status     Assessment of restorative techniques     Bronchial clearance techniques     P.E.P. therapy    Flutter device    Huff cough    Glossopharyngeal breathing (GPB) Unit 5 - Relaxation techniques     Stress     Definition     Sources     Family/social interaction     Decision making     Changes in routine     Changes in work     Physical changes (illness or pain)     Phobias     Body reaction to stress     Effects of unmanaged stress  s p;  Alarm reaction     Resistance     Exhaustion     Stress management     Steps     Give (self) permission to change     Make a commitment     Make a written list     include genuine wants     define impediments     make a plan of action     Relaxation techniques    Progressive muscle relaxation     Scanning     Contract/relax     Imagery     Word (mantra)     Music Unit 6 - Patient Education     Learning Principles     Learning is an experience     Positive aspects     Negative aspects     Uniqueness to the individual     History of patient education     Old attitude     New attitude     Desire for information     Partnership with healthcare     Improved compliance     Fewer complications     How to educate     Domains of learning     Use of instructional objectives     Creating printed materials     Simplicity     Clarity     Type style and margins     Constructing informational data Check list for educat ional materials Information is appropriate in scope Information is appropriate in content for the audience Material is organized in a logical manner Information is consistent with established policy Reading level is appropriate for the audience Illustrations are accurate The aid is practical in terms of cost and usability Unit 7 - Evaluating Equipment Product utilization and the customer Role of the manufacturer Role of the distributer Role of the dealer/retailer Customer/patient relations Selecting products Considering market potential Considering reliability Who is believable Warranties and support Manufacturer Remote service centers  Evaluation performance Purchase considerations     Cash on delivery     Net 30     Delayed billing     Contract pricing     Freight costs     Purchase orders Unit 8 - Oxygen therapy     Benefits     N.O.T.T. study     Lancet study     Qualifying for reimbursement     Private Health insurers     Medicare     Diagnosis     Laboratory evidence     Medi-cal/IMS     Equipment considerations     Stationary tanks     Advantages     Disadvantages     Oxygen concentrat ors     Advantages     Disadvantages     Liquid oxygen systems     Advantages     Disadvantages     Selecting the correct system     Oxygen conserving devices     Cannulas     Electronic conservers     Transtracheal catheters     Home aerosol and humidity therapy     Humidity therapy     Limits of humidification     Types used in home care     Aerosol delivery     Continuous aerosol     Medication aerosol     Hand held nebulization     Metered dose inhaler Unit 9 - Mechanical ventilation     Benefits of home mechanical ventilation     Medical benefits     Financial considerations     Potential candidates     Patient pathology     Patient psychology     Family concerns     Types of ventilators     Positive pressure ventilators     Lifecare     Puritan Bennett     Bear     Negative pressure ventilators     Drinker Collins     Cuirass types     Alternatives to ventilators     Rocking beds     P neumobelts     Chest cuirass     Home ventilator planning     Family concerns     Education     Equipment and home access

Method(s) of Instruction

• Lecture (02)
• DE Live Online Lecture (02S)

Instructional Techniques

Lecture and application of ideas; demonstration of equipment.

Reading Assignments

Students will spend 1-2 hours per week reading from assigned textbook.

Writing Assignments

Students will spend 1-2 hours completing written homework assignments and case studies for each unit of the course.  Proficiency will be demonstrated by satisfactorily completing assignments with a 75% or better.        Students will demonstrate critical thinking skills and apply knowledge of pulmonary patient home care and rehabilitation through satisfactory completion of in-class written exams containing home equipment diagrams, multiple choice and short answer questions and mathematical calculations.

Out-of-class Assignments

Students will spend 1-2 hours per week completing homework assignments and case studies to apply knowledge of the techniques and equipment utilized in the pulmonary patient home care and rehabilitation setting.       Students will spend 1-2 hours per week in small groups working on a patient education project creating an instructional media intended for patient use using one of the themes listed: disease management, using and cleaning home respiratory equipment, or travel tips for patients with breathing problems.

Demonstration of Critical Thinking

Written content based and objective examinations.

Required Writing, Problem Solving, Skills Demonstration

Written examinations.

Eligible Disciplines

Respiratory technologies: Any bachelors degree and two years of professional experience, or any associate degree and six years of professional experience.

Textbooks Resources

1. Required Cairo, J.M.. Mosbys Respiratory Care Equipment, 10 ed. St. Louis, MO: Elsevier, 2018