[Note: if you have not officially enrolled in this course and want to get CEU credit, please enroll here: http://www.ceu.org/enroll.html. Without this enrollment, the credits cannot be sent to your state board for licensure.]
Introduction

Physicians have traditionally had sole responsibility for assessing pulmonary patients, making a diagnosis, and prescribing a respiratory care protocol. In the past, the gathering of patient data, subsequent interpretation of that data, and prescription of therapies was the sole domain of physicians.

Respiratory care practitioners (RCPs) have historically had the option of communicating with attending physicians regarding the patient’s prescribed therapeutic regimen. However, lack of confidence and fear of having their input rejected (and possibly disrespected) inclined many RCPs to remain silent. This resulted in the prescription and performance of numerous costly and unnecessary respiratory procedures.

In recent years, however, the nation-wide heightened focus on controlling health care costs, and the increasingly sophisticated training received by RCPs have led to a considerably expanded role for respiratory therapists in the delivery of health care services. With the advent and proliferation of therapist driven protocols, physicians have come to depend on skillful RCPs for identifying appropriate respiratory care and evaluating the effects the therapy is having on the patient.

In recognition of this expanded role for RCPs, the new matrix for the national exam for respiratory therapists indicates that RCPs should be able to "determine the appropriateness of the prescribed respiratory care plan and recommend modifications where indicated...(RCPs should be able to) analyze available data to determine pathophysiologic state (of patients), review planned therapies, establish therapeutic goals, determine appropriateness of prescribed therapies and goals...(and) recommend changes in therapeutic plans if indicated, based on (patient) data."

"Patient data" and how to interpret it is the focus of this continuing education unit. Therapist driven protocols are based on respiratory practitioners being able to analyze available patient data to determine their pathophysiological state. This requires having excellent observational and clinical evaluation skills.

The evaluation of pulmonary patients calls for the application of all the skills of the trained respiratory care professional. Some of the more important characteristics of the patient’s condition that may be detected by a careful and skilled observer include: the patient’s physical appearance, respiratory status, and even their apparent mental and emotional state.

Evaluation of those characteristics requires the RCP to have in-depth knowledge of respiratory diseases and their symptoms. The RCP must also be able to recognize the physical changes that occur in pulmonary patients, and be aware of the types of "complaints" those changes generate.

The RCP must be aware of the wide variety of diagnostic tests available today, especially those relating to lung function, and be able to ascertain and quantify abnormalities shown on test results. The RCP is responsible for assessing patients for changes in respiratory status, for performing an overall physical assessment, and for interpreting available clinical data including the patient’s hemodynamics, chest x-rays, EKGs, and data from lab tests. In brief, the RCP must be proficient in gathering patient data, analyzing it, and providing a valid interpretation for other health care professionals.

It is also important that RCPs know how to document their findings. One of the most commonly used formats used for documenting patient data is as follows:

• Record when the patient was evaluated, including: day, month, year, and time)
• Document the original diagnosis, and indicate when the symptoms first occurred (if available), and record any problems that are secondary to the primary diagnosis

The format in which the information is recorded varies from institution to institution, but generally includes:

• Subjective assessment: based on the interview with the patients, record their own observations and descriptions of the complaint or symptoms



• Objective data: based on the information obtained from x-rays, diagnostic exams, and notes from the physician and nurse



• Patient evaluation: record the results of the interview, visual assessment, percussion, auscultation, and palpation

• Document the original treatment plan, and document the clinical and therapeutic objectives of that plan

• Patient response: record how the patient responds to application of the therapy



• Document recommendations regarding continuance, modification, or discontinuance of the therapy; if applicable, record recommendations for additional tests and the results of communications with other members of the health care team



• Record the patient assessment in the procedures column of the patient’s Therapy Procedure Log

Some of the most useful methods of gathering data regarding pulmonary patients involve the interview, history taking, and physical examination. While it is at best difficult to separate the three since they often all occur simultaneously in the clinical setting, for the purposes of this CEU module we will try to examine their important characteristics as separate entities.